Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities

Abstract

Survivors of adolescent and young adult (AYA; age 15-39 years at diagnosis) cancer are a growing population with the potential to live for many decades after treatment completion. Survivors of AYA cancer are at risk for adverse long-term outcomes including chronic conditions, secondary cancers, impaired fertility, poor psychosocial health and health behaviors, and financial toxicity. Furthermore, survivors of AYA cancer from racially minoritized and low socioeconomic status populations experience disparities in these outcomes, including lower long-term survival. Despite these known risks, most survivors of AYA cancer do not receive routine survivorship follow-up care, and research on delivering high-quality, evidence-based survivorship care to these patients is lacking. The need for survivorship care was initially advanced in 2006 by the Institute of Medicine. In 2019, the Quality of Cancer Survivorship Care Framework (QCSCF) was developed to provide an evidence-based framework to define key components of optimal survivorship care. In this commentary focused on survivors of AYA cancer, we apply the QCSCF framework to describe models of care that can be adapted for their unique needs, multilevel factors limiting equitable access to care, and opportunities to address these factors to improve short- and long-term outcomes in this vulnerable population.

Figure 1.

Clinical and sociodemographic factors affecting risk of late effects and attainment of life milestones in survivors of adolescent and young adult cancer. *Cancer treatment may include chemotherapy, immunotherapy, surgery and/or radiation therapy.

Figure 2.

Models of survivorship care for survivors of AYA cancer. APP = advanced practice provider; AYA = adolescent and young adult.

Figure 3.

Cancer survivorship care quality framework and barriers to care for survivors of AYA cancer.