From fertility fears to the struggle to maintain mindfulness, interviews with young cancer survivors reveal how shared experiences, exercise, and supportive accountability could help them navigate the emotional challenges of life after treatment.
Study: Stress management, mindfulness, and peer support needs among adolescent and young adult cancer survivors: a qualitative interview study. Image credit: fizkes/Shutterstock.com
A recent study published in Frontiers in Adolescent Medicine explored how 19 adolescent and young adult cancer survivors (AYA-CS) manage everyday stress, finding that exercise and social support were common coping strategies. The findings could inform the development of tailored peer-supported stress-management interventions.
Challenges and psychosocial needs of adolescent and young adult cancer survivors
Adolescent and young adult (AYA) cancer incidence in the U.S. is rising, with breast, testicular, and thyroid cancers comprising over one-third of cases. In 2020, there were about 2.1 million AYA cancer survivors, a number that may have increased since then due to high survival rates. According to previously published estimates cited by the researchers, the 5-year relative survival rate for AYAs is 86.1%, compared to 64.4% for adults over 40.
AYA cancer survivorship brings long-term impacts, including diminished quality of life and elevated mental health challenges, heightened by the demands of emerging adulthood. Previous research estimated that approximately 32% of AYA cancer survivors experience psychological distress, 49% experience anxiety, and 24% experience depression. Many face ongoing psychological and social difficulties, lack age-appropriate psychological care, and have unmet needs in stress management.
The heterogeneity of AYA cancer survivors requires specialized, age-appropriate care. Navigating survivorship during emerging adulthood compounds physical, psychological, social, and financial stressors, increasing distress and disrupting identity, autonomy, and future planning.
AYA cancer survivors experience persistent mental health challenges, with anxiety, developmental disruption, and impaired social and educational outcomes. Common concerns include fear of relapse, fertility issues, and isolation. Patient-centered research is needed to better understand psychosocial adaptation.
Research on survivor coping is limited. Survivors commonly seek social support and focus on controllable aspects, but long-term coping remains poorly understood. Mindfulness may reduce distress, but life demands and heightened awareness of negative emotions hinder consistent practice.
Assessing how AYA-CS manage their stress
The current study included 19 AYA-CS, aged 22–35 years, with time since treatment completion ranging from 1 to 28 years. The sample consisted entirely of cisgender individuals (42% male, 58% female), primarily heterosexual (84%) and white (63%), with Asian and Latine participants each representing 16% and one Black participant.
Diagnoses included a range of cancers, such as Hodgkin’s lymphoma, leukemia, medulloblastoma, and sarcoma, with ages at diagnosis spanning 3 to 33 years. Treatments received included chemotherapy, radiotherapy, and surgery.
Participants were purposively recruited via a community survivorship program and a national non-profit organization supporting the AYA cancer community. Eligibility required being 18–39 years old, diagnosed with cancer, and at least one year post-treatment. Exclusions included individuals receiving treatment for PTSD, psychosis, or epilepsy/seizures due to potential adverse effects associated with mindfulness-based interventions in these populations.
Of the 20 individuals identified, 16 were screened; 13 met eligibility and enrolled. Four participants were recruited from the non-profit, and two additional participants joined via snowball sampling. Data collection included a demographic questionnaire and semi-structured Zoom interviews lasting approximately 40–63 minutes, guided by topics such as stress management, mindfulness, and peer support. Interviews were held privately, audio-recorded, transcribed, de-identified, and supported by interviewer field notes.
Three central themes in AYA cancer survivorship
The current study identified three central themes characterizing AYA-CS experiences, based on in-depth interviews with 19 participants. The first theme emphasized that the impact of cancer on survivors’ identities was highly variable. For some, cancer became a distant chapter, while for others, it remained a central, ongoing influence due to persistent physical effects like neuropathy or psychological challenges such as anxiety around health surveillance.
Fertility and family planning emerged as particularly stressful issues, especially for women, who reported concerns about early menopause and the financial barriers to fertility preservation. One participant described being unable to afford fertility preservation after insurance declined coverage, estimating the expense at $10,000–$15,000. These identity issues often intersected with worries about relationships and future family plans.
The second theme highlighted that stress management was a universal concern, and all participants described relying on family and friends for social support, alongside various personal coping strategies. Exercise emerged as the most commonly discussed stress-management activity, including walking, running, and strength training. Six participants reported engaging in activities such as reading and journaling, and four practiced mindfulness at the time of the interviews.
However, many struggled to sustain mindfulness outside of structured environments. Social support from family and friends was described as critical, but participants also sought self-driven practices to manage the ongoing stressors of survivorship. Several participants used encouragement, positive reinforcement, and accountability from others to maintain healthy habits, including sharing their progress through social media and fitness-tracking platforms.
The third theme revealed that peer support within the AYA-CS community was described as uniquely meaningful. Participants valued the understanding and instant camaraderie found with other survivors, which often provided validation and motivation. Some also described opportunities for peer mentorship, where survivors could encourage and inspire others through shared experiences.
However, they emphasized that the diversity of experiences, shaped by factors like age at diagnosis, cancer type, and gender, meant that not all peer connections felt relatable. Those diagnosed young or with rare cancers sometimes struggled to find peers who could truly understand their journey.
These themes together show that AYA-CS survivorship is a dynamic, multifaceted experience, marked by shifting identities, ongoing stress management efforts, and both the benefits and complexities of peer support.
Stress management strategies among AYA-CS
This study displays the intricate relationship between survivorship, identity, and stress management for AYA-CS. Despite personal and systemic barriers, participants showed notable resilience and flexibility, using peer support and practical coping strategies to manage stress and maintain healthy behaviors during a critical stage of development.
The findings suggest that future stress-management interventions could combine mindfulness practices with peer support and supportive accountability, including collaborative goal-setting, encouragement, and nonjudgmental feedback. Such approaches may help survivors maintain healthy habits when personal motivation fluctuates.
Nonetheless, interpreting these findings should account for several limitations, including the small sample diversity, potential recall and self-selection biases, and methodological constraints. To strengthen the transferability and applicability of future research, studies should recruit more diverse samples, tailor interventions to developmental needs, and pursue innovative approaches to engage marginalized groups and address the specific challenges AYA-CS face throughout survivorship.
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