Cancer patients belonging to the adolescent and young adult (AYA) age group have unique and very specific needs, which require special attention from the caring staff. The difficulty in maintaining the personal and professional development at this age is both natural and normal. Adding to this, coping with a life-threatening disease turns this stage in life into a period with many dilemmas and challenges of quite a complex nature. AYA patients have to deal with issues above and beyond the disease itself, which create a very complex coping picture. On top of that, prognosis for this age group has not improved in recent years, unlike the situation in other age groups like children and adults. The literature on this subject is extensive and comprehensive. However, most of the papers on this subject are very specific and narrow in their approach, each dealing with a specific topic. In this article, we bring together many different papers which make a wide and comprehensive picture of the subject of AYAs coping with cancer, coupled with recommendations for the caring staff. In this review we focus on the various aspects of the disease and treatments in AYAs, based on the conceptual model of quality of life proposed by Ferrell and colleagues [Cancer Nurs 1992;15:153-160; Cancer Nurs 1992;15:247-253], including physical, social, emotional and spiritual aspects. From the psychological standpoint, most of the papers discuss the negative aspects; however, in this article we try to include some articles from the positive psychology school of thought. From our findings it is apparent that there is an opportunity and need to further explore research in this regard. It is apparent that taking a unique approach to AYA cancer patients is needed in order to deal with the unique needs of this age group. This article aims at putting a framework around this issue, with actionable recommendations for the caring staff.

1.
World Health Organization: Maternal, newborn, child and adolescent health. 2013. http://www.who.int/maternal_child_adolescent/topics/adolescence/dev/en/index.html.
2.
Bleyer A, Budd T, Montello M: Adolescent and young adult with cancer. Cancer 2006;107:1645-1655.
3.
Wood WA, Lee SJ: Malignant hematologic diseases in adolescents and young adults. Blood 2011;117:5803-5815.
4.
Fern L, Davies S, Eden T, Feltbower R, Grant R, Hlawkins M, Whelan J: Rates of inclusion of teenagers and young adults in England into National Cancer Research Network clinical trials: report from the National Cancer Research Institute (NCRI) Teenage and Young Adult Clinical Studies Development Group. Br J Cancer 2008;99:1967-1974.
5.
Pollock BH: Where adolescents and young adults with cancer receive their care: does it matter? J Clin Oncol 2007;25:4522-4523.
6.
Ferrell B, Grant M, Schmidt GM, Rhiner M, Whitehead C, Fonbuena P, Forman SJ: The meaning of quality of life for bone marrow transplant survivors. 1. The impact of bone marrow transplant on quality of life. Cancer Nurs 1992;15:153-160.
7.
Ferrell B, Grant M, Schmidt GM, Rhiner M, Whitehead C, Fonbuena P, Forman SJ: The meaning of quality of life for bone marrow transplant survivors. 2. Improving quality of life for bone marrow transplant survivors. Cancer Nurs 1992;15:247-253.
8.
Enskar K, Carlsson M, Golsater M, Hamrin E: Symptom distress and life situation in adolescents with cancer. Cancer Nurs 1997;20:23-33.
9.
Taylor RM, Pearce S, Gibson F, Fern L, Whelan J: Developing a conceptual model of teenage and young adult experiences of cancer through meta-synthesis. Int J Nurs Stud 2013;50:832-846.
10.
Gibson F, Mulhall AB, Richardson A, Edwards JL, Ream E, Sepion BJ: A phenomenologic study of fatigue in adolescents receiving treatment for cancer. Oncol Nurs Forum 2005;32:651-660.
11.
Erickson JM, Beck SL, Christian B, Dudley WN, Hollen PJ, Albritton K, Sennett MM, Dillon R, Godder K: Patterns of fatigue in adolescents receiving chemotherapy. Oncol Nurs Forum 2010;37:444-455.
12.
Lai JS, Kupst MJ, Cella D, Brown SR, Peterman A, Goldman S: Using Q-methodology to understand perceived fatigue reported by adolescents with cancer. Psychooncology 2007;16:437-447.
13.
Ream E, Gibson F, Edwards J, Seption B, Mulhall A, Richardson A: Experience of fatigue in adolescents living with cancer. Cancer Nurs 2006;29:317-326.
14.
Richardson A: A critical appraisal of the factors associated with fatigue; in Armes J, Krishnasamy M, Higginson I (eds): Fatigue in Cancer. Oxford, Oxford University Press, 2004, pp 29-50.
15.
Hinds PS, Hockenberry M, Rai SN, Zhang L, Razzouk BI, McCarthy K, Cremer L, Rodriguez-Galindo C: Nocturnal awakening, sleep environment interruptions and fatigue in hospitalized children with cancer. Oncol Nurs Forum 2007;34:393-402.
16.
Perdikaris P, Merkouris A, Patiraki E, Tsoumakas K, Vasilatou-Kosmidis E, Matziou V: Evaluating cancer related fatigue during treatment according to children's, adolescents' and parents' perspectives in a sample of Greek young patients. Eur J Oncol Nurs 2009;13:399-408.
17.
Baggott C, Dodd M, Kennedy C, Marina N, Matthay KK, Cooper BA, Miaskowski C: Changes in children's reports of symptom occurrence and severity during a course of myelosuppressive chemotherapy. J Pediatr Oncol Nurs 2010;27:307-315.
18.
Hockenberry MJ, Hooke MC, Gregurich M, McCarthy K, Sambuco G, Krull K: Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide. Oncol Nurs Forum 2010;37:E16-E27.
19.
Walker AJ, Gedaly-Duff V, Miaskowski C, Nail L: Differences in symptom occurrence, frequency, intensity, and distress in adolescents prior to and one week after the administration of chemotherapy. J Pediatr Oncol Nurs 2010;27:259-265.
20.
Walker AJ, Johnson KP, Miaskowski C, Lee KA, Gedaly-Duff V: Sleep quality and sleep hygiene behaviors of adolescents during chemotherapy. Clin Sleep Med 2010;6:439-444.
21.
Erickson JM, Macpherson CF, Ameringer S, Baggott C, Linder L, Stegenga K: Symptoms and symptom clusters in adolescents receiving cancer treatment: a review of the literature. Int J Nurs Stud 2013;50:847-869.
22.
Walker AJ, Pongsing Y, Nail L, Pedhiwala N, Leo M, Price J, Lee K, Gedaly-Duff V: Sleep-wake patterns of school-age children and adolescents before diagnosis and during induction chemotherapy for acute lymphocytic leukemia. J Pediatr Nurs 2011;26:e37-e44.
23.
Erickson JM, Beck SL, Christian BR, Dudley W, Hollen PJ, Albritton KA, Sennett M, Dillon RL, Godder K: Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy. J Pediatr Hematol Oncol 2011;33:e17-e25.
24.
Walker AJ, Johnson KP, Miaskowski C, Gedaly-Duff V: Nocturnal sleep-wake parameters of adolescents at home following cancer chemotherapy. Biol Res Nurs 2012;14:236-241.
25.
Hinds PS, Hockenberry MJ, Gattuso JS, Srivastava DK, Tong X, Jones H, West N, McCarthy KS, Sadeh A, Ash M, Fernandez C, Pui CH: Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer 2007;110:2321-2330.
26.
Holdsworth MT, Raisch DW, Frost J: Acute and delayed nausea and emesis control in pediatric oncology patients. Cancer 2006;106:931-940.
27.
Ramini SK, Brown R, Buckner EB: Embracing changes: adaptation by adolescents with cancer. Pediatr Nurs 2008;34:72-79.
28.
Iestra JA, Fibbe WE, Zwinderman AH, van Staveren WA, Kromhout D: Body weight recovery, eating difficulties and compliance with dietary advice in the first year after stem cell transplantation: a prospective study. Bone Marrow Transplant 2002;29:417-424.
29.
Rodgers C, Young A, Hockenberry M, Binder B, Symes L: The meaning of adolescents' eating experiences during bone marrow transplant recovery. J Pediatr Oncol Nurs 2010;27:65-72.
30.
Ameringer S: Barriers to pain management among adolescents with cancer. Pain Manag Nurs 2010;11:224-233.
31.
Collins JJ, Byrnes ME, Dunkel IJ, Lapin J, Nadel T, Thaler HT, Polyak T, Rapkin B, Portenoy RK: The measurement of symptoms in children with cancer. J Pain Symptom Manage 2000;19:363-377.
32.
Jacob E, Hesselgrave J, Sambuco G, Hockenberry M: Variations in pain, sleep, and activity during hospitalization in children with cancer. J Pediatr Oncol Nurs 2007;24:208-219.
33.
Miller E, Jacob E, Hockenberry MJ: Nausea, pain, fatigue, and multiple symptoms in hospitalized children with cancer. Oncol Nurs Forum 2011;38:E382-E393.
34.
Wolfe J, Grier HE, Klar N, Levin SB, Ellenbogen JM, Salem-Schatz S, Emanuel EJ, Weeks JC: Symptoms and suffering at the end of life in children with cancer. N Engl J Med 2000;342:326-333.
35.
Calissendorff-Selder M, Ljungman G: Quality of life varies with pain during treatment in adolescents with cancer. Ups J Med Sci 2006;111:109-116.
36.
Hedström M, Ljungman G, von Essen L: Perceptions of distress among adolescents recently diagnosed with cancer. J Pediatr Hematol Oncol 2005;27:15-22.
37.
Larouche SS, Chin-Peuckert L: Changes in body image experienced by adolescents with cancer. J Pediatr Oncol Nurs 2006;23:200-209.
38.
Wallace ML, Harcourt D, Rumsey N, Foot A: Managing appearance changes resulting from cancer treatment: resilience in adolescent females. Psychooncology 2007;16:1019-1027.
39.
Williamson H, Harcourt D, Halliwell E, Frith H, Wallace M: Adolescents' and parents' experiences of managing the psychosocial impact of appearance change during cancer treatment. J Pediatr Oncol Nurs 2010;27:168-175.
40.
Hendricks-Ferguson V: Hope and spiritual well-being in adolescents with cancer. West J Nurs Res 2008;30:385-401.
41.
Hilton S, Hunt K, Emslie C, Salinas M, Ziebland S: Have men been overlooked? A comparison of young men and women's experiences of chemotherapy-induced alopecia. Psychooncology 2008;17:577-583.
42.
Eiser C, Absolom K, Greenfield D, Snowden J, Coleman R, Hancock B, Davies H: Follow-up care for young adult survivors of cancer: lessons from pediatrics. J Cancer Surviv 2007;1:75-86.
43.
Thomas DM, Seymour JF, O'Brien T, Sawyer SM, Ashley DM: Adolescent and young adult cancer: a revolution in evolution? Intern Med J 2006;36:302-307.
44.
Levine J, Canada A, Stern CJ: Fertility preservation in adolescents and young adults with cancer. J Clin Oncol 2010;28:4831-4841.
45.
Cobb S: Social support as a moderator of life stress. Psychosom Med 1976;38:300-314.
46.
Cassano J, Nagel K, O'Mara L: Talking with others who ‘just know': perceptions of adolescents with cancer who participate in a teen group. J Pediatr Oncol Nurs 2008;25:193-199.
47.
Grinyer A: The biographical impact of teenage and adolescent cancer. Chronic Illness 2007;3:265-277.
48.
Kelly D, Pearce S, Mulhall A: ‘Being in the same boat': ethnographic insights into an adolescent cancer unit. Int J Nurs Stud 2004;41:847-857.
49.
Lockhart IA, Berard MF: Psychological vulnerability and resilience to emotional distress: a focus group study of adolescent cancer patients. Int J Adolesc Med Health 2001;13:221-229.
50.
Olsen PR, Harder I: Keeping their world together - meanings and actions created through network-focused nursing in teenager and young adult cancer care. Cancer Nursing 2009;32:493-502.
51.
Stegenga K, Ward-Smith P: On receiving the diagnosis of cancer: the adolescent perspective. J Pediatr Oncol Nurs 2009;26:75-80.
52.
Zebrack B, Chesler MA, Kaplan S: To foster healing among adolescents and young adults with cancer: what helps? What hurts? Support Care Cancer 2010;18:131-135.
53.
Evan E, Zeltzer LK: Psychosocial dimensions of cancer in adolescents and young adults. Cancer 2006;107(suppl 7):1663-1971.
54.
Barrera M, Wayland L, D'Agostino NM, Gibson J, Weksberg R, Malkin D: Developmental differences in psychological adjustment and health-related quality of life in pediatric cancer patients. Child Health Care 2003;32:215-232.
55.
Treadgold CL, Kuperberg A: Been there, done that, wrote the blog: the choices and challenges of supporting adolescents and young adults with cancer. J Clin Oncol 2010;28:4842-4849.
56.
Haase J: The components of courage in chronically ill adolescents. Adv Nurs Sci 1987;9:64-80.
57.
Haase J: The adolescent resilience model as a guide to interventions. J Pediatr Oncol Nurs 2004;21:289-299.
58.
Meltzer LJ, Rourke MT: Oncology summer camp: benefits of social comparison. Children's Health Care 2005;34:305-314.
59.
Docherty A: Experience, functions and benefits of a cancer support group. Patient Educ Couns 2004;55:87-91.
60.
McGrath P: Finding from an educational support course for patients with leukemia. Cancer Pract 1999;7:198-204.
61.
King R, Bambling M, Lloyd C, Gomurra R, Smith S, Reid W: Online counseling: the motives and experience of young people who choose the Internet instead of face to face or telephone counseling. Couns Psychother Res 2006;6:169-174.
62.
Finfgeld DL: Therapeutic groups online: the good, the bad, and the unknown. Iss Mental Health Nurs 2000;21:241-255.
63.
Olsen PR, Harder I: Caring for teenagers and young adults with cancer: a grounded theory study of network-focused nursing. Eur J Oncol Nurs 2011;15:152-159.
64.
Marcia JE: Development and validation of ego identity status. J Pers Soc Psychol 1966;3:551-558.
65.
Larsson G, Mattsson E, von Essen L: Aspects of quality of life, anxiety, and depression among persons diagnosed with cancer during adolescence: a long-term follow-up study. Eur J Cancer 2010;46:1062-1068.
66.
Jordgarden A, Mattsson E, von Essen L: Health-related quality of life, anxiety and depression among adolescents and young adults with cancer: a prospective longitudinal study. Eur J Cancer 2007;43:1952-1958.
67.
Stava CJ, Lopez A, Vassilopoulou-Sellin R: Health profiles of younger and older breast cancer survivors. Cancer 2006;107:1752-1759.
68.
Mor V, Allen S, Malin M: The psychosocial impact of cancer on older versus younger patients and their families. Cancer 1994;74:2118-2127.
69.
Bellizzi KM, Smith A, Schmidt S, Keegan TH, Zebrack B, Lynch CF, Simon M: Positive and negative psychosocial impact of being diagnosed with cancer as an adolescent or young adult. Cancer 2012;15:5155-5162.
70.
Decker CL: Coping in adolescents with cancer: a review of the literature. J Psychosoc Oncol 2006;24:123-140.
71.
Decker CL: Social support and adolescent cancer survivors: review of literature. J Psychosoc Oncol 2007;16:1-11.
72.
Sorgen KE, Manne SL: Coping in children with cancer: examining the goodness-of-fit hypothesis. Child Health Care 2002;31:191-207.
73.
Decker C, Phillips CR, Haase JE: Information needs of adolescents with cancer. J Pediatr Oncol Nurs 2004;21:327-334.
74.
Hinds PS: Adolescent-focused oncology nursing research. Oncol Nurs Forum 2004;31:281-287.
75.
Hinds PS, Quargnenti A, Fairclough D, Bush AJ, Betcher D, Rissmiller G, Pratt CB, Gilchrist GS: Hopefulness and its characteristics in adolescents with cancer. West J Nurs Res 1999;21:600-620.
76.
Hendricks-Ferguson V: Relationships of age and gender to hope and spiritual well-being among adolescents with cancer. J Pediatr Oncol Nurs 2006;23:189-199.
77.
Die-Trill M, Stuber ML: Psychological problems of curative cancer treatment; in Holland J (ed): Psycho-Oncology. New York, Oxford University Press, 1998, pp 897-906.
78.
Zeltzer LK: Cancer in adolescents and young adults. Cancer 1993;71:3463-3468.
79.
Keene N, Hobbie W, Ruccione K: Childhood Cancer Survivors: A Practical Guide to Your Future, ed 2. Sebastopol, O'Reilly Media, 2007.
80.
Jeven RF: It All Begins with Hope. San Diego, Lura Media, 1991.
81.
Parse RR: Hope: An International Human Becoming Perspective. Sudbury, Jones & Bartlett, 1999.
82.
Hinds PS, Martin J: Hopefulness and the self-sustaining process in adolescents with cancer. Nurs Res 1988;37:336-340.
83.
Ritchie MA: Self-esteem and hopefulness in adolescents with cancer. J Pediatr Nurs 2001;16:35-42.
84.
Wu LM, Chin CC, Haase JE, Chen CH: Coping experiences of adolescents with cancer: a qualitative study. J Adv Nurs 2009;65:2358-2366.
85.
Juvakka T, Kylma J: Hope in adolescents with cancer. Eur J Oncol Nurs 2009;13:193-199.
86.
Tedeschi R, Park CL, Calhoun LG: Posttraumatic growth: positive changes in the aftermath of crisis. Mahwah, Erlbaum, 1998.
87.
Tedeschi R, Calhoun L: Trauma and Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, Sage, 1995.
88.
Turner-Sack A, Menna R, Setchell SR: Posttraumatic growth, coping strategies, and psychological distress in adolescent survivors of cancer. J Pediatr Oncol Nurs 2012;29:70-79.
89.
Fernandez C, Fraser GAM, Freeman C, Grunfeld E, Gupta A, Mery LS, Schacter B: Principles and recommendations for the provision of healthcare in Canada to adolescent and young adult-aged cancer patients and survivors. J Adolesc Young Adult Oncol 2011;1:54-59.
90.
O'Connor AP, Wicker CA, Germino BB: Understanding the cancer patient's search for meaning. Cancer Nurs 1990;13:167-175.
91.
Chiu L: A phenomenological study on searching for meaning in-life in women living with breast cancer. Hu Li Yan Jiu 1999;7:119-128.
92.
Ritchie MA: Psychosocial functioning of adolescents with cancer. A developmental perspective. Oncol Nurs Forum 1992;19:1497-1501.
93.
Woodgate RL: Adolescents' perspectives of chronic illness: ‘it's hard'. J Pediatr Nurs 1998;13:210-223.
94.
Paloutzian RF, Ellison CW: Loneliness, spiritual well-being, and the quality of life; in Peplau LA, Perlman D (eds): Loneliness: A Source Book of Current Theory, Research and Therapy. New York, Wiley, 1982.
95.
Lin HR, Bauer-Wu SM: Psycho-spiritual well-being in patients with advanced cancer: an integrative review of the literature. J Adv Nurs 2003;44:69-80.
96.
Taylor EJ: Factors associated with meaning in life among people with recurrent cancer. Oncol Nurs Forum 1993;20:1399-1405.
97.
Swensen CH, Fuller S, Clements R: Stage of religious faith and reactions to terminal cancer. J Psychol Theol 1993;21:238-245.
98.
Edmonds CV, Lockwood GA, Cunningham AJ: Psychological response to long-term group therapy: a randomized trial with metastatic breast cancer patients. Psychooncology 1999;8:74-91.
99.
Miller DL, Manne SL, Taylor K, Keates J, Dougherty J: Psychological distress and well-being in advanced cancer: the effects of optimism and coping. J Clin Psychol Med Settings 1996;3:115-130.
100.
Ballard A, Green T, McCaa A, Logsdon MC: A comparison of the level of hope in patients with newly diagnosed and recurrent cancer. Oncol Nurs Forum 1997;24:899-904.
101.
Flemming K: The imponderable: a search for meaning. The meaning of hope to palliative care cancer patients. Int J Palliat Nurs 1997;3:14-18.
102.
Benzein E, Norberg A, Saveman BI: The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliat Med 2001;15:117-126.
103.
Thomas J, Retsas A: Transacting self-preservation: a grounded theory of the spiritual dimensions of people with terminal cancer. Int J Nurs Stud 1999;36:191-201.
104.
Mahon SM, Casperson D: Exploring the psychosocial meaning of recurrent cancer: a descriptive study. Cancer Nurs 1997;20:178-186.
105.
Roud PC: Psychosocial variables associated with the exceptional survival of patients with advanced malignant disease. Int J Psychiatry Med 1986-1987;16:113-122.
106.
Yang KP, Yin TJ: Defining the content domain of health related quality of life for terminally ill cancer patients. Hu Li Yan 1999;7:129-144.
107.
Bull BA, Drotar D: Coping with cancer in remission: stressors and strategies reported by children and adolescents. J Pediatr Psychol 1991;16:767-782.
108.
Kyngas H, Mikkonen R, Noursiainen EM, Rytilahti M, Seppanen P, Vaattovaara R, Jamsa T: Coping with the onset of cancer: coping strategies and resources of young people with cancer. Eur J Cancer Care (Engl) 2001;10:6-11.
109.
Nichols ML: Social support and coping in young adolescents with cancer. Pediatr Nurs 1995;21:235-240.
110.
Parry C, Chesler MA: Thematic evidence of psychosocial thriving in childhood cancer survivors. Qual Health Res 2005;15:1055-1073.
111.
Tebbi CK, Mallon JC Richards ME, Bigler LR: Religiosity and locus of control of adolescent cancer patients. Psychol Rep 1987;61:683-696.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.