Promoting Health and Care Transitions in the Long-Term AYA Survivor

Abstract

A large proportion of survivors of cancer diagnosed when they were AYAs experience some adverse effects on their health, some that do not become apparent for years or even decades after the exposure to the anticancer therapies. The developing and maturing organ systems of AYAs have different sensitivities to radiation therapy, chemotherapy, and surgery than do those of younger or older cancer patients. Virtually all organ systems can be affected, depending upon the therapeutic exposure, leading to a wide array of late effects, including second cancers, cardiovascular and pulmonary disease, cognitive dysfunction, and musculoskeletal problems. Some initially subclinical effects may exacerbate common diseases associated with aging, such as cardiovascular, skeletal, and endocrine disorders, and contribute to poor quality of life and premature death. Sociodemographic factors, details of treatment, and health behaviors also influence the magnitude of impairment in specific health status domains. Through risk-based care and education about the health risks conferred by the cancer experience, clinicians caring for long-term survivors play a critical role in the prevention, diagnosis, and rehabilitation of cancer-related complications and adjustment to chronic health conditions predisposed or exacerbated by cancer. Consequently, health professionals caring for AYA cancer survivors may influence their future health positively by correcting knowledge deficits, addressing factors that enhance an individual survivor’s vulnerability to health problems, and providing personalized health counseling that promotes the practice of health-promoting behaviors. This chapter describes the healthcare of survivors of cancer diagnosed during the AYA years, including risk-based screening and surveillance for late effects, transition of AYA healthcare, and models of AYA survivorship care. The promotion of healthy lifestyle habits is discussed, emphasizing the impact of such habits on the expression of late effects.