Adolescents and young adults who survive cancer face a complex landscape of late effects, treatment complications, and psychosocial challenges that extend decades beyond their initial diagnosis. A practice review published in the Canadian Medical Association Journal outlines evidence-based clinical approaches to managing this vulnerable population, emphasizing the need for coordinated, multidisciplinary survivorship care.
Key takeaways
- Adolescents and young adults (AYAs) comprise 5–10% of all cancer diagnoses but face distinct late effects from chemotherapy, radiation, and surgery that differ from older adults
- Cardiotoxicity, secondary malignancies, gonadal dysfunction, and cognitive impairment are among the most common long-term complications requiring systematic screening
- Survivorship care plans, fertility counselling, and transition from paediatric to adult oncology services are critical interventions with evidence of improved outcomes
Study at a Glance
| Source | Canadian Medical Association Journal |
| Article type | Evidence-based practice review |
| Focus | Long-term management of adolescent and young adult cancer survivors |
| Population | Patients aged 15–39 diagnosed with cancer |
| Scope | Clinical assessment, late effects screening, psychosocial support |
Common Late Effects in Adolescent and Young Adult Cancer Survivors
Frequency of major complications requiring clinical monitoring and intervention
Source: Canadian Medical Association Journal practice review | Georgian Medical Journal News
Late Effects and Cardiotoxicity: The Silent Threat
Chemotherapy agents—particularly anthracyclines and targeted therapies—and thoracic radiation pose substantial risks for cardiomyopathy and arrhythmia in AYA survivors, according to the CMAJ review. These complications may emerge years or even decades after treatment completion, making systematic cardiac screening essential.
The review recommends baseline and periodic echocardiography, electrocardiography, and biomarker assessment (including troponin and B-type natriuretic peptide) for patients exposed to cardiotoxic agents. Clinical vigilance during pregnancy, a life stage when cardiac demand increases substantially, is particularly important for female survivors. This coordinated approach to clinical surveillance has become standard in specialized survivorship programmes.
Fertility, Sexuality, and Reproductive Health in Young Survivors
Gonadal dysfunction—affecting both testicular and ovarian function—ranks among the most frequently encountered long-term complications in AYA cancer survivors. The practice review emphasizes that fertility counselling should occur before cancer treatment whenever possible, enabling options such as sperm banking, egg or embryo cryopreservation, or ovarian tissue banking.
Beyond biological fertility, the review notes that psychological impacts on sexuality, body image, and intimate relationships are underrecognized in clinical practice. Addressing these psychosocial dimensions—through counselling, peer support groups, and specialized survivorship clinics—improves quality of life and long-term mental health outcomes. Early, honest discussion of reproductive and sexual health, supported by evidence-based resources, distinguishes high-quality AYA survivorship programmes.
Transition of Care and Survivorship Planning
A critical gap in AYA cancer care occurs during transition from paediatric to adult oncology services—typically around age 18–21. The CMAJ review highlights that formal survivorship care plans, incorporating detailed treatment summaries and late-effects screening protocols, significantly improve continuity and patient engagement. Such plans should document all chemotherapy agents, doses, radiation fields and doses, and surgical procedures—essential information for predicting and monitoring late effects.
Coordinated multidisciplinary teams—including medical oncologists, cardiologists, endocrinologists, mental health specialists, and survivorship nurses—demonstrate improved screening adherence and early detection of complications. Establishment of dedicated AYA survivorship clinics, where feasible, creates a bridge between paediatric and adult medicine while addressing the unique developmental, social, and reproductive priorities of this age group. Supporting this model is increasingly recognized as both clinically effective and cost-effective by healthcare systems across health policy frameworks.
Adolescents and young adults comprise 5–10% of cancer diagnoses but require distinctly different survivorship protocols addressing late effects, reproductive health, psychological adjustment, and transition to adult care.
— Canadian Medical Association Journal practice review
What this means
Frequently asked questions
What is the difference between late effects and recurrence in cancer survivors?
Late effects are new medical conditions caused by cancer treatment itself—such as cardiotoxicity from chemotherapy or secondary cancer from radiation—occurring months or years after treatment ends. Recurrence refers to return of the original cancer. Both require monitoring, but screening strategies, risk factors, and management differ substantially, as outlined in the CMAJ review.
At what age should transition from paediatric to adult oncology occur?
Most cancer centres recommend transition between ages 18–21, though age alone should not be the only criterion. The transition process should be gradual, planned, and supported by a written care plan that summarizes treatment history and identifies specific follow-up needs. The goal is to ensure continuity while respecting the patient’s increasing autonomy and adult healthcare context.
Is pregnancy safe for female cancer survivors?
Pregnancy can be safe for many female survivors, but requires pre-pregnancy assessment of cardiac function, endocrine status (thyroid, ovarian reserve), and other organ systems affected by treatment. The CMAJ practice review recommends close collaboration between oncology, obstetrics, and cardiology; most survivors can successfully carry pregnancies with appropriate planning and monitoring.
As the population of AYA cancer survivors grows—driven by improved cure rates and earlier detection—the demand for specialized, evidence-based survivorship care continues to increase. Integrating systematic screening, multidisciplinary support, and patient-centred planning into routine cancer follow-up will reduce preventable morbidity, improve quality of life, and enable survivors to fully participate in education, work, relationships, and parenthood. Healthcare systems that invest in AYA survivorship infrastructure now will see measurable gains in long-term health outcomes and population health equity.
Source: Adolescents and young adults living with and beyond cancer, Canadian Medical Association Journal
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