搜索结果：Journal of adolescent and young adult oncology

Our study aimed to investigate the experiences of adolescents and young adults (AYAs) with cancer from racially/ethnically diverse and/or 2SLGBTQIA + communities within the Canadian healthcare system to identify areas for improvement in their cancer care experience. The study included participants who self-identified as racially/ethnically diverse and/or 2SLGBTQIA + , diagnosed with cancer between ages 15 and 39 years, currently aged 18 years or older, and received or were receiving cancer care in Canada. Patient partners with lived experience of cancer were recruited as collaborators. Semi-structured virtual interviews were conducted using an interview guide, and transcripts were analyzed using framework analysis. Twenty-three participants (17 racially/ethnically diverse; 1 sexual/gender diverse; 5 both racially and sexually diverse) were interviewed. Positive experiences reported by participants included being able to identify with healthcare providers (HCPs), effective communication, comprehensive information sharing, and access to support services tailored for younger patients. Negative experiences were characterized by perceptions of judgmental attitudes and racialization from HCPs, the necessity of self-advocacy to obtain resources, systemic barriers to care, and psychosocial difficulties. Participants' recommendations for improving cancer care included increasing the diversity of HCPs, implementing equity, diversity, and inclusion training, and enhancing both communication and information dissemination practices. The experiences of diverse AYAs revealed both facilitators and barriers to equitable cancer care. Findings emphasize the need for workforce diversity and equity-informed practices to advance culturally responsive oncology care. Précis: This study examined the cancer care experiences of racially/ethnically diverse and/or 2SLGBTQIA + adolescents and young adults in Canada, revealing both supportive interactions and significant barriers such as discrimination and systemic inequities. Participants recommended increasing provider diversity, equity-focused training, and improved communication to create more inclusive and responsive cancer care.

Adolescents and young adults (AYAs) with cancer face unique developmental, psychosocial, and care transition challenges between pediatric and adult oncology systems. Multidisciplinary team (MDT) approaches are promoted to address these complex needs; however, collaboration, implementation, and impact on AYA care remain inconsistently described in the literature. This systematic review synthesizes evidence on how MDTs are organized, enacted, and experienced in AYA oncology care and examines implications for patient-centered, developmentally appropriate care. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a search of CINAHL, PsycINFO, and PubMed was conducted for studies published between January 2000 and March 2025. Eligible studies were peer-reviewed articles in English involving participants aged 15-39 years with cancer who addressed survivorship and multidisciplinary teamwork. Of 1048 screened records, 15 studies met the inclusion criteria and were included in the synthesis. Four overarching themes were identified: (1) core elements of effective MDT collaboration, including flexible professional roles, MDT communication, and shared decision-making with AYAs; (2) addressing the unique psychosocial and developmental needs of AYAs, supporting care coordination, and psychosocial support; (3) implementation and functions of MDTs across the AYA cancer care continuum, facilitating smoother transitions between pediatric and adult services; and (4) the impact of MDT care on patient outcomes, including improved adherence to follow-up care and enhanced psychosocial well-being. Evidence shows MDTs function as relational processes shaping AYA cancer care quality, not just organizational structures. Effective MDTs emphasize patient-centered collaboration and multidisciplinary trust across the cancer trajectory. Future research should evaluate how MDT processes influence clinical, psychosocial, and survivorship outcomes for AYA.

Adolescent and young adult (AYA) patients with cancer face numerous challenges, particularly at the end-of-life. However, little is known about how the patients and their families experience end-of-life care. We aimed to compare the quality of end-of-life palliative care and the levels of depression and grief among bereaved families of AYAs and middle-aged patients with cancer, and to identify associated factors. We conducted a secondary analysis of a nationwide mortality follow-back survey based on death certificates of patients who died from cancer in 2017 and 2018. Subjects were classified into two groups AYA (aged 20-39 years) and the middle-aged (aged 40-64 years). End-of-life quality was evaluated using the Care Evaluation Scale, Good Death Inventory, and Memorial Symptom Assessment Scale. Depression and grief levels among bereaved family members were also evaluated. We analyzed 261 and 5790 bereaved families from the AYA and middle-aged groups, respectively. While the quality of end-of-life palliative care did not differ clinically significantly between the AYA and middle-aged group, the levels of grief and depression were significantly higher in the AYA compared with the middle-aged group (Effect Size [ES] = 0.57, p < 0.0001; ES = 0.22, p = 0.001, respectively). Although end-of-life care quality was comparable between AYAs and middle-aged patients, bereaved families of AYA patients experienced significantly greater grief and depression. These findings underscore the need for tailored bereavement support for AYA families.

Adolescent and young adult (AYA) patients with cancer face complex decisions about family building, often compounded by misconceptions about hereditary cancer risk. Although guidelines recommend early discussion of fertility- and genetics-related risks, these topics are inconsistently integrated into routine care. To address this gap, we developed Reproductive Education and Fertility Links for Cancer Treatment (REFLECT), a digital health application designed to provide education and decision support related to fertility, genetic risk, and future family building for AYAs with cancer. This study developed and pilot-tested REFLECT to support informed decision-making. REFLECT was developed using evidence-based content and implemented on a web-based platform integrating multimedia education and decision support. Two iterative rounds of user testing were conducted with AYA survivors (ages 18-39) using a Learner Verification framework to assess comprehension, usability, relevance, and acceptability. Participant feedback informed iterative refinements. Participants (N = 16) reported that REFLECT was engaging, easy to navigate, and relevant to fertility, genetics, and future family-building concerns. Iterative testing identified opportunities to improve navigation, accessibility, and content organization, which were addressed through refinement. Participants reported increased confidence in discussing fertility preservation and genetic risk with providers and emphasized the value of an integrated patient-centered tool, particularly at the time of diagnosis. This pilot demonstrates that REFLECT is feasible, acceptable, and usable among AYAs. By integrating fertility and genetic risk education with decision support in an accessible digital format, REFLECT addresses a critical gap in AYA oncology care. These findings support further evaluation in clinical settings.

The impact of diagnosis and treatment on adult survivors of childhood and adolescent cancer gives rise to unique informational needs, highlighting the need for alternative methods to address their questions. However, topics of interest to this population remain unclear. This study explored the primary inquiries expressed by survivors when engaging with a chatbot tailored to address their needs and examined how these inquiries related to participant characteristics. A sample of 119 adult survivors of childhood and adolescent cancer completed an online survey regarding inquiries for a tailored chatbot. A comprehensive three-step approach to topic modeling and content analysis was conducted. The analyses classified 1237 questions into 11 topics: health and daily life management; psychological distress; cancer history disclosure; coping with side and late effects; causes, diagnosis, and treatment of cancer; social policy and services; academic continuity and school reentry; social relationships and reintegration; concerns related to cancer recurrence; peer survivors and communication; and social stigma and coping. The topics differed based on age group, education level, recurrence, age at diagnosis, and time since diagnosis. These findings underscore the importance of addressing diverse informational needs regarding health and psychosocial concerns among cancer survivors. Findings also highlight the critical role of oncology professionals in overseeing digital triage and psychosocial assessment and delivering tailored support to meet the concerns of survivors as they navigate challenges and opportunities in adulthood, ultimately promoting their overall health and well-being.

Fertility preservation (FP) is essential for adolescents and young adults (AYAs) with cancer aged 15-39, yet gaps persist in guideline-concordant care. Despite American Society of Clinical Oncology (ASCO)'s 2018 recommendations, clinician and systemic barriers hinder timely FP counseling. Allied health care professionals (AHPs) play a critical role in supporting patient education and support. This study examined AHPs' conceptualizations of optimal FP care, assessed alignment with ASCO guidelines, and identified facilitators and barriers to implementation. This study analyzed data from Cohort 4 (2020) of the Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) program, an 8-week web-based training for AHPs on AYA reproductive health communication. A directed content analysis was used to qualitatively examine factors influencing FP care delivery. Multilevel themes were analyzed to identify potential mechanisms to facilitate optimal FP care, resources needed for implementation, and barriers to FP patient education. Among 130 AHPs (92% female, 72% White), most were social workers (29%) or oncology nurses (25%), working in academic cancer centers (49%). Alignment with ASCO guidelines was observed in fertility risk discussions (72%) and specialist referrals (56%). Key facilitators included patient education (46%), clinician training (48%), and interdisciplinary collaboration (47%). Primary barriers identified were systemic challenges (20%), including financial constraints, limited institutional resources, and time pressures. AHPs demonstrated strong commitment to advancing FP care for AYAs with some alignment to ASCO guidelines. Persistent gaps in psychosocial support and system-level resources highlight the need for expanded clinician education, stronger interdisciplinary networks, and institutional prioritization to ensure equitable, developmentally appropriate FP care.

Theoretical models on fear of cancer recurrence (FCR) have been developed and validated for adult cancer survivors, despite high levels of FCR being found in adolescents and young adults (AYAs). This study intended to empirically validate a model of FCR for AYAs based on the theoretical models of Lee-Jones and Lebel. One hundred AYAs diagnosed with cancer between the ages of 15 and 25 were included (59% female). Data were collected online and in-person from four hospitals and one association for young cancer patients in Portugal using the Quality of Life (QoL) Questionnaire Core-30, the FCR7 scale, the Emotion Regulation Questionnaire, the 15-item Systematic Clinical Outcome and Routine Evaluation scale, the Satisfaction with Social Support Scale, and the Hospital Anxiety and Depression Scale. A path analysis showed an excellent model fit: &#x3c7;2(28) = 30, p = 0.363; Bentler comparative fit index (CFI) = 0.99; Tucker-Lewis index = 0.98; root-mean-square error of approximation = 0.03; standardized root-mean-square residual = 0.08. Significant paths were found from FCR to depressive symptoms and QoL, with friends' support moderating the path between FCR and depressive symptoms. Depressive symptoms and QoL were also related to emotion suppression and friends' support. Being satisfied with their friends' support seems to be protective for AYAs with high FCR levels, while satisfaction with family support does not seem to have an influence. This diverges from previous models, supporting the need for a distinct AYA model. Additionally, emotion suppression was related to depression and QoL, but not FCR.

Adolescents and young adults (AYAs) with cancer have unique physical, emotional, and social challenges. We aimed to identify key concerns among AYAs with cancer, evaluate pathways for connecting patients with resources, and inform the development of an AYA oncology program. This study was conducted at Mayo Clinic in Arizona and included English-speaking patients aged 18-39 years with recently diagnosed cancer. Participants completed a modified Needs Assessment Service Bridge questionnaire, which assessed patient-perceived needs with 39 items spanning 7 domains. An AYA nurse navigator discussed each participant's results with them and connected them to the desired resources. Of 52 eligible patients, 32 (62%) completed the questionnaire. Among them, 30 (94%) reported unmet needs in at least 1 domain and 19 (59%) reported unmet needs in 5 or more domains. The domains with the most frequently reported needs were health behaviors and wellness (81%), emotional health (72%), finances and everyday needs (59%), and work- and education-related assistance (56%). Younger participants reported more needs related to school life and scholarships/loans than did older participants. No significant differences were observed between the responses of men and women. Of 133 total needs identified by all participants, 93 (70%) were addressed by connecting patients to relevant resources. Systematic assessment of AYA needs and targeted connection to resources are essential for individualized and developmentally appropriate care. The current study identified key service gaps at our institution and will guide the continued evolution of our comprehensive AYA oncology program.

Community-based organizations play an essential yet underrecognized role in addressing health inequities faced by adolescent and young adult (AYA) cancer survivors, particularly those from underrepresented communities. Elephants and Tea, a nonprofit organization, launched One Herd, a digital storytelling and health equity campaign designed to elevate lived experiences of underserved AYA survivors. This article describes the conception and development of that campaign and presents findings from its needs assessment. One Herd followed a five-phase process (1) assembling a multidisciplinary advisory team of underrepresented AYA survivors; (2) identifying campaign priorities and conducting a national needs assessment to inform content development; (3) analyzing survey findings and creating survivorship-centered content; (4) disseminating content through digital, print, webinar, and live storytelling platforms; and (5) evaluating campaign reach and perceived impact. A national needs assessment identified social and structural barriers to equitable survivorship care, guided by social determinants of health and community-engaged frameworks. Eighty-one AYA cancer survivors completed the survey; 76 were included in the final analysis. Participants reported multilevel inequities, including limited access to fertility preservation resources, perceived bias and discrimination in health care, and unmet needs for peer connection and identity-affirming support. Findings informed the development of survivor-centered digital storytelling and educational materials for community and provider audiences. Dissemination formats included a print and digital magazine, webinars, and live storytelling events, with workforce education integrated into Elephants and Tea's AYA Program for Oncology Workforce Education and Resources. Early feedback identified survivor stories as the most impactful campaign component. One Herd demonstrates how community-led, research-informed storytelling can operationalize narrative equity and bridge survivor experience with system-level education in AYA cancer care.

Adolescents affected by cancer experience unique educational and social challenges during high school due to cancer diagnosis, treatment, and survivorship. High school experiences may also be impacted by developmental stage at diagnosis. This study aims to compare the high school experiences related to age at diagnosis (childhood or adolescence) from adolescent and young adult and parent perspectives. We used purposive sampling to recruit youths and parents to semistructures interviews, including 18 youths (11-23 years), diagnosed during childhood (n = 8; age at diagnosis M = 6.8) and adolescence (n = 10, age at diagnosis M = 13.8), and 13 parents (34-65 years), of youths diagnosed in childhood (n = 8, child age at diagnosis M = 6.9) and adolescence (n = 5, child age at diagnosis M = 13.6). Interviews were transcribed verbatim and analyzed thematically. We identified two common themes for youths: Academic Calibration, highlighting the adjustments to academic performance and engagement throughout the cancer journey, and (Dis)connection, describing shifts in social identity and peer relationships. For parents, themes included: Navigating School Engagement, reflecting challenges with education engagement, and Social Flux, capturing changes in social functioning and peer interactions. Distinct subthemes were identified across all youths, including Missing Out, Social Isolation and School Takes a Back Seat, detailing the social and academic experiences of youths diagnosed in adolescence. This study underscores the shared and distinct challenges faced by adolescents affected by cancer in high school. Disruptions to social networks faced by adolescents with cancer and enduring academic challenges of adolescents diagnosed in childhood underscore the need for tailored, comprehensive support.

Nasopharyngeal carcinoma (NPC) is a rare cancer, especially in nonendemic regions such as North America, occurring in a bimodal age distribution with the first peak in adolescents and young adults (AYA). Limited data exist on treatment outcomes in this group. The purpose of our study is to evaluate treatment outcomes of NPC in the AYA population in British Columbia, Canada, and evaluate late effects. We conducted a retrospective cohort study of AYA patients (ages of 15-39 years at diagnosis) diagnosed with NPC and treated between 2000 and 2015. Demographics, treatment outcomes, and late toxicities were collected. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier and Cox regression. Locoregional recurrence and distant metastatic recurrence were evaluated using the competing risk method. Late effects were described qualitatively and quantitatively. The cohort included 97 patients: 93 received curative intent treatment, 3 received palliative treatment, and 1 was excluded from survival analysis. Five-year OS rates were 81% (Stage I/II), 80% (Stage III), and 68% (Stage IV), with corresponding DFS rates of 78%, 77%, and 66%. The addition of neoadjuvant and/or adjuvant chemotherapy to radiotherapy was associated with improved survival. Advanced-stage disease had a higher incidence of locoregional relapse. Common late toxicities included xerostomia, hearing loss, epistaxis, and hypothyroidism. Although survival rates in our cohort were comparable to existing literature, the rate of late toxicities was high. These findings support the need for AYA-tailored treatment strategies and survivorship care to minimize long-term complications and optimize quality of life.

Psychosocial screening integration has been recognized as a standard of care, though successful implementation relies heavily on provider engagement. The current study examined provider perceptions on integrating a psychosocial screening tool as part of the standard of care at a comprehensive cancer center that primarily serves patients with hematologic malignancies. The Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST) or Adolescent and Young Adult Psycho-Oncology Survivorship Screening Tool (AYA-S-POST) was administered to patients in the Transplant and Cellular Therapies (TCT) clinic as part of a broader program development initiative. Research personnel then designed a survey to assess provider perceptions of integrating the AYA screening tool into clinical care. Survey items were adapted from a prior study. Information regarding provider perceptions of integrating age-appropriate psychosocial screening was then analyzed. Fourteen of the eligible 20 providers (eight physicians and six APPs) provided feedback on the AYA screening tool. A total of 13 providers (92.9%) had discussed the screener during a medical visit with a YA patient. Overall, TCT providers had neutral to positive perceptions of the AYA screening tool. Results of the current study show that providers in a high-volume adult oncology clinic have generally positive views of integrating an age-appropriate psychosocial screening at point of care. With acceptability from providers, routinely screening YAs could move toward more consistently addressing their unmet needs and enhancing the quality of their oncology care.

To clarify communication preferences regarding the disclosure of bad news in adolescent and young adult (AYA) patients with hematological malignancies. A cross-sectional study was conducted from January 2021 to March 2022 using a five-point Likert-scale questionnaire. Participants were patients diagnosed between the ages of 15-29 years and aged <40 years at the time of the survey. Preferences regarding physician communication during the disclosure of bad news were assessed. Trend tests were performed for items showing substantial interindividual variability. Data from 90 participants (49 male) were analyzed. Compared with adult cancer populations, AYA patients were less likely to prefer receiving bad news in the presence of family or to prioritize reassurance or emotional support. Over 90% preferred detailed and concrete information about their medical condition, including unfavorable information, and wanted physicians to listen to their distress and concerns. Seventy percent preferred receiving information about life expectancy. Participants wanted physicians to break bad news to them first while also valuing physicians' consideration for their family members. Trend test results indicated that a preference for "Using indirect or softened wording" when delivering bad news was associated with younger age at diagnosis (<20 years), male sex, and shorter time since diagnosis (<5 years). Married participants more often preferred "Breaking bad news before it is fully confirmed." AYA patients generally prefer clear and accurate disclosure of medical information while valuing physicians' consideration for their family members. Many prefer factual information before or alongside emotional support, highlighting the need for flexible, individualized communication strategies.

There is increasing recognition of the critical need to support informal caregivers of young adults with cancer, including parents. Given the unique developmental needs of young adults, cancer diagnosis and treatment have a profound impact on their parents. However, there is limited psychosocial support provided to parents of young adults with cancer to date. Following a program improvement framework, a virtual six-session parent support group curriculum was developed and adapted to provide specialized psychosocial care to parents of young adults receiving cancer care in 2025. The participants provided feedback and completed an evaluation. Thirty-four parents (85% female) of young adults participated, with 19 (55%) completing the evaluation. The majority of participants evaluated the program as accessible (95%) and relevant (84%) to the parent's shared concerns and experiences. The program was highly rated as supportive (95%) engaging (100%) and was unanimously recommended to other parents (100%). Additionally, parents reported feeling more connected to others (79%), empowered with knowledge (90%), and an improved perceived capacity (79%) to navigate the unique concerns related to their young adult's cancer. This novel parent program has the potential to address the distinct psychosocial needs among parents, which are currently overlooked in existing models of young adult cancer care.

In East Africa and beyond, uncertainty regarding the underlying aetiology of febrile illnesses may result in inappropriate treatment. In our study, we aimed at enhancing our understanding of antibiotic use patterns, prescribing practices and factors influencing antibiotic use in this region by exploring the pathways of care for acute febrile illnesses in three countries in East Africa. Between October 2021 and February 2024, acute febrile patients were enrolled in six health facilities in the eastern Democratic Republic of the Congo (DRC), Kenya, and Uganda. Our cross-sectional study assessed sociodemographic and clinical data along with initial diagnosis and antibiotic treatment record, collected at the initial outpatient and enrolment visit. A total of 4,806 subjects were enrolled: 1,370 in DRC, 1,468 Kenya, 1,968 Uganda. About a quarter of the total population (23.3%) reported having already sought care before enrolment, most frequently in DRC (36.6%) at pharmacies (83.9%), and in Uganda (27.9%) at hospital (84.1%). Fifty percent of the DRC study population reported antibiotics use before enrolment, much higher than Kenya (3.3%) and Uganda (11.2%). Undifferentiated febrile illness was suspected in 37.5% of cases. At enrolment, in all countries, antibiotics were prescribed for 72.9% of cases (DRC 87.2%&#x202f;>&#x202f;Kenya 68.9%&#x202f;>&#x202f;Uganda 65.8%), with a non-negligible prescription of watch antibiotics (33.0%), prevalent in DRC (62.2%). In Kenya and Uganda, access antibiotics prevailed (80.9 and 67.1%, respectively). Prescription of watch antibiotics for undifferentiated febrile illnesses was strongly associated with a positive Widal test and access to hospital. Different patterns of access to care and antibiotic use for acute febrile illness were observed among countries. DRC had the highest level of pharmacy attendance prior to accessing the formal healthcare sector, as well as the highest reported use of antibiotics before formal care. It also showed the highest proportion of watch antibiotic use within the formal healthcare sector, even among patients without a confirmed diagnosis. Urgent targeted action is needed through effective and sustainable antimicrobial stewardship programs targeting both the formal and informal health sectors.

Research on the impact of integrative oncology (IO) programs on quality of life (QoL) among young adults with cancer is limited. The present study explored the impact of a patient-tailored IO program for young patients undergoing active oncology care. This pragmatic, prospective and preference-controlled study examined patients aged 18-45 referred by oncology healthcare providers to an IO consultation and 6 weekly treatments addressing QoL-related concerns. High adherence to integrative care (high-AIC, vs. low-AIC) was defined as attending&#x2009;&#x2265;&#x2009;4 IO sessions, with baseline and 6-week symptoms assessed using ESAS (Edmonton Symptom Assessment Scale); EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and MYCAW (Measure Yourself Concerns and Wellbeing) tools. Of 180 patients, 137 (76%) were high-AIC, with similar baseline demographic, cancer-and QoL-related characteristics in both groups. At 6 weeks, high-AIC patients reported greater improvement on ESAS (p&#x2009;=&#x2009;0.046) and MYCAW (p&#x2009;=&#x2009;0.008) wellbeing; ESAS nausea (p&#x2009;=&#x2009;0.027); EORTC dyspnea; and EORTC role functioning (p&#x2009;=&#x2009;0.031). Significant within-group improvement was observed in older high-AIC patients (aged 40-45, n&#x2009;=&#x2009;72), as opposed to no improvement in young high-AIC patients (aged 18-39, n&#x2009;=&#x2009;65) on ESAS fatigue (p&#x2009;=&#x2009;0.033), anxiety (p&#x2009;=&#x2009;0.001), and breathing (p&#x2009;=&#x2009;0.016); and wellbeing on ESAS (p&#x2009;=&#x2009;0.006) and MYCAW (p&#x2009;<&#x2009;0.001). Young patients with cancer highly adherent to a 6-week IO program reported significantly improved wellbeing, more significantly among older patients. Further research is needed to explore the impact of IO programs on young patients with cancer, addressing their unique psychological, social, and spiritual needs.

The original Reproductive Concerns After Cancer (RCAC) scale is a well-validated instrument. However, its gender-specific nature hinders direct comparison of scores across genders and limits its efficiency in clinical practice. The study was conducted in two phases. First, items from the original female and male RCAC scales were rigorously evaluated and consolidated using a Delphi expert panel and face validity testing, resulting in a preliminary 7-item version. Second, psychometric validation was performed on a sample of 1,049 young cancer survivors (609 males, 440 females) recruited from two specialist oncology hospitals in China. Participants were diagnosed with a range of cancers, including colorectal, lung, breast, thyroid, gastric, and ovarian tumors. The psychometric evaluation encompassed item analysis, content validity, confirmatory factor analysis (CFA), convergent validity with the Patient Health Questionnaire-9 (PHQ-9), internal consistency reliability, and test-retest reliability. The original 18-item scale was successfully reduced to a 7-item unisex instrument, the RCAC-7. Psychometric testing demonstrated that the RCAC-7 has satisfactory internal consistency (Cronbach's &#x3b1; = 0.770; McDonald's &#x3c9; = 0.889) and excellent test-retest reliability (r = 0.930-0.970). The content validity index was good. Convergent validity was supported by a strong positive correlation with the PHQ-9 (r = 0.783, p < 0.01). Furthermore, confirmatory factor analysis confirmed a robust one-factor structure, indicating good model fit. The RCAC-7 is a valid and reliable unisex tool for measuring reproductive concerns in young cancer survivors. Its brevity and strong psychometric properties make it highly suitable for rapid screening and use in both clinical practice and large-scale research settings.

Adolescent and young adult (AYA) patients with cancer frequently experience psychosocial distress, yet age- and gender-related differences in distress in routine care are not fully understood. To examine age- and gender-related differences in distress and specific psychosocial concerns among AYA patients with cancer using routine distress screening. This retrospective single-center study included AYA patients aged 15-39 years who completed distress screening with the Distress Thermometer (DT) and problem checklist prior to first-line cancer treatment. Clinically significant distress was defined as DT &#x2265; 4 based on NCCN guidelines and institutional practice. Distress levels and checklist items were compared across age groups (teens, 20s, 30s), gender, cancer stage, and time from diagnosis to screening. Among 213 patients, clinically significant distress (DT &#x2265; 4) was more frequent among teenage males than among males in their 30s. Female patients reported more emotional concerns across all ages, while fertility-related concerns were reported by both males and females. Financial concerns, reflecting financial toxicity, were most common among patients in their 30s and those with advanced-stage disease. A shorter interval between diagnosis and screening was associated with higher distress levels. Using the standard DT cutoff of &#x2265;4, distress among AYA patients with cancer varied significantly by age and gender. Teenage males represented a particularly vulnerable group with elevated distress at diagnosis, while financial toxicity was a major concern among patients in their 30s. These findings emphasize the need for early, age- and gender-tailored psychosocial screening and support in AYA oncology care.

To reduce worldwide inequalities, WHO made a call for action to eliminate cervical cancer by vaccinating 90% of girls, screening 70% of women, and treating 90% of pre-cancers and cancers. Low-income countries and lower-middle-income countries (LMICs) are far from reaching the WHO elimination targets compared with high-income countries (HICs). Using mathematical modelling, we aimed to examine the following questions: (1) Are we on the path to cervical cancer elimination in LMICs and HICs? (2) What is the potential evolution of inequalities in cervical cancer between LMICs and HICs under current screening and vaccination coverage? And (3) what would be the potential impact of enhanced prevention strategies (ie, human papillomavirus [HPV] vaccination and screening) on inequalities and cervical cancer elimination? We used the HPV-ADVISE model to project the age-standardised cervical cancer incidence in 67 LMICs and 42 HICs for different HPV vaccination and screening scenarios. For the status quo scenario (of HPV vaccination and screening), we modelled the vaccine used, the start year of vaccination, vaccination coverage, and the target population for each country, and current screening coverage in LMICs and HICs. We examined five enhanced prevention strategies for LMICs: (1) status quo for all countries using the nine-valent vaccine; (2) reaching 90% vaccination coverage for girls-only routine vaccination; (3) reaching the WHO vaccination, screening, and treatment elimination targets; (4) adding routine vaccination for boys with 90% coverage (ie, universal routine vaccination) and multi-age-cohort vaccination; and (5) reaching the WHO elimination targets combined with universal routine and multi-age-cohort vaccination. Inequalities were measured as the age-standardised cervical cancer incidence (ASR) ratio between LMICs and HICs (RRLMIC/HIC=ASRLMICs/ASRHICs). Under the status quo, the model projected that cervical cancer incidence in LMICs would decrease by only 23% while HICs would reach elimination by 2048 (age-standardised cervical cancer incidence <four cases per 100&#x2008;000 women-years), leading to substantial increases in inequalities (RRLMIC/HIC=3 in 2022 and 12 in 2105). Reaching 90% vaccination coverage among girls in LMICs would reduce these inequalities (RRLMIC/HIC=2 in 2105) and lead to elimination in LMICs outside sub-Saharan Africa. To reach equality between LMICs and HICs and elimination in all LMIC regions, LMICs would need to reach the WHO elimination targets and introduce universal vaccination and multi-age-cohort vaccination. Worldwide inequalities in cervical cancer have been projected to increase dramatically without enhanced HPV prevention strategies. Reaching WHO vaccination and screening elimination targets or introducing universal vaccination with high coverage is necessary to eliminate cervical cancer in LMICs, which would substantially attenuate worldwide inequalities. Canada Research Chairs Program, Canadian Institute of Health Research, and Fonds de recherche du Qu&#xe9;bec through the research centre grant for the CHU de Qu&#xe9;bec-Universit&#xe9; Laval Research Center.