Adolescents and young adults (AYAs) with cancer face a unique set of emotional, developmental, and medical challenges — and findings of a new study hint at how this disease may be affecting their mental health.

Cancer incidence among AYAs has been rising in recent years, placing more young people in the position of navigating a life-threatening illness during a critical stage of identity formation and independence. To better understand the symptom burden facing this growing population of patients with cancer, the authors of the new research, published in JAMA Network Open, analyzed patient-reported outcomes from a large multisite cancer symptom management trial. They noted that another study published in the journal found “alarming” increases in rates of death by suicide among AYA patients in recent years.

The new analysis examined symptom burden among nearly 41,000 patients with cancer, including 2598 AYAs aged 18-39 years. Drawing from patient-reported outcomes collected as part of the E2C2 trial, the researchers assessed rates of depression, anxiety, fatigue, sleep disturbance, pain, and physical function impairment.

AYAs were significantly more likely than older adults to report moderate or severe symptoms of anxiety and depression, the study found.

These results add to a growing body of evidence that mental health support is a critical — yet often underresourced — aspect of cancer care for young people.

How Does the Study Advance Knowledge About Mental Health in This Group?

While previous research has documented elevated psychosocial distress in AYAs, this large cross-sectional study is one of the most robust to quantify symptom severity using validated scales across a diverse patient population.

According to the findings, AYAs had significantly higher rates of moderate (26.1% vs 18.9%) and severe (10.7% vs 7.7%) anxiety than older adults. Similarly, they experienced more moderate (20.8% vs 17.1%) and severe (7.4% vs 6.5%) depression. In contrast, they were less likely to report fatigue or physical function impairment, while there was no difference in moderate or severe pain or sleep disturbance between AYAs and older adults.

“It is not surprising to see higher rates of poor mental health among AYAs with cancer compared to older adults,” said Abby Rosenberg, MD, MS, MA, chief of Pediatric Palliative Care and Psychosocial Oncology/Palliative Care at Dana-Farber Cancer Institute and director of Palliative Care at Boston Children’s Hospital, Boston. “Not only because we see similar patterns in population mental health but also because cancer adds to the normal stressors of young adulthood.”

Why Are AYAs at Such High Risk for Psychological Distress?

The findings reflect the unique developmental and psychosocial vulnerabilities of this age group. For many AYAs, a cancer diagnosis collides with milestones such as pursuing education, building careers, establishing relationships, and gaining independence.

“When you add cancer and its challenges to the other expected challenges of this age range, you can appreciate the risks to concurrent mental health,” said Rosenberg, who is a pediatric oncologist. “For many young adults, cancer represents an existential and substantial threat to their identity. It may be the most challenging experience of their life so far.”

Moreover, she noted, many AYAs have yet to fully develop the stress management or resilience strategies that older adults may have cultivated, placing them at higher risk for psychological distress.

How Can Clinicians Better Support AYA Patients?

Experts agree that one of the most important steps is to integrate mental health into routine care — both in screening and in conversation.

“I think a key thing is to normalize it,” Rosenberg said. “Just as we ask about nausea and fatigue, let’s also ask about coping and resilience.”

At Texas Children’s Cancer and Hematology Center, Houston, mental health is embedded in the care model. “We administer questionnaires to screen for and identify mental health concerns,” said Omar Shakeel, MD, an oncologist and assistant professor in the Department of Pediatrics, Division of Oncology/Hematology at Baylor College of Medicine, Houston, who provides clinical care at Texas Children’s Hospital. “A full-time social worker is available to provide assessments and connect patients with appropriate counseling services.”

Shakeel emphasized that acknowledging the emotional impact of cancer is critical, particularly in a population that may feel reluctant to speak up. “It is important for healthcare professionals to emphasize that caring for emotional well-being is just as important as caring for physical health,” he said.

What Interventions Could Help?

Despite increased awareness of the problem, access to mental health services remains inconsistent — often hampered by a national shortage of mental health professionals, according to Rosenberg. She suggests that digital tools may offer part of the solution but notes that they rely heavily on patient initiative.

Rosenberg pointed to collaborative care models and brief, evidence-based interventions as promising avenues. Digital mental health programs and resilience skills training could help meet the need, “particularly if integrated into oncology workflows,” she said.

Embedding mental health support in cancer centers — whether through dedicated social work staff, routine screening, or digital augmentation — may help close the gap.

Which AYA Patients Are Most at Risk — and How Can We Identify Them?

The study also identified key risk factors for severe symptom burden among AYAs. In multivariable analysis, higher rates of depression, anxiety, and other symptoms were significantly associated with:

• Female sex,
• Living in micropolitan areas,
• Divorced or separated relationship status,
• Government insurance, and
• Disability or nonemployment (including students and military service members).

Tumor type and metastatic status were not associated with worse symptoms — reinforcing that psychosocial context, rather than clinical factors alone, may be the strongest predictor of mental health distress in this population.

These findings suggest that mental health screening should be both universal and sensitive to social determinants of health.

“Many of these young folks have yet to develop coping or resilience skills,” Rosenberg said. “So their mental health is additionally at risk.”

Rosenberg and Shakeel reported having no relevant financial disclosures.

Meg Barbor is a freelance writer for Medscape Medical News.