I spent time reflecting on my work with the adolescent and young adult (AYA) oncology population in honor of AYA Awareness Week. Before sitting down to write, I revisited thank-you notes, emails, and even funeral cards from clients and families. These reminders grounded me in the reality that this population carries a uniquely complex survivorship experience—one that extends far beyond the completion of treatment. 

We are seeing increasing rates of cancer diagnoses among young adults. According to national data, tens of thousands of individuals between the ages of 15 and 39 are diagnosed each year, with early-onset cancers steadily rising (National Cancer Institute, n.d). In my private practice, I often extend the AYA lens into the 40s, as many individuals are still navigating parallel stressors—fertility concerns, raising children, career development, financial strain, and caring for aging parents. 

Survivorship for this population is not simply about being “done” with treatment. Instead, it is often marked by the challenge of getting back on track—re-entering careers, rebuilding relationships, reconsidering family planning, and addressing financial toxicity. Layered onto this are ongoing fears of recurrence, infertility concerns, and the physical or late effects of treatment that can persist for years. 

One of the most consistent themes I encounter in my work is grief. Grief and cancer are deeply intertwined, especially for AYAs, who are developmentally at a stage where life is expected to be expanding—not contracting. I often conceptualize their experience through multiple forms of grief: 

• Disenfranchised grief arises when others minimize the cancer experience—comments like “you had the good kind” or “at least you didn’t need chemotherapy” can leave individuals feeling invalidated and isolated.  

• Chronic grief reflects the ongoing nature of loss, particularly when treatment results in long-term health conditions or extended medication regimens.  

• Ambiguous loss captures the disorienting sense that one’s former identity is gone, even though they are physically present, living with uncertainty about the future.  

• Anticipatory grief appears when individuals mourn milestones they are missing—proms, weddings, career opportunities—due to treatment.  

• Compounded or cumulative grief often defines survivorship, as multiple losses occur simultaneously, including social disconnection, career disruption, and physical changes.  

In many ways, survivorship becomes a process of grieving not just what was lost, but what was expected. 

Mental health struggles such as anxiety and depression are also highly prevalent, both during and after treatment. Fear of recurrence can be particularly intrusive, often surfacing during follow-up scans or even in moments of physical discomfort. For some, this fear shapes daily decision-making and limits their ability to re-engage fully in life. 

In my clinical work, one of the first things I address is the pressure many AYAs place on themselves to “bounce back.” We spend time identifying and challenging internalized narratives such as “I should be grateful,” or “I should be back to normal by now.” Removing the word “should” from their vocabulary can be both simple and transformative. 

I also spend significant time addressing toxic positivity. While well-intentioned, messages that emphasize staying positive can invalidate the very real pain, fear, and anger that AYAs experience. I create space for the full range of emotions, reinforcing that distress does not negate resilience. 

Storytelling is another powerful tool. Many young adults hesitate to share their experience, fearing they will burden others or cause discomfort. In therapy, I invite them to begin by sharing their story with me. This often becomes a first step toward reclaiming their narrative and, when appropriate, sharing it more broadly in ways that feel safe and empowering. 

Reinvention is also a central theme. Survivorship often requires individuals to reimagine their identity, values, and goals. Rather than rushing this process, I encourage small, manageable steps—exploring interests, reconnecting socially, or redefining what fulfillment looks like. Building community is essential, but I approach this carefully. Many AYAs experience appointment fatigue and may feel overwhelmed by structured support groups. Some also absorb others’ stories deeply, which can increase distress. I work collaboratively to identify support systems that feel sustainable and aligned with their needs. 

When addressing concerns such as infertility or family planning, I provide psychoeducation while also holding space for the emotional complexity these topics carry. Similarly, when working through career or financial stressors, I integrate problem-solving with emotional processing, recognizing that these challenges are both practical and deeply personal. 

Resources can play an important role in survivorship, though they must be tailored to the individual. I often encourage patients to explore AYA-specific organizations, peer mentorship opportunities, and survivorship programs that address both medical and psychosocial needs, while emphasizing that participation should never feel obligatory. Rather than pressuring patients to engage, I encourage them to explore what resonates and to notice which spaces feel supportive versus overwhelming. I also remind patients that meaningful connection can exist outside of cancer-specific communities, through interests and identities unrelated to their diagnosis.    

Ultimately, the foundation of my approach is relational. My goal is to meet each individual exactly where they are, without expectation or agenda. Survivorship is not linear, and there is no “right” way to move forward after cancer. By creating a space that prioritizes authenticity, flexibility, and compassion, I aim to support AYAs as they navigate the ongoing, often complex process of rebuilding their lives. 

References 

National Cancer Institute. (n.d.). Adolescents and young adults with cancer. Surveillance, Epidemiology, and End Results (SEER) Program. https://seer.cancer.gov/statfacts/html/aya.html 

American Cancer Society. (n.d.). Cancer facts & statistics. https://www.cancer.org/research/cancer-facts-statistics.html 

What’s Your Grief. (n.d.). About us. https://whatsyourgrief.com/about-us/