Global disparities in supportive and survivorship care among adolescent and young adult cancer patients.

PURPOSE OF REVIEW: Adolescents and young adults (AYAs) with cancer are a vulnerable population affected by disparities in survivorship care access. These disparities are pronounced in low- and middle-income countries (LMICs) but exist even within high-income settings, affecting vulnerable and underserved groups. This expert review explores disparities in fertility preservation, psychosocial health, nutritional care, cardiovascular health, and secondary malignancies of AYA survivorship.

RECENT FINDINGS: Fertility preservation services are often inaccessible due to high costs, limited provider training and knowledge, cultural stigma, and urban-centric availability, especially in LMICs. Psychosocial distress is widespread, exacerbated by structural barriers, stigma, and mental health service scarcity. Nutritional disparities lead to malnutrition and obesity, with food insecurity and limited access to high-quality diets affecting treatment outcomes. Cardiovascular complications, including physical inactivity, are usually under-monitored, despite growing recognition of exercise as an essential part of survivorship. Approaches to standardize the monitoring of secondary malignancies are needed.

SUMMARY: These gaps reflect broader disparities, including limited infrastructure, lack of provider training, and absence of culturally tailored care models. Global organizations such as the Multinational Association of Supportive Care in Cancer (MASCC) can support the integration of resource-adapted, patient-centered supportive care guidelines into existing health systems. Addressing the complex and interrelated barriers faced by AYA survivors can improve survivorship outcomes and promote more equitable access to high-quality care.