Patterns of Distress and Symptom Burden Among Female Adolescent and Young Adult Survivors of Breast and Gynecological Cancers.

BACKGROUND

Patient-reported outcome measures can improve symptom management, but age-specific adaptations for adolescent and young adult (AYA) cancer survivors remain limited.

OBJECTIVE

We examined real-world distress prevalence and symptom burden patterns among AYA survivors within the first 3 years of survivorship compared with older adults.

METHODS

We conducted a secondary analysis of routine outpatient distress screening data in Singapore. Female breast and gynecological cancer survivors who completed the Distress Thermometer and Problem List between September 16, 2019, and September 30, 2021, were included and stratified into AYAs (15-39 years) and adults (≥40 years). Clinically significant distress (score ≥4) and problem prevalence were compared using χ 2 tests, and symptom burden profiles were identified using latent class analysis.

RESULTS

Among 1338 survivors, 90 (6.7%) were AYAs. The prevalence of clinically significant distress was similar between AYAs and adults (42.2% vs 39.6%, P =.621), but AYAs more frequently reported emotional problems (56.7% vs 38.9%, P =.001), work/school concerns (13.3% vs 4.1%, P <.001), caregiving responsibilities (11.1% vs 4.7%, P =.007), fertility issues (13.3% vs 0.1%, P <.001), and sexual health concerns (6.7% vs 1.0%, P <.001). AYAs were overrepresented in moderate (48.9% vs 42.4%) and high (10.0% vs 5.3%) symptom burden profiles ( P =.045).

CONCLUSION

AYA breast and gynecological cancer survivors experience distinct emotional and practical challenges and higher symptom burden than older survivors.

IMPLICATIONS FOR PRACTICE: Incorporating age-tailored screening items and training clinicians to interpret results through an age-sensitive lens may strengthen AYA survivorship care.