October 12, 2020

Quality of Life in the Adolescent and Young Adult Oncology Population

Despite psychosocial challenges, quality of life in AYAs is similar to older adults undergoing blood and marrow transplantation


By Seth Rotz, MD


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Blood and marrow transplantation (BMT) is a potentially curative treatment for adolescent and young adults (AYA) with hematologic cancers. However AYAs undergoing BMT are susceptible to many age-specific psychosocial factors that may impact transplant outcomes and quality of life (QOL).1

Psychosocial challenges of early adulthood intensified by hematologic cancer

Although outcomes for AYAs undergoing BMT have improved in recent years, they remain inferior to younger children.2 Inferior outcomes may be due to disease or host biology, behavioral differences, and/or treatment settings and available support.2

Several psychosocial challenges unique to AYA patients have been postulated to impact outcomes. AYAs may have significant disruption to education plans, and unemployment during and after treatment is common. Unemployment and underemployment challenges coupled with the high cost of medical care can lead to financial toxicity.


Psychosocial challenges include disruption of normal life-stage processes, such as forming peer and romantic relationships, exploring autonomy, initiating sexual exploration, completing education, establishing careers and raising families.3,4 Adolescence and young adulthood is also a time frame when several psychological conditions develop, such as anxiety, depression, panic and mood disorders.5

Study suggests QOL not severely impaired

With these psychosocial challenges in mind, we aimed to determine if AYAs have inferior QOL before and after allogeneic BMT compared to other adults.6 Additionally, we were interested in whether or not pre-hematopoietic cell transplantation QOL for AYA transplant recipients changed over time.

QOL data were collected prospectively before and after transplant on 431 recipients age 15-60 from 2003-2017 using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) questionnaire. Interestingly, QOL did not differ among younger AYA, older AYA or older adults at any time in the first year after allogeneic BMT for total scores or for any of the individual domains of the FACT-BMT assessment. Further, from 2003-2017, AYA allogeneic recipients experienced modest improvement in total FACT score, suggesting improvements in QOL. Together these data suggest that despite unique challenges for AYA BMT patients QOL is not severely impaired compared to older adults, and QOL has improved for this population in more recent years.



  1. Husson O, Huijgens PC, van der Graaf WTA. Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies. Blood. 2018;132(4):385-392.
  2. Mehta PA, Rotz SJ, Majhail NS. Unique challenges of hematopoietic cell transplantation in adolescent and young adults with hematologic malignancies. Biol Blood Marrow Transplant. 2018;24(12):e11-e19.
  3. Zebrack B, Isaacson S. Psychosocial care of adolescent and young adult patients with cancer and survivors. J Clin Oncol. 2012;30(11):1221-1226.
  4. Docherty SL, Kayle M, Maslow GR, Santacroce SJ. the adolescent and young adult with cancer: a developmental life course perspective. Semin Oncol Nurs. 2015;31(3):186-196.
  5. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359-364.
  6. Mathanda RR, Hamilton BK, Rybicki L, Advani AS, Colver A, Dabney J, Ferraro C, Hanna R, Kalaycio M, Lawrence C, McLellan L, Sobecks R, Majhail NS, Rotz SJ. Quality-of-life trajectories in adolescent and young adult versus older adult allogeneic hematopoietic cell transplantation recipients. Biol Blood Marrow Transplant. 2020 Aug;26(8):1505-1510.

About the author

Dr. Rotz is Assistant Professor of Pediatrics at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

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