Navigating Cancer in Your 20s and 30s: Emotional Support for Young Adults

As cancer diagnoses continue to rise among younger adults, increasing attention is being placed on the emotional and psychosocial impact of the disease, according to Anjali Albanese, an oncology social worker at Fox Chase Cancer Center. Beyond the physical toll of treatment, younger patients frequently face disruptions to their sense of identity, relationships, and future plans, leading to challenges such as isolation, anxiety, and grief.

These issues were a central focus during the NCCN Annual Conference session on supporting younger adults across the care continuum. Following the discussion, CURE sat down with Albanese, where she shares insights into the emotional complexities younger adults face after a cancer diagnosis.

CURE: From a psychosocial perspective, what are the biggest emotional challenges young adults face after a cancer diagnosis?

Albanese: I always find that question so interesting because there are so many. When you think about more of the common emotional challenges, I would say loss of control is huge; loss of the ability to sort of plan your future, plan your life, or plan your schedule. Suddenly you're inundated with doctor's appointments, medical treatments, and side effects of treatments. It becomes difficult to figure out, "How do I feel like myself and get to live my life while I'm also dealing with this cancer diagnosis?"

People talk about isolation, feeling like they are out of sync with their peers. They don't know how to connect with their friends; the things their friends are worried about and talking about just feel so distant or so far removed from where they are. People say things like, "I just don't know how to... I feel like I don't know how to talk to people anymore."

It's like, physically, they're still the same person, but mentally and emotionally they've been pushed into adulthood. So, you know, social gatherings, dating, all that kind of stuff; it's so loaded for them that nothing just feels light and fun. Everything feels like it comes with five other things right behind it.

People often talk about, too, the anxiety that they feel because now they're thinking about their mortality at an age when you're not really supposed to be thinking about that. They talk about depression, just feeling like everybody else is leaving them behind and doing things that they would rather be doing, but they didn't get a choice.

The big one for me that I see a lot, though people don't often describe it this way, is grief. Because I think as a society, when we think about grief, we think about the loss of a person. When you say, "I'm grieving," people think, "Oh, well, who died? Who did you lose?" But in essence, they lost the person that they were before that diagnosis happened. I think that we don't really do people favors when we think about grief and only incorporate it as the loss of a person, because they're grieving little losses all along the way.

Grief really can complicate, emotionally, how this experience gets played out for them.

How can care teams better integrate mental health and social support into routine oncology?

The key for that is to reduce the stigma, just make it part of, "Hey, you're here. You have cancer. Let's take care of you as a whole person." Because I think when people feel like they're being singled out, then they start wondering, "Did I say something that made the doctor think I needed a social worker? Did I act a certain way?" Suddenly it's not a supportive thing; it's a judgment thing.

When physicians bring us in early on, because the whole purpose that person is there for is the doctor, right? They're walking in with all their hopes and dreams and it's basically, "Fix me." So, for that doctor, that's a lot, and there are so many things they have to try and incorporate in that visit that it's nice when they pull us in. Then it takes a little bit of the burden or the onus off of them to give us the opportunity to do more of that mental health psychosocial screening and then figure out as a team how we can best support them. No one person can take on one person's complete care; it really takes a team approach.

What barriers might prevent younger patients from accessing support services, and how can they be addressed?

A lot of times, barriers are time. They want to have time to talk to somebody or participate in a support group, but they're trying to balance family, work, or school along with a cancer diagnosis. For some people, like I said, it's the stigma — like, "I don't need that. I'm fine. I'm doing okay. I have a great support system." But I think what people forget is they tend to protect the people that they love, and so by not saying how they're thinking and feeling, or not feeling like they have permission to be raw with their emotions, they're holding so much in. And then you see that kind of play out later on.

Feelings are a lot. I always use the analogy of plumbing: it's like when you have a leak with water, that water is going to come out one way or another. If it's being redirected, it's coming out. It's easier if you kind of fix it or address it early on because, if not, it's just going to come out when you least expect it and at a very inopportune time.

How do relationships, including dating and even family dynamics, shift for younger patients during treatment in a way that older adults with cancer might not experience?

It has a lot to do with the timing in their life when this cancer is entering their world. Dating is hard no matter how old you are, but it's even more complicated when people want to have fun and go out. That social aspect of dating is such a huge part, and now suddenly it's like, "Well, I can't go out. I can't be in a crowded space because I'm on active treatment," or my energy is super low, or smells make me nauseous. It's like, how do you still have that normal dating life?

Plus, not to mention that's a lot for that other person to sort of take on, because now they're choosing to love you, they're choosing to be a part of this experience with you, but they're now worrying with you, they're now thinking about things with you, and they're making adjustments in their own life that are challenging.

Then I think for families, especially when it's a parent whose child has been diagnosed, it's so hard. As a parent, I would imagine it's hard not to want to baby them, right? You want to fix it as a parent; you want to make it okay. But yet, you have to be respectful that they're an individual. They want autonomy. They want the ability to make their own decisions because this is their body and their life.

As a parent, you just want to fix it; you want to jump in there and say, "Okay, this is what we're going to do. Here's the plan." And that may not be what they need or want in that moment. So, it's sort of walking that fine line of, "How can I respect who you are as a person while still being involved and being able to care for you and provide support?"

What advice would you have for patients advocating for their own emotional and social needs?

I would say, don't stop putting your emotional and mental health needs on the same forefront as your physical needs. Remember that all is part of who you are as a person. Your physical, mental, and emotional health make us who we are.

When advocating, realize you should advocate the same way you would to make sure you were getting the best care that you could get, seeing the best doctors that you could see and staying on top of all the new advancements in treatment. Make sure you put that same energy and focus into addressing your mental health and your emotional health, because they're both equally as important as your physical health. It's so important.
Transcript has been edited for clarity and conciseness.

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