Unmet psychosocial needs in AYAs cancer patients: A multilevel analysis of socioecological determinants

While advances in cancer treatment have significantly improved survival rates, mounting evidence indicates a parallel rise in unmet psychosocial needs among adolescent and young adult (AYA, 15–39 years) patients. Analyzing SEER-Medicare linked data (2000–2022) and national health surveys, this multilevel study reveals that 36.7% of AYAs exhibit clinically significant psychological distress. Three-level hierarchical modeling identifies critical socioecological determinants: At the community level, poverty rate and mental health provider shortages amplify economic toxicity; household-level financial strain mediates depression risk; and individual-level maladaptive coping strategies triple anxiety likelihood. Some employed survivors report workplace discrimination, correlating with delayed return to work. And the experience of pathological guilt over familial caregiving burdens exacerbates social withdrawal. By bridging biomedical and social determinants, this research calls on people in society to pay more attention to the psychological needs of cancer patients.