The Landscape of Adolescent and Young-Adult (AYA) Survivorship: A Case Report and Narrative Review of Legislation, Research and Gaps in AYA Survivorship in the U.S.

Hematologic malignancies are the most common cancers of childhood, comprising 28% of pediatric cancers. Decades of therapeutic innovation have led to survival rates of greater than 90% for this condition. However, high-dose chemotherapy can carry significant immediate and delayed toxicities. Adolescents and young-adults (AYA) from ages 15-39 are particularly vulnerable for treatment-related toxicities. This is amplified by gaps in care provision for adolescent patients and fragmentation within the U.S. insurance system. This review explores contributors to this vulnerable period for AYA patients and major milestones for the AYA survivorship movement. Our review also highlights a case vignette of a leukemia AYA survivor that faced a near-lethal complication of his chemotherapy a decade after remission. Our review supports ongoing research on AYA cancer survivorship and efforts to standardize the management for this uniquely underserved population.