Distress in Adolescent and Young Adult Patients with Cancer: Age- and Gender-Related Differences in a Retrospective Screening Study

BACKGROUND: Adolescent and young adult (AYA) patients with cancer frequently experience psychosocial distress, yet age- and gender-related differences in distress in routine care are not fully understood. PURPOSE: To examine age- and gender-related differences in distress and specific psychosocial concerns among AYA patients with cancer using routine distress screening. METHODS: This retrospective single-center study included AYA patients aged 15-39 years who completed distress screening with the Distress Thermometer (DT) and problem checklist prior to first-line cancer treatment. Clinically significant distress was defined as DT ≥ 4 based on NCCN guidelines and institutional practice. Distress levels and checklist items were compared across age groups (teens, 20s, 30s), gender, cancer stage, and time from diagnosis to screening. RESULTS: Among 213 patients, clinically significant distress (DT ≥ 4) was more frequent among teenage males than among males in their 30s. Female patients reported more emotional concerns across all ages, while fertility-related concerns were reported by both males and females. Financial concerns, reflecting financial toxicity, were most common among patients in their 30s and those with advanced-stage disease. A shorter interval between diagnosis and screening was associated with higher distress levels. CONCLUSIONS: Using the standard DT cutoff of ≥4, distress among AYA patients with cancer varied significantly by age and gender. Teenage males represented a particularly vulnerable group with elevated distress at diagnosis, while financial toxicity was a major concern among patients in their 30s. These findings emphasize the need for early, age- and gender-tailored psychosocial screening and support in AYA oncology care.