Advance Care Planning for Adolescents and Young Adults with Cancer: A Clinical Review

Adolescents and young adults (AYAs) diagnosed with cancer experience unique psychosocial distress and worse clinical outcomes compared to their younger and older peers. Additionally, the developmental emergence of identity and independence for AYAs—and the effects of oncology therapy on these milestones—adds complexity to communication and medical decision-making among patients and families. Given these circumstances, AYAs require thoughtful approaches for advance care planning (ACP). In many cases, specialty palliative care (SPC) teams can provide an extra layer of support to both patients and families as well as primary oncology teams in navigating ACP and ensuring goal-concordant care. While some adult studies have recently questioned the effectiveness of standard ACP methods, other new investigations specifically in the AYA cancer population have demonstrated multifaceted benefits. With the understudied nature of both ACP techniques and the AYA population in general and the constant evolution of communication preferences in the digital technology era, pediatric oncology clinicians may be unsure of current best practices for how to guide their older patients during conversations about their illness. We aim to review the most recent evidence regarding ACP for AYAs with cancer, with an emphasis on describing practical bedside tools and the advantages of collaborating with SPC teams to promote optimal outcomes.