Social Isolation in Japanese Adolescents and Young Adults with Hematologic Malignancies: A Focus on Peer Relationships and Occupational Therapy Implications

PURPOSE: Adolescents and young adults (AYAs) with hematologic malignancies in Japan face unique psychosocial challenges, particularly in maintaining peer relationships. Despite the critical role of peer interactions in this developmental stage, research remains limited. This study aimed to examine the characteristics of social isolation in this population and explore its implications for occupational therapy (OT). METHODS: = 55) and qualitative analysis using Steps for Coding and Theorization (SCAT) of semistructured interviews conducted with five participants. Psychological assessments included the Object Relations Scale, Parent-Child Trust Scale, Multidimensional Empathy Scale, Affiliation Motive Scale, the Japanese version of the PedsQL Cancer Module, and the Cancer Fatigue Scale. Cluster and factor analyses were conducted on quantitative data, and themes were extracted from the interview narratives. RESULTS: Two psychosocial clusters were identified in this study. Cluster 2 exhibited greater difficulties in peer relationships, mental fatigue, and appearance-related issues. Factor analysis revealed two domains: psychosocial burden and physical/cognitive impact. Qualitative data highlighted disruptions in friendships, ambivalence toward illness disclosure, and shifts in relational values. Mixed-methods integration revealed that participants with higher psychosocial and cognitive burdens reported more strained peer experiences. CONCLUSIONS: Peer relationship challenges among AYAs with cancer are shaped by reciprocal social dynamics and not solely by individual vulnerabilities. These findings underscore the need for OT in Japan to expand beyond inpatient physical rehabilitation to include developmentally appropriate community-based psychosocial interventions that support social reintegration.