Genomic distinctions in adolescent and young adult cancer: A comprehensive review.

Purpose: Data are lacking on the distribution, factors associated with, and long-term impact of diminished health-related quality of life (HRQoL) at diagnosis in adolescent and young adult (AYA) cancer survivors (≥2 years post cancer diagnosis). Our goal was to fill this gap in knowledge. Methods: A cohort of AYA (15y - 39y) cancer patients treated at MD Anderson between 2000-2016 who had survived at least 2 y was identified from our Institutional Tumor Registry. HRQoL was assessed at diagnosis with the SF12v1 questionnaire. Demographic and behavioral risk factors, tumor type, and vital status were ascertained. Physical composite summary (PCS) and mental composite summary (MCS) scores were generated from SF12 responses following mean-based normalization; PCS or MCS < 50 indicated “poor” HRQoL. Statistical tests included ANOVA, quantile regression, and multivariable Cox proportional hazards. Results: 2,609 AYA cancer survivors (75% diagnosed between age of 26-39 y; 67% White, 18% Hispanic and 9% Black) were included. Breast cancer was the most frequent diagnosis (25%), followed by sarcoma (12%) and Hodgkin lymphoma (10%). Median follow-up for participants was 10.5 y. Overall mean PCS and MCS scores at diagnosis were 45.3 (SD: 11.4) and 47.0 (SD: 10.5), respectively. Female AYA cancer patients had significantly higher PCS, yet lower MCS compared to their male counterparts (both P<0.001). A positive association between age at diagnosis and PCS was observed (P<0.001), in contrast to the inverse association with MCS (P<0.001). Differences in PCS (P<0.001) and MCS (P=0.001) were also evident by tumor type. For example, women with breast cancer reported the most favorable PCS (51.5) at diagnosis, yet among the lowest MCS (46.1) of the nine tumor types analyzed. The Black AYA population had a larger burden of poor PCS at diagnosis with 61% of patients reporting scores <50 compared to 55% of Hispanic and 51% of non-Hispanic whites. Significant predictors of diminished PCS in AYA cancer survivors in the bottom 25% of PCS scores were younger age at diagnosis (P=0.003), male gender (P<0.001), diagnosis of a hematologic malignancy versus solid tumor (P<0.001), smoking (P=0.003) and not consuming any alcohol currently (P<0.001). Overall, low PCS (<50) at diagnosis (HR=1.57, P<0.001), and diagnosis of a solid tumor compared to a hematologic malignancy (HR=2.33, P<0.001) were associated with lower survival. Conclusions: In this large, diverse AYA cancer survivor cohort, physical and mental HRQoL at diagnosis were impacted by AYA’s age at diagnosis, gender, tumor type, and smoking status. Low PCS at diagnosis was an independent predictor of diminished survival among AYA cancer survivors ≥2y post diagnosis. Our findings suggest that patient-reported poor physical well-being at diagnosis is a biomarker of poor prognosis for AYA cancers. Further studies are needed to identify interventions to improve outcomes for this population. Citation Format: Goldy C. George, Clark R. Andersen, Xiaohui Tang, John A. Livingston, Michael E. Roth, Michelle A. Hildebrandt. Health-related quality of life at diagnosis in survivors of adolescent and young adult cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1997.

ObjectiveTo evaluate the burden and trends of digestive system cancers in adolescents and young adults (AYAs) globally between 1990 and 2021.MethodsData were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (1990–2021). We analyzed global, regional, and national disease burdens by calculating the age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) for AYAs. Joinpoint regression calculate the average annual percentage change (AAPC) in incidence, mortality, and DALYs for digestive system cancers in the AYAs. Decomposition analysis illustrate the impact of epidemiological changes, population growth, and population aging on the disease burden.ResultsGlobally, the ASIR (AAPC: 0.37) of AYAs with colorectal cancer (CRC) showed an increasing trend, whereas the ASIR of AYAs with esophageal cancer (EC), gastric cancer (GC), pancreatic cancer (PC), and liver cancer (LC) showed a decreasing trend. The ASMR and age-standardized rates (ASR) of DALYs for all five types of digestive system cancers in AYAs also showed a decreasing trend. By gender, the ASIR for males has increased with an AAPC of 0.84. For the other four types of digestive system cancers in AYAs, both males and females showed a decreasing trend. For AYAs with CRC, the fastest increase in ASIR (AAPC: 0.73) was observed in the 30–34 age group. Regarding SDI regions, we found that the ASIR of AYAs with CRC increased in all five Social Demographic Index (SDI) regions. For AYAs with PC, the burden was increased in low and low-middle SDI. In the AYAs with LC, the ASIR also increased in low-middle SDI. For AYAs with EC and GC, both showed a decreasing trend across all five SDI regions.ConclusionThe study results provide insights into the global distribution and severity of the burden of digestive system cancers among AYAs. The burden of AYAs with CRC is rapidly increasing worldwide, particularly among males, those aged 30–34, and in high-middle SDI. The disease burden varies across different SDI regions. These findings highlight the need for targeted preventive measures and suggest adjusting CRC screening guidelines.

Adolescent and young adult (AYA) patients with cancer have not attained the same improvements in overall survival as either younger children or older adults. One possible reason for this disparity may be that the AYA cancers exhibit unique biologic characteristics, resulting in differences in clinical and treatment resistance behaviors. This report from the biologic component of the jointly sponsored National Cancer Institute and LiveStrong Foundation workshop entitled "Next Steps in Adolescent and Young Adult Oncology" summarizes the current status of biologic and translational research progress for 5 AYA cancers; colorectal cancer breast cancer, acute lymphoblastic leukemia, melanoma, and sarcoma. Conclusions from this meeting included the need for basic biologic, genomic, and model development for AYA cancers as well as translational research studies to elucidate any fundamental differences between pediatric, AYA, and adult cancers. The biologic questions for future research are whether there are mutational or signaling pathway differences (for example, between adult and AYA colorectal cancer) that can be clinically exploited to develop novel therapies for treating AYA cancers and to develop companion diagnostics.

Cancer in adolescents and young adults (AYA) represents a higher fraction of all cancer in countries that are still undergoing a demographic transition. Such countries tend to have much younger populations, and therefore unless they have a particularly low incidence of cancer in this age group, will have a higher burden of cancer (absolute number of cases with cancer) in AYA. Cancers in AYA are comprised of the tail end of the incidence curve of cancers that have their peak incidence, or occur almost exclusively in childhood, the beginning of the incidence curve of cancers that primarily affect the elderly, and a third set of cancers that have their peak incidence (or are at least common) in the AYA age group (e.g., testicular cancer, sarcomas, melanoma, thyroid cancer). Many, but not all, of these cancers require radiation or cancer surgery, but the poorest countries do not have a sufficient number of radiation therapy units and surgical oncologists, or indeed medical and pediatric oncologists, to deal with the burden of cancer they face. The AYA age group is particularly important, both with regard to their contribution to the economy now and in the future (the majority are in the "working" age-group defined as 15-64 years), as well as their important role in caring for their families. Moreover, some of these cancers are eminently curable with chemotherapy alone, and more could be cured by simply improving the efficiency of existing health services and providing education and training to both the public as well as oncologists and other specialists required for the care of AYA (although such individuals will not necessarily be exclusively concerned with this age group). Of particular importance is the detection and diagnosis of cancer patients at the earliest possible time in the course of their disease. Avoiding delays in initiating therapy, which are partly due to the poverty and lack of education of the public as well as to a failure on the part of primary health care providers to recognize the possibility of cancer, would lead not only to improved survival and less toxicity, but is likely to reduce the need for radiation as well as the cost of treatment. There are few good quality clinical trials that take place in the LMIC (in relationship to the extent of the existing cancer burden), and research training should be an integral component of capacity building. Research on the efficacy and toxicity of standardized treatment approaches that are either based on principles established in the HIC, or adapted from treatment protocols used in the HIC, would be a good place to begin, but health policy and multisectoral collaboration are essential if improved survival rates are to be achieved. Decisions will also need to be made regarding the treatment of diseases in which radiation or cancer surgery are important elements, when one or both of the latter are unavailable. Late effects are important in this young population in HIC, and protocol adaptations or design in LMIC should take into consideration the significant fraction of cured patients with late effects who were treated in HIC in an era where improving response and survival rates was the paramount consideration-the situation that applies today in less developed countries. Special adolescent units which better deal with psychological issues of young cancer patients are rare in LMIC and the psychosocial issues faced by adolescents are much less studied. Although survival is the first consideration, attention to psychosocial and financial issues may reduce existing delays in initiating therapy and also the fraction of patients that abandon therapy.

Background and aimsDigestive tract cancers, encompassing esophageal, stomach, colorectal cancers, account for about 20% of all cancer cases worldwide. This study seeks to examine the global epidemiological trends of these cancers in adolescents and young adults (AYA) from 1990 to 2021, as well as the related risk factors, to offer valuable insights for the formulation of health policies and the efficient distribution of public health resources.MethodsData from the Global Burden of Disease 2021 (GBD 2021) were utilized to conduct a comprehensive assessment of the global incidence, death, and disability-adjusted life years (DALYs) of digestive tract cancers within the AYA population. The correlation between cancer burden and socioeconomic development was examined by Socio-Demographic Index (SDI) regions. Use comparative risk assessment from GBD to evaluate risk factors for cancer deaths and DALYs. Assess incidence trends with BAPC model.ResultsThe global burden of digestive tract cancer increased at different rates from 1990 to 2021. In 2021, colorectal cancer in AYA accounted for 70,201 incidences, 26,222 deaths, and 1,538,837 DALYs worldwide. In contrast, esophageal and stomach cancer had lower burdens in 8,164 and 42,039 incidences, respectively. While the incidence and death rates of esophageal and stomach cancers have declined, colorectal cancer have shown a significant increase in AYA. The age-standardized incidence rate (ASIR) of colorectal cancer correlates positively with SDI. In AYA, level 2 risk factors for colorectal cancer include alcohol use, dietary risks, high body mass index, high fasting plasma glucose, low physical activity, and tobacco. For esophageal cancer, the risk factors are alcohol use, dietary risks, and tobacco, and for stomach are dietary risks and tobacco. By 2040, the ASIR of the three digestive tract cancers in AYA will all decrease according to the BAPC model prediction.ConclusionThe study of digestive tract cancers in AYA serves to identify risk factors within the realm of public health, facilitate the rational allocation of medical resources. Moreover, it can attend to the physical and mental health requirements of AYA individuals and enhance the cognitive framework regarding cancer.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14880-9.

A need to examine survival trends of individual cancers in older adolescents and young adults (AYAs) is prompted by overall survival trends that have indicated a lack of progress in survival improvement for AYAs compared with both younger and older cancer patients. The most recent Surveillance, Epidemiology and End Results (SEER) data were used to ascertain survival trends of the 24 most frequent cancers in AYAs. Of the 20 types of cancers in 15- to 39-year-olds evaluable for survival rate trends, only eight had evidence for a statistically significant improvement in their age-adjusted 5-year survival rate since 1985. As of 2000-2007, of the 24 most common types of cancer in American AYAs, nine had an age-adjusted 5-year survival rate in excess of 80% and eight had a survival rate below 60%. In 19 of 21 cancers for which a comparison of survival by gender is feasible, AYA males had a worse survival rate than females. Of the 23 types of cancer that are classifiable as distant disease, 13 had 5-year survival rates of less than 30%. While some progress has been made, the lack of improvement for some cancers with distant disease is disappointing. Increased survival of AYA cancer patients offers significant societal gains in terms of years of productivity compared to older adults. If the potential long-term economic impact of health in AYAs is considered, the need to improve the survival of AYAs with cancer is obvious.

The development of adolescent and young adult (AYA) oncology as a burgeoning discipline that is now into its own adolescence may be best illustrated by the surge in AYA oncology publications in peer-reviewed journals during the past three years. Prior to 2007, the number of articles identified by the search term ‘‘adolescents young adults cancer’’ in the PubMed database ranged from 129 to 381 per year. Since then, the number increased to 598 in 2007, 1971 in 2008, and 4045 in 2009. The dramatic increase is still well short of the 7000–7500 articles per year that the ‘‘children cancer’’ search term identifies, especially when one considers that the number of cancer patients in the AYA age group is four to six times greater, depending on what age range is used for the AYA group. Nonetheless, the change in publication rate of AYA cancer reports and reviews is striking testimony of need and partial success. To understand the history that led to this revolution, several of its pioneers in England, the United States, and Canada were convened for a roundtable discussion to offer their recall. As described below, the original seed appears to have been sowed in England, thanks to Ian Lewis and London’s Teenage Cancer Trust. A root took hold a decade later when national statistics in the United States showed a survival progress gap that was analogized to the famous London Tube gap between the platform and the Underground train. The stems that then broke ground were conferences, organizations, hospital and outpatient programs, scientific reviews, and international collaborations. The participants in this Roundtable undoubtedly neglected many other events along the way, but they are all appreciative of the emerging buds and blossoms of AYA oncology. Most of all, they sense that AYAs around the world will ultimately truly benefit in improved prevention, early detection, and treatment of cancer during the prime of their lives.

e19116 Background: Mental distress is associated with poor treatment adherence and adverse psychosocial outcomes, and cancer survivors, especially adolescent and young adults (AYA), may experience greater distress than older adults and the general population. We tested this hypothesis by examining the association between AYA vs. adult cancer survivors vs. the general population without a history of cancer, and mental distress. Methods: Using the 2014-2017 National Health Interview Surveys, 2,516 AYA cancer survivors (aged 15 – 39 years) were identified. We then used propensity score matching (matched on sociodemographics, comorbidities, smoking status and visit to mental health professional in past year) to create 2,516 older cancer survivors (aged ≥ 40 years); and 2,516 adults without cancer (general population) as the comparison groups. Mental distress (outcome of interest) was measured using the validated Kessler nonspecific mental/psychological distress (K6) scale. The 6-item K6 scale examines how frequently within the past 30 days an individual felt nervous, hopeless, restless or fidgety, worthless, sad, and that everything was an effort. Responses were summed to yield a score ranging between 0 and 24 and classified as none/low (0≤K6 < 5), moderate (5≤K6 < 13), and severe (K6≥13) mental distress. Two separate weighted multinomial logistic regression models estimated the odds of mental distress in study population (AYA vs. adult cancer survivors; and AYA vs. general population), adjusting for known covariates. Results: Mental distress was more prevalent among AYAs than adult cancer survivors (moderate: 24.0% vs 18.3%; and severe: 5.7% vs 4.2% [ P= .0002]); and the general population (moderate: 24.3% vs 16.7%; and severe: 6.1% vs 5.3% [ P< .0001]). Similarly, prevalence was higher among adult cancer survivors than the general population (moderate: 16.8% vs 13.6%; and severe: 3.2% vs 2.7% [ P= .0002]). In the multivariable multinomial analyses, AYAs had greater odds of mental distress (aORmoderate = 1.44; 95% CI 1.09, 1.89; and aORsevere = 1.77; 95% CI 1.21, 2.58) vs. adult cancer survivors. AYAs also had greater odds of mental distress vs. the general population (aORmoderate = 1.39; 95% CI 1.08, 1.79), but no significant difference in severe distress. Conclusions: About 1-in-4 AYA cancer survivors report some mental distress, and distress is more prevalent among this younger age group than older adults with cancer and the general population. Psychosocial care may be especially needed in this younger population to mitigate adverse psychosocial outcomes.

11104 Background: Research addressing the supportive care needs of diverse adolescent and young adult (AYA) cancer survivors remains underdeveloped relative to younger and older cancer survivor populations. Given their distinct developmental, psychosocial, and healthcare challenges, it is critical to characterize the unmet supportive care needs (USCN) specific to AYAs. This study aimed to compare self-reported USCN between AYA and older (>39 years old) cancer survivors to identify age-specific gaps in care and opportunities to improve outcomes. Methods: Between October 2019 and October 2024, 20,520 cancer survivors (n=1,287 AYA and n=19,233 non-AYA) at Sylvester Comprehensive Cancer Center completed the My Wellness Check (MWC) questionnaire. MWC is fully integrated and scored in real-time in the electronic health record, and evaluates 16 domains of supportive care needs (e.g., stress management, financial concerns, informational resources, transportation) alongside patient-reported outcomes (PROs; PROMIS measures of pain interference, fatigue, physical function, anxiety, and depression) and health-related quality of life (HRQOL; FACT-G7). Sociodemographic and clinical characteristics and the prevalence of USCNs were compared between AYA and other cancer survivors using chi-square and t-tests. Results: The AYA group had a higher proportion of females (64% vs. 51%), non-White (20% vs. 14%), Hispanic (56% vs. 44%), uninsured (4% vs. 3%), and unpartnered individuals (59% vs. 34%) compared to non-AYAs (all p s < 0.01). Across both groups, the most frequently reported USCNs were general cancer education (11%), coping with a cancer diagnosis (11%), and financial concerns (9%). AYAs were more likely to report at least one USCN compared to non-AYA survivors (33% vs. 28%). AYAs were also more likely to endorse needs related to coping with a cancer diagnosis (14% vs. 11%), financial concerns (12% vs. 9%), work-related issues (6% vs. 3%), oncofertility (10% vs. 1%), and childcare (3% vs. 0.5%) (all p s < 0.001). No significant differences were observed for other USCN, including transportation, housing, family problems, sexual health, spiritual concerns, access to medicines, and advance directives. Conclusions: While both AYA and non-AYA cancer survivors face substantial unmet supportive care needs, AYAs exhibit additional challenges, particularly in areas such as financial concerns, work-related issues, fertility preservation, and childcare. These findings align with prior research while uniquely emphasizing the unmet needs of a more ethnically diverse population. This study underscores the urgent need for targeted assessments and interventions to address the unique supportive care needs of AYA cancer survivors, ensuring equitable and age-appropriate survivorship care.

Simple SummaryThe internet has become an important health information source for patients with cancer. AYAs (adolescents and young adults; 18–39 years at time of diagnosis) can be considered as digital natives; they work with the internet and related technologies in their daily lives. It is likely that AYAs are more used to using the internet, while older cancer patients might prefer former ways of information provision to obtain health-related information. The question arises whether internet use and eHealth needs of AYA cancer patients are comparable to those of older ones. By conducting a cross-sectional survey, we evaluated differences in cancer-related internet patterns between AYAs and older cancer patients (40+ years at time of diagnosis). A better understanding of differences between generations will help inform healthcare providers on how to guide cancer patients of different ages regarding cancer-related internet use.Background: Our aim was to evaluate differences in cancer-related internet patterns between AYAs (adolescents and young adults; 18–39 years at time of diagnosis) and older adult cancer patients (40+ years). Methods: Cross-sectional surveys were distributed among AYA and older adult cancer patients regarding cancer-related internet use and eHealth needs. Results: 299 AYAs (mean age 31.8 years) and 270 older adults (mean age 55.8 years) participated. AYAs searched significantly more often on the internet on a daily basis just before diagnosis (45% vs. 37%), right after diagnosis (71% vs. 62%) and during treatment (65% vs. 59%) compared to older adults. During follow up, there was a trend that AYAs searched less often on the internet compared to older adults (15% vs. 17%). AYAs searched more often on topics, such as alternative or complementary therapies, treatment guidelines, fertility, end of life, sexuality and intimacy, lifestyle and insurance. AYAs felt significantly better informed (75%) after searching for cancer-related information compared to older adults (65%) and had significantly less unmet needs regarding access to their own medical information (22% vs. 47%). AYAs search more on the internet on a daily basis/several times per week in the diagnosis and treatment phase than older cancer patients. They search on different topics than older adults and seems to have less unmet eHealth needs.It is important that these are easy to find and reliable.

Lower birth rates and higher pregnancy loss are observed after childhood cancer. Studies specific to adolescent and young adult (AYA) cancer rarely have information on pregnancies that do not end in live birth, fertility preservation strategies, or detailed cancer treatment information to assess these risks. To address this gap, we examined pregnancy outcomes after cancer in a cohort of 30,020 AYAs with detailed clinical records. We identified 6021 survivors of AYA cancer matched to 23,999 AYAs without cancer enrolled in the Kaiser Permanente California health systems during 2004-2016. Of these, 950 survivors had ≥1 pregnancy during follow-up through 2018. Hazard ratios (HR) and 95% confidence intervals (CI) for pregnancy were estimated using multivariable subdistribution hazard models accounting for competing risks. Relative risks (RR) and 95% CIs for pregnancy loss were calculated with multivariable Poisson regression with generalized estimating equations. Pregnancy was less common after AYA breast (HR = 0.57; 95% CI: 0.50, 0.66) or gynecologic cancer (HR = 0.55; 95% CI: 0.42, 0.73) compared to AYAs without cancer. Among AYAs with cancer, some alkylating and platinum chemotherapy agents, but not gonadotoxic radiation, were associated with a lower likelihood of pregnancy. Use of assisted reproductive technologies was not common, and 69% of pregnancies after AYA cancer resulted in live birth. Pregnancy loss was not statistically significantly elevated for any cancer type. Among survivors, pregnancy loss was more common at older ages, with smoking during pregnancy, and among those who received cyclophosphamide. Our findings inform reproductive counseling and prenatal care for reproductive age cancer survivors.

Approaches to Increasing Clinical Trial Access and Enrollment for Adolescents and Young Adults with Cancer.

PURPOSEThe epidemiology of cancer in adolescents and young adults (AYAs) is distinct and underinvestigated. Therefore, we investigated the incidence of cancer in AYAs in Jordan.PATIENTS AND METHODSWe accessed all records submitted to the Jordan Cancer Registry between 2000 and 2017. We included all patients, age 15-39 years, who were ordinarily resident in Jordan. We then calculated frequencies, age-adjusted incidence rates (AAIRs), and annual percentage changes (APCs) and performed subgroup analyses by biologic sex, age subgroups, and site (SEER AYA site recode/WHO 2008). We also performed site-specific trend analyses using joinpoint models.RESULTSWe identified 14,115 eligible patients, of whom 1,531 (10.8%), 4,278 (30.3%), and 8,306 (58.8%) were 15-19, 20-29, and 30-39 years old at diagnosis, respectively. The numbers of male and female AYAs were 5,792 (41.0%) and 8,323 (59.0%), respectively. The crude number of cases increased from 654 in 2000 to 954 in 2017 (APC, 2.6%). The overall AAIR ranged from 32.3 in 2000 to 24.3 in 2017 (APC, –1.7%). The AAIR was 27.6 over the full study period and was higher in females (34.1) than in males (21.6). Carcinomas, lymphomas, and leukemias were the most common cancers. The incidence rates of the majority of cancers trended downward over the study period.CONCLUSIONThe incidence of cancer in AYAs in Jordan is relatively low and declining. However, the absolute number of cases is increasing because this downtrend does not offset the effect of a high population growth rate; almost a 1,000 cases of cancer are now diagnosed every year, which represents a significant increase in the burden of cancer in a developing country with limited healthcare resources.

e22528 Background: Adolescents and young adults (AYA) who experienced cancer treatment sometimes show posttraumatic stress symptoms (PTSS) and yet report positive psychological changes, known as posttraumatic growth (PTG). Literature suggests PTSS and PTG are not on opposite ends of a single spectrum but rather coexist. It is expected to have distinct relationships with social support, and yet, the roles of peer support remain unknown. This study examines PTG and PTSS, and their correlates with peer support among AYA cancer survivors. Methods: A cross-sectional study was conducted using a questionnaire survey with AYA cancer survivors. A total of 212 AYA survivors were recruited from 11 cancer centers and 12 cancer patients’ communities. They completed a self-report measure of the PTG Inventory and the Impact of Event Scale revised (IES-R) to assess PTSS. Diagnosis, treatment, peer support (i.e., affiliation to AYA patients’ community and friendship with other AYA cancer patients), and social status information was also collected from questionnaires. A series of multiple regression analyses was used to identify significant correlates among peer support, PTG and PTSS. Results: PTG and PTSS were not significantly correlated with each other, being consistent with the previous studies. PTG was positively associated with male gender, years since diagnosis, good communication with others, and friendship with other AYA cancer patients. Friendship with other AYA cancer patients was positively associated with not just the overall PTG but all five domains of PTG. PTSS was associated with years since diagnosis, unemployed status, and symptom of late effects. PTSS was, however, unlike PTG, not related with friendship with other AYA cancer patients or affiliation to AYA patients’ community. Conclusions: Good communication and friendship with other AYA cancer patients is suggested to play an important role in PTG but not PTSS. Psychosocial intervention to facilitate peer support among AYA cancer patients would possibly contribute to revive their lives through PTG. Future studies should further investigate what factors would contribute to alleviation of PTSS and foster PTG. Clinical trial information: UMIN000035439.

229 Background: Adolescent and Young Adult (AYA) cancer survivors experience psychological sequelae, yet causal pathways between AYA cancer, mood disorders, and mental healthcare remain unclear. The 2019 National Health Interview Survey (NHIS) applies the Patient Health Questionnaire-8 item (PHQ8) and Generalized Anxiety Disorder-7 item (GAD7), providing validated evaluation of mental health (MH) in a national sample. We investigated how AYA cancer history affects MH symptoms and MH care utilization. Methods: Descriptive statistics evaluated depression (PHQ8), anxiety (GAD7), use of MH medications, and receipt of psychotherapy in three groups: adults with AYA cancer history, adults with Older Adult (OA) cancer history, and cancer-free adults. Structural Equation Modeling (SEM) was used to estimate cancer survivorship impact on medication use and receipt of therapy (total effects), as well as direct/indirect effects through depression and anxiety (mediated effects). Results: AYA cancer survivors had higher mean PHQ8 (3.64, 2.80, 2.43, p < 0.001) and GAD7 (3.05, 1.90, 2.05, p < 0.001) compared to OA survivors and cancer-free adults. They reported more medication use for MH (24.8%, 21.0%, 15.2%, p < 0.001), and received therapy more often (14.0%, 8.6%, 9.5%, p = 0.001). Total effects models showed AYA survivors were more likely to have received therapy (OR 1.55, 95% CI 1.20-2.00) and to have taken medications (OR 1.84, 95% CI 1.49-2.28) compared to cancer-free adults. Mediated models examined indirect (mediated by MH symptoms) and direct (residual) pathways. All indirect partial paths (regressor to mediator or mediator to outcome) showed large, significant effects (p < 0.001), except for regression of GAD7 on OA survivors. Direct paths showed large, significant effects of AYA and OA survivorship on medication use, but small nonsignificant effects on therapy. Indirect full paths (regressor to outcome through mediators) demonstrated smaller effects than direct pathways, but overall larger effects for AYA survivors than OA survivors. Conclusions: AYA survivors experience worse MH symptoms and are more likely to utilize MH care than OA survivors and cancer-free adults. Effects of cancer survivorship on MH care utilization were mediated through MH symptom severity. Mediated effects were larger for AYA survivors than OA survivors.[Table: see text]