Unveiling perspectives on the psychosocial impacts of childhood cancer survival on young adult survivors’ reassimilation journey: A qualitative exploration

Abstract

Background

Approximately 82% of children with childhood cancer survive more than five years after diagnosis. Living as a cancer survivor elicits a new reality that can include psychosocial impacts. These psychosocial impacts interact collectively, especially regarding reassimilation, and are rarely explored.

Objective

To explore the psychosocial impacts of surviving childhood cancer and reassimilation back into society in young adult survivors of childhood cancer.

Methodology

Individual in-depth semi-structured interviews were conducted with childhood cancer survivors and explored psychosocial aspects associated with returning to work, school, and social environments after remission. Interpretive phenomenological analysis was conducted once interviews were manually transcribed. A group interview with survivors was held to discuss the study’s findings and interpretation.

Results

Individual interviews and the group interview revealed three major themes: outlook on reassimilating, outlook on coping, and outlook on cancer.

Conclusions

This work is a first step to understanding how survivors’ personal outlook on coping and healthcare system barriers play influential roles in reassimilation following cancer treatment. Survivors expressed the need for reliable survivorship information and improved communication with healthcare providers regarding what to expect, so they could feel prepared for life post-cancer. These aspects need to be explored more deeply through other qualitative studies.

INTRODUCTION

Childhood cancers occur between birth and 14 years, are rare compared to other cancers in humans, and differ from adult cancers in terms of growth, metastasis, treatment, and patient response (Murphy et al., 2013). The most common types of childhood cancers are leukemias, brain and spinal cord tumours, lymphomas, soft tissue sarcomas, and renal tumours (Xie et al., 2018). Surviving childhood cancer is highly probable in high-income countries, and the trajectory of survivorship depends on the cancer type (Bhakta et al., 2017). Although children who live at least five years after their initial diagnosis are considered survivors, challenges extend for them into the rest of their lives, far beyond that benchmark (Welch et al., 2000). Between 60% and 90% of childhood survivors develop one or more chronic health conditions and 20% to 80% experience severe or life-threatening complications during adulthood (Hudson et al., 2013). In most studies, approximately 75% to 80% of survivors do not experience psychological impairments; however, a quarter still experience distress (Brinkman et al., 2018; Norsker et al., 2020).

Aside from physical late effects due to treatment, such as secondary cancers, heart damage, lung damage, infertility, chronic hepatitis, and alterations in growth and development, there are lasting psychosocial effects that survivors face. They are more susceptible than adult survivors to depression, anxiety disorders, posttraumatic stress disorder (PTSD), high rates of stress, lower educational attainment, unemployment, lower household income, risky health behaviours (e.g., increased smoking, alcohol use), and poor health outcomes (e.g., fatigue, sleep disturbances; Bitsko et al., 2016). There is a need to address the psychosocial domain of cancer survivorship for this population, specifically during reassimilation after cancer treatment. Reassimilation is one of the most important challenges faced by young adult cancer survivors and is identified as a priority to address in future survivorship research (Howard et al., 2018). There is a link between reassimilation and the psychosocial impacts of childhood cancer. However, it is not well understood how the context of transitioning from cancer patient to survivor and reassimilation impacts other aspects of their lives (White et al., 2018). The extent to which reassimilating impacts the trajectory of psychosocial development as children develop into young adults is also unclear.

Assimilation is defined as “the process of receiving new facts, or of responding to new situations in conformity with what is already available to consciousness” (Merriam-Webster, n.d.). Survivors are faced with a new reality (responding to a new situation) following treatment and are faced with having to navigate that reality based on their own perspectives (what is already available to consciousness). The research context in this study is exploring reassimilation, which is a subsequent assimilation. In this case, reassimilation is explored and described as the return to life following cancer treatment, which includes navigating school, work, and social relationships. The term ‘transition’ will be used in this paper to describe reassimilation, as a type of reintegration with society where cancer survivors re-establish social norms (e.g., friend groups, go back to school/work, or start relationships that previously were difficult due to being sick or on active treatment).

The primary objective of this study was to explore the trajectory of young adult survivorship in the context of reassimilation by observing the survivors’ outlook about their experience regarding their mental health, relationships, and success on their journey through life. The secondary objectives were to explore the psychosocial impacts of surviving childhood cancer, how intricately these psychosocial impacts were associated with each other, and the internalization of these impacts. Description of such understanding is lacking within the survivorship literature. The research questions are, how do the psychosocial impacts of surviving childhood cancer interact collectively throughout reassimilation, and what is the lasting impact of these interactions in young adults?

METHODOLOGY

Qualitative approach

Interpretive phenomenology focuses on interpretation and deciphers the concept of being in the world (Neubauer et al., 2019). There are few documented evaluations of the psychosocial burdens of surviving childhood cancer, and how they interact collectively throughout the childhood cancer survivor (CCS) experience, particularly within the context of transitioning from cancer patient to survivor and how transition impacts other aspects of life. Interpretive phenomenology moves beyond description, instead seeking out the meanings embedded in everyday occurrences and describing how individuals interpret the contexts of their lived experiences (Neubauer et al., 2019). Interpretive phenomenology has yet to be applied to understanding the transition from childhood cancer patient to survivor, transitioning back into society and dealing with the lasting psychosocial impacts of surviving childhood cancer.

Study population and sampling strategy

This study was approved by the Research Ethics Board at Ontario Tech University. To be included, participants had to be between the ages of 18 and 29 years, be currently in remission (no active cancer treatment) and survived at least five years since their diagnosis. Given that this study relied on recalling, comprehending, and analyzing feelings and experiences to explore the nuances of survivorship, inclusion criteria required survivors to have had a diagnosis of cancer between 5 and 16 years of age. Those who were not Canadian residents or not diagnosed and treated in Canada were excluded.

Criterion and snowball sampling were used through Childhood Cancer Survivor Canada. An announcement was placed on Childhood Cancer Survivor Canada’s Facebook and Instagram pages between November 9, 2021, and June 16, 2022, containing a Google Form link outlining the consent and the main research objective. The projected target for the study’s sample was eight participants, which is appropriate for a study of this kind and in reaching data saturation (Creswell & Poth, 2018). There were nine individuals who consented to participate, of which one pilot-tested the interview guide, one did not meet the study criteria, and three did not respond to follow-up emails.

Data collection

The “Childhood Cancer Continuum” is a conceptual framework based on the “Commission on Social Determinants of Health Framework,” addressing the underlying mechanisms and pathways of social inequities in and after childhood cancer (Erdmann et al., 2019). The conceptual framework of “Interrelated Processes of Managing Impacts and Effects to Achieve/Maintain Quality of Life for Childhood Cancer Survivors” is based on a grounded theory approach describing interrelated processes of coping and environmental supports that survivors used to manage the lasting impacts of cancer (Tsonis et al., 2012). These frameworks informed the interview guide for this study, as they consider the challenges faced by cancer survivors as they transition back to life following treatment. Examples of interview questions include, “Would you mind describing the kind of experience you had with childhood cancer?”, “How did experiencing childhood cancer impact your daily life when you were first diagnosed?”, and “Please tell me about the impact your experience with cancer has had on your mental health.”

The interview guide was piloted for 60 minutes. None of the tested questions required adjustments or modifications. Prompts were used to probe deeper into experiences. Participant characteristics were obtained with brief demographic questions at the start of the interviews. Individual in-depth semi-structured interviews were conducted virtually by author SR and lasted 29 to 63 minutes. Once individual interviews were completed, participants were contacted to participate in a group interview.

The group interview involved participants number 2 and 4 and lasted for approximately 60 minutes. In this group interview, participant quotes and associated interpretations of the individual interview data were presented, at which point participants shared their own thoughts and interpretations of the data. The interpretations offered a method of validation and guided discussion regarding the collected data.

Data analysis

All interviews were transcribed manually from their recordings and given participant codes (P1, P2, etc.). After transcription, interpretive phenomenological analysis (IPA) was performed through Taguette©, a software used to assist in assigning codes to transcripts. Interpretation occurs at two levels. First, observations were interpreted through the eyes of the participants and how they interpreted their context. This first level involves viewing or experiencing the phenomenon from the subjective perspectives of the participants. The second level is to understand the meaning of the participants’ experiences, to provide a “thick description” or a rich narrative story of the phenomenon that can communicate why participants felt the way they did (Elliot & Timulak, 2005). This is an iterative process of moving back and forth between the observations made and the context, to understand and explain the discord present in these subjective viewpoints and experiences.

Reflexive journaling and bracketing were performed by the investigator in the notes made after each interview, which generated a list of significant statements or themes. Thematic analysis was utilized in developing textural and structural descriptions. Transcription and analysis were conducted by SR. Implementing methods for credibility enhances trust-worthiness and validates the research process and its findings (Lincoln & Guba, 2000). Credibility demonstrates that there is truth in the presented findings and ensures rigor in the research process (Lincoln & Guba, 2000). This was achieved by prolonging engagement with participants via the member-checking process.

Member checking was completed in two steps to allow participants to validate, clarify, or elaborate on the research product and either confirm or challenge the interviewer’s interpretations (Iivari, 2018). In the first step, participants received their interview transcript, to review and confirm their own data. Only two of four transcripts were validated through this method, as no responses were received from other participants when contacted. The second member-checking step involved a group interview where the preliminary themes emerging from the data were shared with participants. Participants number 2 and 4, who participated in the individual interviews, confirmed, and elaborated on the themes and interpretations created from individual interviews. There were no responses from the other participants to the group invitation. The group session was a 50-minute conversation, held based on participant’s availability to discuss the study’s findings and the interviewer’s interpretations. This group interview was a final step in analysis to complete the interpretations by author SR.

To enhance credibility, theory triangulation allows the use of multiple theories or hypotheses when examining a phenomenon from different perspectives (Lincoln & Guba 2000; Morrow, 2007). A holistic approach, as opposed to exploring certain outcomes in isolation, enabled an understanding in this study of the relationships between outcomes and how several areas of a survivor’s life are interconnected (Landier et al., 2018). This enhanced the interview data, as it added context to the CCS experiences. Statements that considered multiple contexts, instead of isolated ones, within the survivorship experience were generated, analyzing whether outlook on reassimilation, outlook on coping, and outlook on cancer were connected, as revealed by the participant’s responses. Reflective journaling allowed the investigator to enforce transparency throughout the research process (Ortlipp, 2008). Bracketing, which is the monitoring of oneself, allowed the investigator to manage subjectivity and assumptions or biases regarding the phenomenon under study (Morrow, 2007). Both methods were conducted after every interview, where the investigator would write a summary of what stood out the most regarding the participant’s experience, giving insight to emerging themes.

RESULTS

Four individuals were included in this study through individual interviews and shared their experiences with childhood cancer. Two of four participated in the subsequent group interview. Table 1 depicts the sample characteristic. There were three major themes derived from the collected data during analysis. Each major theme was based on the participants’ perspectives of themselves, of their environment, or provided a more objective account of their experience.

Table 1.

Sample Characteristics

Participant ID	P1	P2	P3	P4	Mean
Age at diagnosis	13 years	10 years	14 years	16 years	13.25 years
Years into Survivorship	15 years	9 years	11 years	10 years	11.25 years
Diagnosis	Malignant fibrous histiocytoma or spindle cell sarcoma	Acute lymphoblastic leukemia	Stage 3 Hodgkin lymphoma	Stage 4 B Hodgkin lymphoma
Treatment	Chemotherapy and surgery	Chemotherapy, CAR T-cell	Chemotherapy and radiation	Chemotherapy, radiation and surgery
Ethnicity	Caucasian and South American	Caucasian	Middle Eastern	Caucasian
Gender	Female	Male	Female	Male
Employment status	Personal trainer	Student	Call center	Student
Age at interview	29	24	27	26	26.5 years

Outlook on reassimilating

Outlook on reassimilating is one of the three major themes. It explained sentiments regarding the aftermath of survivors’ experience with cancer, and changes observed within their social environments, such as family, friends, peers, and relationships. There were two subthemes. One sub-theme, “Perceived ability to reassimilate”, explored participant perspectives on returning home, to school, or to work after having cancer, and how their ability to transition post-treatment was impacted.

P1 stated: That’s where I think a lot of the trauma really happened, because it was like, “Deal with it,” and “life or death,” but then nobody bothered to transition me into normal life, or to help me understand what I’d expect.

Participants also shared their sentiments regarding returning to school after cancer treatment and the kinds of barriers they faced in that environment. Specifically, barriers associated with their ability to adjust to a learning environment and the sentiments associated with this experience were shared. Even years later, in the pursuit of post-secondary studies, a survivor described how cancer had limited them in their academic progress and achievement due to a learning disability. However, there were instances where participants felt they were able to overcome barriers faced in a work or school environment. P3 stated, “It’s [school] something I enjoyed.”

The second sub-theme, “Forming connections,” explained survivors’ perceived ability to re-establish a relationship with their peers, family, and friends after having cancer, and how establishing or maintaining these connections was altered.

P1 expressed, “A lot of things as a teenager or as a young adult that might seem like really cool, important milestones weren’t quite as important to me.”

Some participants also shared ways they felt their cancer experience altered their ability to connect with members of their peer group, ultimately altering what participants perceived as priorities and how their views fundamentally differed from those of their peers.

P2 shared, “You don’t really know what this is like. You’re upset that you broke up with your boyfriend or girlfriend” and I’m like, “My platelet count is down by three points, and I’m worried I’m going to get cancer again”. The levels of stuff are very different. Just trying to tell people in my peer group that was really, really hard.

Outlook on coping

Outlook on coping described survivors learning to embrace their new reality and sharing inward perspectives on themselves during their experience while exploring mental health and coping behaviours. Three subthemes emerged. “Ability to cope” depicted perceived difficulties in accepting new circumstances and learning to deal with life experiences while transitioning. Participants also associated their ability to cope with accessing resources and having the appropriate support when transitioning.

P1 shared, “I felt very angry, because not only was my body failing me, it felt like people were failing me, because nobody actually taught me how to cope with it, or how to deal with it, or how to figure out how to get back to where I wanted to be.”

“Views on oneself” described what values have changed and any characteristics that were impacted by cancer during their transition from patient to cancer survivor. While these changes vary from survivor to survivor, some participants shared how cancer had shaped all aspects of their transition using a positive outlook, especially regarding the people they are now.

P4 expressed, There are all these setbacks that are attributed to cancer, but also you don’t want to make that a scapegoat. So, it’s a tough game to play, especially since I’m so far out of cancer treatment, it’s like, is it cancer? Is this an issue of survivorship, or is this me?

Some participants also shared what kinds of aspects they associated with transitioning post-treatment, and what they are facing now, as they are moving on from their cancer experience.

P1 stated, There was that kind of fear of rejection, and my own self worth was measured by how independent I was for a lot of my life. It was a bit difficult in that sense, where I didn’t see myself as somebody worthy of getting to know or dating, because I didn’t find myself, that I felt I had less value because I was so dependent on other people. I think that was the difficulty, and even now I still struggle with it at times, just more in terms of the judging my worth by my own views.

“Coping tools” described tools, methods, or protective mechanisms used to navigate and mitigate difficult situations. Participants also shared some positive aspects to their coping mechanisms and how it aided them with their experience at the beginning of their transition process and at present.

P3 shared, Humour. Sarcasm (laughs). That is the number one thing I’d call my main weapon.

Outlook on cancer

Outlook on cancer explained participants’ experiences with cancer as they were/are facing it. Two sub-themes were generated. “Perspective as a patient” outlined sentiments regarding their experience being hospitalized as a patient and understanding their circumstance.

P2 shared,You develop really strong attachments to the nurses, the social workers, the doctors.

Participants’ experiences with cancer were not limited to their interactions with staff, as some participants also shared their sentiments as a patient navigating the healthcare system and the kinds of barriers they faced.

“The aftermath” communicated attitudes regarding their experiences as survivors and their evolving relationship with cancer, including developing perspectives using the term “survivor” to describe themselves and their journey. Some participants shared their experiences in retrospect, including their current sentiments recounting their experiences with childhood cancer.

P4 stated, “Survivor” isn’t really the term at all. It’s more like “victim.” Surviving implies a hard stop and moving on. Whereas I’m still dealing with my diagnosis or repercussions of my diagnosis, which are not seen or appreciated by others in healthcare sectors and it’s frustrating. It’s a lifelong diagnosis for sure.

Using their own perspectives, participants provided insight and guidance for children who are now diagnosed with cancer and learning to navigate their current circumstances and survivors managing their post-cancer experiences.

P4 shared, [You] incessantly call your oncologist and radiologist or whatever and keep getting the follow-up as long as you can and try and get all of these things, because there aren’t programs in survivorship for people our age.

The idea that not every survivor shares the same experiences has been shown in other research describing the different challenges faced due to cancer type, treatment received and how survivors perceived their reality (Bitsko et al., 2016). The perspectives shared during the group interview in this study emphasized that personal outlook and barriers to care seem to play an increasingly influential role in the transition of survivors. Participants expressed that achieving a sense of normalcy or feeling as though they can successfully adjust to their new circumstances are of importance.

As expressed by three survivors in this study, there was a gap between preparedness and transition post treatment, which could positively or negatively impact the process of transition. In addition to this, it is entirely possible to have positive and negative views regarding their outlook on cancer. Participants agreed that there were positive and negative aspects to their experience not only with cancer, but also in navigating their experiences with their peers. Some participants recognized having a relatively positive outlook as a patient was due to the support received from hospital staff during hospitalization. However, survivors expressed that there is a lack of communication between patients and hospital staff, specifically regarding the psychosocial impacts of survivorship, where survivors did not feel supported and did not feel prepared for their transition. Survivors reiterated this sentiment by expressing what gaps they felt were in place, as it related to their care as a survivor. This discussion ultimately confirmed the findings of this study.

DISCUSSION

This preliminary exploration revealed themes influencing the participants’ experiences with transitioning post treatment and how the theme topics interact with each other. The results describe how the topics contributed to the survivorship experience and how they impacted the survivorship trajectory for these survivors of childhood cancer.

Participant’s personal outlook on coping

Participants’ perspectives on cancer are influenced by their perceived coping ability, which is linked to self-perception and success in their environments. This aligns with previous studies emphasizing that, whether positive or negative, perspective is more strongly associated with psychosocial well-being than sociodemographic and medical characteristics (Van Erp et al., 2021; Zebrack & Landier 2011). Self-perception impacts coping ability and various aspects of life, including forming relationships and academic or employment environments (Tremolada et al., 2017).

Independence seems to play a crucial role in the trajectory of transitioning from their childhood cancer experiences for adolescents and young adults (AYA) and has been utilized as a predictor of psychosocial outcomes such as academic achievement, contentment, and relationship satisfaction (Tremolada et al., 2017). Perceptions regarding their cancer experiences are a continuously evolving aspect for many participants. In fact, AYA survivors expressed that maturity affects their perspectives and experiences, as they prioritize health concerns over social connections, supporting the findings of other studies (Anthony et al., 2019; Dattilo et al., 2021).

Since participants expressed that they are still learning to navigate their connections with their peers, it is unclear how lasting this sentiment is, and if participants will ever feel as though they can fully navigate these aspects of survivorship. Also, feeling ill-equipped, not understanding what to expect, and perceived access to information are indicators for preparedness. This was confirmed in the group interview, where the transition from patient to survivorship care has been illustrated as a hand-off experience. Instead of having access to the whole hand, survivors are holding on to one finger in their transition. The hand, in this metaphor, is the healthcare system and healthcare providers. The finger that survivors cling to represents the little information and support that is provided, feeling partially supported into their transition. Participants explicitly expressed that the support available to survivors is not necessarily deficient, however, it is not promoted, maintained or of good quality. Hence, their perceived access to information influences preparedness. Ultimately, participants are looking for reliability. Largely, the lack of preparedness seems to delay the transition process. This lack can hinder coping and forming connections; it can result in or exacerbate positive or negative coping behaviours and shape the overall outlook of survivorship (Belpame et al., 2021).

Barriers to care

During hospitalization, participants in this study had a relatively positive outlook due to the support received from the hospital staff. This was consistent with another study containing a larger sample (Belpame et al., 2021). Post hospitalization, our participants felt unsupported and unprepared for transitioning. Communication with hospital staff regarding the psychosocial effects such as changes to activities of daily living, fertility concerns, re-connecting with family and peers was lacking (Gianinazzi et al., 2022; Howard et al., 2018; Levine et al., 2019; Sadak et al., 2020). In fact, it is relatively unknown how effectively staff communicate the risks of late psychosocial effects to survivors (Cox et al., 2016). This study was a starting point to reveal that there was very little to no information communicated to survivors regarding transitioning and the challenges they may face as a result of their cancer experience. There are few supportive resources provided to survivors tailored to assist them in their post-cancer experiences (Levine et al., 2019; White et al., 2018). This lack of support can be a barrier to effective survivorship care and, ultimately, reduce the ability of childhood cancer survivors to transition post-cancer treatment.

Participants in this study expressed that the support available to survivors is not promoted, maintained, or of good quality, and neglects the holistic experience that is survivorship. It does not encompass all facets of survivorship. This aligns with sentiments expressed by survivors in another study (Anestin et al., 2018). There is a greater need for emotional and informational support for survivorship care for childhood cancer survivors. In this study, participants did not feel as though they could ask hospital staff for help, rather relying on staff to raise the topic. These sentiments are common among adolescent and young adult survivors, as they find they are being told by hospital staff that what they were feeling was normal, or they were feeling too embarrassed (Bender et al., 2022). More positive experiences, specifically regarding socialization and community support, may help survivors better navigate their survivorship experiences and develop happiness and positivity. In turn this would impact future mental health and perceived general health (Weinstein et al., 2018).

Limitations

The main limitation in this study was the small sample size as a result of challenges faced in recruitment. Recruitment saw a low response to study invitations on social media posts. In the end, the decision to close recruitment was made pragmatically after a long recruitment time. It is typical for phenomenological studies to include 6–10 participants; thus a group interview was held to compensate for the small sample size (Morse, 1994). Despite acquiring a sample of four, the methods, tools, and design of this study emphasized phenomenological principles through exploring context and meaning (Lopez & Willis, 2004). The sample composition contained a representation of survivors diagnosed with Hodgkin Lymphoma, which does not fully reflect the broader pediatric cancer population. There are several psychosocial disparities across survivors of childhood cancer based on age at diagnosis, treatment type, and cancer type, which can shape reassimilation experiences (Gurney et al., 2009), but there was not the range of these characteristics in the small sample. Furthermore, the lack of recruitment incentives may have lessened potential engagement. Lastly, studies aimed at observing the psychosocial experiences of survivorship typically experience challenges to recruitment, as the perceived burden is high and individual benefit is less clear (Hulbert-Williams et al., 2019). Recruitment reliance on CCSC may have introduced bias by excluding survivors not affiliated with the organization.

Implications

Implications for Healthcare Professionals (HCPs)

According to the AYA participants in this study, HCPs are mostly preoccupied with treatment. The opportunities to educate the young patient regarding their health outcomes are relatively absent and can leave survivors feeling as though they are unprepared for life beyond cancer and hospitalization. Early introduction to transition and better provision of information may improve the transition process (Landier et al., 2018). There is an emphasis emerging on improving communication, reducing fear and anxiety, and maintaining a positive outlook, as it pertains to the unmet psychosocial needs of this population (Maurice-Stam et al., 2022). Advising and encouraging the use of available survivorship resources, such as groups and programs based on patient demographics such as age and cancer type, can provide a more personalized type of care and support. Advocating and encouraging survivors to seek out hospital and community-based resources to supplement their survivorship experience will not only educate them on what to expect from their survivorship, but also can provide the necessary resources to aid in the process of transitioning. This can result in increased self-perception, independence, and success in their lives post cancer. The issues resulting in a challenging transition process can be addressed with improved communication between HCPs and patients, which may address the lack of comprehensiveness that is associated currently with cancer care. Recommending and referring follow-up appointments for patients during and after their treatment, specifically to discuss latent effects such as mental health, changes expected in returning to life, and other psychosocial aspects, can go a long way and may enhance communication between HCPs and survivors. Participants expressed that during hospitalization they developed a strong bond with oncology nurses, making these HCPs ideally suited to help patients manage this aspect of their well-being through supportive care (Young et al., 2020).

Future directions

Due to the small sample size, the application of the findings in a wider way is indeterminable. However, the study findings highlight the need for further investigation into survivorship and transitioning. What is especially necessary is understanding how transitioning can be addressed and implemented as part of care within a healthcare setting, and the feasibility of this care being provided by HCPs. This study utilized a qualitative approach to survivorship and was able to offer a first exploration of several aspects of survivorship, as it pertains to transitioning by young adult survivors. Working alongside these survivors may be an asset to further exploring aspects of survivorship for interventional and program development. With these perspectives, researchers might begin to understand and help bridge the gap of communication between survivors and the healthcare system, particularly in the psychosocial scope of transitioning. In conducting further examinations, researchers are encouraged to recruit through survivorship clinics as a supplement to community organizations.

CONCLUSION

This study offers a preliminary exploration of themes influencing young adult survivors’ transition experiences and how these themes interact with each other. The research highlights the holistic nature of survivorship and its trajectory, shedding light on the meaning and impact of these experiences on survivors’ progress in returning to school, and to social and work environments. This first exploration emphasized the need for further investigation into survivorship using a holistic perspective.