Table 3.

Key Themes and Supporting Quotes.

Theme	Representative Quotes
Theme 1: Social isolation and loss of independence	“I probably could have used, I probably could have used the, a friend. Or I just felt very, I felt very alone growing up because I felt somewhere between, and like even like I think more recently I have connected to more programs through MSK […] for like a good stretch in there between like age 16 and 26/27, I was just like floating around like I still have all these problems but like my friends don’t fully get why I am so tired” (LGBTQ+ Group 1)
Theme 1.1: Desire to connect with peers	“I felt very much like I was seeking some kind of peer support when I was going through treatment and was able to find it just through happenstance because there was another person who was my age and my gender going through a very similar treatment process with a very similar diagnosis and we just happened to be on the same hospital floor. And so if we hadn’t been able to make that connection I think I would have felt incredibly isolated. Even though I was seeing other people that were potentially my age, just like not having a way or a mechanism to reach out or communicate and make that connection was hard.” (18+, treated in Pediatric Service Group)
Theme 2: Uncertain sense of the future and a need for conversations around survivorship, long-term, and late effects	“And so the transition from being super present there all the time [in the hospital] and feeling like it’s your second home almost to just having to leave is like, ‘Okay, bye’ You take on a different role and you’re a different person.” (18+, treated in either Service Group)
	“I wish that I had asked more questions about all of the different kinds of support that I might be interested in engaging with or receiving after treatment, especially things like financial planning, things like resources, things like even like applying for disability, like any-anything having to do with returning to, to life that I just didn’t talk to my doctors about and I didn’t really attempt to seek those kinds of supports elsewhere. And I wish that I had.” (18+, treated in Pediatric Service Group)
Theme 3: Greater control over discussions with the care team	“So now [that I’m] older I kind of feeling like I want to take more my charge of my like care and my parents, my parents obviously are just involved in everything, but I just kind of wish I could do more.” (18+, treated in Pediatric Service Group)
	“When I was going to chemotherapy I didn’t have a lot of energy, so I had my mom, or my sister, or my girlfriend take me. After I was done with chemo and whenever I had like an appointment, I basi-cally went by myself. I told my mom when I’d go, but I go in one-on-one with a doctor because I think that’s where I feel most comfortable. I think parents freak out. It’s going to happen. So, I think begin-ning of my stage I had my parents and my sister all with me, but toward the end when I had to go for a checkup when I had to go for like a result after like an MRI or a CT, I just went by myself because I felt more comfortable and I can be 100% honest with the doctor.” (18+, Treated in Medical Service Group)
Theme 4: Need for additional navigational and social/caregiver supports	“If you think about other big things that happen in people’s lives, like childbirth and stuff, there is like a whole book, and there’s all these things […] I just feel like there are things [with cancer treatment] that you could potentially have a portal or some like very general info that would be helpful. Like where would I get food if I’m hungry? If I’m nauseous, what do I do about that? Just the like weird things that people need to know, like where are the bathrooms, and how many people can come with you to an appointment and all that? All the weird FAQs of weird stuff that I think does come up in a time that can be so confusing and so scary and there’s so much fear and nervousness, and there’s so much you’re trying to figure out and digest.” (18+, treated in either Service Group
Theme 5: Developing an inclusive AYA space in the hospital	“[This discussion] made me think of like the new lounge that they have upstairs for like teens and young adults, and just like making sure like that’s an inclusive space too because if you are going to have like romcoms include queer romcoms, if you are going to have literature, you are going to have books and stuff, include queer writers, like maybe have like a celebrate those queer writers, queer artists, queer musicians. Like make it known to everyone that it’s like ok to be not straight or gender nonconforming. All of that message goes a long, like a little bit goes a long way in my opinion.” (LGBTQ+ Group 2)
Theme 6: LGBTQ AYAs experience distinct concerns	“I didn’t identify as gay, I didn’t identify as a lesbian, I just even, what I identify as a queer now, [but] I didn’t have the language for that at the time and so it was really hard for me to like ask questions about sex, I didn’t know how to say, ‘I am this and so I need help with this.’ […] But often I was approached as a straight woman and so I was starting on an identity I wasn’t even, that I wasn’t.” (LGBTQ+ Group 2)
	“I was 22 and I was in my first real relationship with my first relationship with someone of the same sex so it was really definitely scary to me […] I mean it sounds kind of funny now but at that time like how will I be sexually active while I am going through chemo and it was something that I thought a lot about [… I asked] ‘can I have sex?’ or whatever, and it was sort of like the answer was ‘oh my god, yes but always use a condom!’ and I was just like, I can’t press further to really get myself to do it. Ya, and I was assumed straight probably throughout most my conversations with doctors” (LGBTQ+ Group 2)
	“So, for me, my treatment was like one full calendar year of like constant eighteen chemos. And so, I felt like I lived at [the hospital] that year and so bringing in the fullness of my identity to it was really important. And I came out, I am queer, cis queer to my palliative care team because they asked if there’s anything to know about you. And that was a really nice way to ask that, I thought and gave me that space to come out […] So, I feel like coming out to my palliative care team was a really positive thing for me.” (LGBTQ+ Group 1)