AYA Survivorship: The Late-Effects Checklist Every Adolescent & Young-Adult Survivor Should Carry
A plain-English checklist of the late effects adolescent and young-adult cancer survivors most often see fall off the schedule — and what to log in your own chart so they don't.
Adolescent and young-adult (AYA) cancer survivors — diagnosed between roughly 15 and 39 — sit in a scheduling blind spot. Pediatric oncology has aged you out; adult primary care has never seen a survivor with your exposure history. Here is the checklist most AYA survivors say fell off their calendar first.
Cardio-oncology (anthracyclines, chest radiation)
Doxorubicin, epirubicin, and chest-field radiation raise long-term cardiomyopathy risk in a dose-dependent way. The COG-LTFU baseline is a screening echocardiogram at entry to long-term follow-up and then every 2–5 years depending on cumulative dose and radiation exposure. Log your total cumulative anthracycline dose (mg/m²) and any radiation field that included the heart — your future PCP will need both numbers to set the interval.
Endocrine, fertility, bone density
Alkylators, pelvic/cranial radiation, and stem-cell transplant conditioning are the exposures that most often disturb thyroid, pituitary, gonadal, and bone health years later. If fertility preservation was not discussed at diagnosis, it is not too late to have the conversation — many survivors still have options. Add a DXA baseline to your list if you had steroids, transplant, or premature menopause.
Second cancers and screening
Certain regimens raise the risk of specific second malignancies — for example, breast MRI screening for women who had chest radiation before age 30, colonoscopy earlier than the general-population schedule after abdominal/pelvic radiation. Carry your regimen list so your next clinician can match it to the right screening cadence.
Cognition, mood, sleep, sexual health
The 'invisible' late effects — chemo-associated cognitive change, PTSD from treatment, insomnia, sexual dysfunction after pelvic surgery/radiation — are under-asked-about in short primary care visits. Logging even a monthly one-line entry in your own chart gives you a trend line to point at.