Cancer Puts Life and Dreams on Hold for Younger Adults

A cancer diagnosis is a shock at any age, but it hits differently when you're young. It can be an emotional roller coaster—and you don’t know where it’s headed. One moment, you were excited about college, your new job, or your next date. The next, your plans are put on hold. Your dreams of a wedding, a house, or a family suddenly feel uncertain.

You might wonder, “How did this happen to me, and am I going to be okay? Will I still be attractive if cancer treatment leaves surgery scars, a colostomy bag, or a mastectomy? Will this affect my friendships and dating life? How will l handle the ups and downs of weight gain and loss that come with treatment? What about my partner and my kids?"

This is the reality for people who have early onset cancer, a term commonly used for cancer diagnosed in adults between the ages of 18 and 49.

“Cancer is so unexpected—the younger you are, the more it seems to come completely out of the blue,” says Nancy Borstelmann, PhD, MPH, LCSW, co-director of the Early Onset Cancer Program at Yale Cancer Center, which cares for patients ages 18 to 45. “You are confronted by questions you’ve never had to consider before. The stress and anxiety can feel overwhelming.”

Younger adults may have some heightened and unique psychosocial needs in comparison to people in older age groups in which cancer more typically presents. The Early Onset Cancer Program brings together multidisciplinary experts to address early onset challenges through cancer research, psychosocial support, and clinical care. Some early initiatives are focused on psychosocial concerns and include an ongoing support group for cancer patients ages 18 to 49 and another for family and friends who are close supporters of the patient.

“We help them focus on the here and now—and on continuing to do whatever brings meaning and purpose to their lives,” says Angela Khairallah, MSW, LCSW, Smilow oncology social work manager, who has counseled patients at Smilow Cancer Hospital for more than a decade. “Those are the things that I want to help them focus on, regardless of whether they have a very curable, early-stage cancer or a metastatic cancer. We want to help them live each day as fully as they can.”

While a cancer diagnosis can be hard on anyone, research shows younger adults with cancer face higher rates of emotional stress, anxiety, depression, and even suicide, according to the American Psychological Association (APA).

Considering the median age of cancer diagnosis is 67, according to the National Cancer Institute, younger, otherwise healthy adults are likely occupied with so much else in these earlier decades of life, making the diagnosis even more jarring. There are many potential impacts and these can vary based on their stage of life, support networks, and the specifics of the cancer diagnosis and treatment plan, Borstelmann says.

Adults in their 20s are often gaining independence, finishing school, figuring out work and careers, and exploring relationships. “They may think they’re on a path and a cancer diagnosis can really throw that off,” she says.

People in their 30s and 40s are often immersed in jobs and families. For them, a diagnosis is not only emotionally difficult, but also a major interruption. They might worry about juggling new medical bills with the financial responsibility of paying rent or supporting a family. Some may be grappling with questions about fertility as they face treatments such as chemotherapy or radiation, and needing to work through decisions about egg or sperm-banking, or embryo freezing.

Money can be a major concern, as younger adults often have less savings. Many young survivors have heightened concerns about the cancer returning and disrupting their lives again. “They have so much of life still ahead of them,” Khairallah says. “They think, ‘What if it comes back while my children are small?’”

Khairallah once asked members of an early onset cancer support group how they reacted to hearing their diagnosis. Across the board, the first thought was, “I’m going to die,” she says.

The excellent news is that many cancers are more more treatable than they used to be—in fact, cancer survival rates are improving—and each case is different. The American Cancer Society Cancer Facts and Figures 2025 report shows that while certain cancers, including such common ones as breast and colorectal cancers, are rising in younger adults, overall cancer deaths are declining.

It’s true that too much information can be overwhelming, but several studies have shown that knowledge about the disease can help lower anxiety and stress, and empower people to make more informed decisions, Borstelmann says. For example, while breast cancer tends to present as more aggressive disease in younger women, many do well, with new therapies making even more advanced breast cancers more treatable. “A diagnosis and the many impacts on a person’s life can create a sense of loss of control, and reliable information that is relevant for them and their situation can help with feeling more grounded and in control,” she adds.

Both Borstelmann and Khairallah recommend caution around seeking information on the internet, especially social media influencers and blogs where you aren’t sure where the advice is coming from. “There is a lot of information out there that is incorrect or misleading, and this can heighten distress and do harm instead of helping,” Borstelmann warns. She recommends sticking with reliable sources such as the American Cancer Society or other recommended sources from the cancer care team.

Open communication can benefit both younger cancer patients and their loved ones. Borstelmann recommends thinking about having many conversations over time, giving everyone space to share their thoughts, feelings, and questions, so no one feels alone. “Listening to your family’s concerns is important, validating, and reassuring for them,” she says. “It can be a few minutes to touch base before an appointment or a longer conversation when there is time. And it can be helpful to think about this as not just one conversation; it’s likely many over the course of time and care, and it does not necessarily follow a straight line.”

Parents are often unsure about how to share information with children, or even if they should. Borstelmann says, “It’s natural to want to protect children because that’s what parents do. But research in this area shows that sharing information in an age-appropriate way is best,” she adds. “If children don’t hear it from you, they may hear or overhear it from someone else, and that is not the way you would want them to find out about your cancer.”

Borstelmann says it is important to emphasize three broad messages for children about cancer: It’s nothing you did or said, it’s not contagious, and you will be taken care of. Of course, there are many questions that can and will come up, but the basic message is one of reassurance and safety, given potential changes in their lives and routines.

She also emphasizes making sure family members expect and are able to manage disruptions such as a surgery, multiple appointments, or a hospital admission. It’s also important to discuss any observable changes, such as hair loss from chemotherapy, Borstelmann says. “Set the foundation in terms of open communication, so when there is a pivot or new information, it’s not such a surprise.”

A cancer journey has many stressful points, from starting treatment or having a major surgery to entering the survivorship phase, says Khairallah. She recommends taking intentional steps to maintain a sense of normalcy. Some advice:

• Keep doing what you love. Continue with your hobbies, whether that’s cooking, volunteer activities, or playing with your children. One woman Khairallah counseled never stopped lifting weights competitively during treatment. “Doing the things you enjoy doing—to the extent that you can—is going to help you," she says.
• Tap into your support system. Lean on family, friends, or community groups. Sometimes, help can come from the most unexpected places. “It can be quite surprising to a person when the people they never thought they could depend on turn out the be the ones who are always there,” Khairallah adds.
• Get help with sexuality and intimacy. For young women, a mastectomy can impact body image and sense of self. Similarly, a diagnosis of testicular cancer might upend a man’s self-image. Yale Medicine’s Sexuality, Intimacy, and Menopause Program provides psychological services for women experiencing sexual dysfunction or early menopause after cancer treatment. Men can also seek support from counselors or doctors such as urologists.
• Turn to your religion or faith. If it’s a source of comfort, church or some other sort of spiritual practice can help. It’s also common for people to feel angry and pull away from their faith during this time. The best approach is to figure out what works for you.
• Address financial and practical concerns. Medical bills can take a toll, especially on younger adults whose financial lives may not yet be stable. Many hospitals and cancer centers offer resources to connect patients with financial aid and other support.
• Let other people help. Friends, family, and neighbors often want to help but don’t know how. Khairallah suggests making a list of things they can do to help, from shopping for groceries to helping cook a meal to walking the dog and then giving yourself permission to ask for help when you need or want it.

Cancer is a major life stressor that can bring up a range of emotions: Anger, fear, guilt, sadness, and loneliness are among them. Younger adults who might talk to their friends about any other problem may find that even the most well-meaning friends have no experience with cancer and don’t really understand.

If you feel overwhelmed, don’t try to go it alone. Talk with your cancer care team, or someone you trust as a first step. It may be helpful to talk with one of the clinical social workers or another mental health professional. Some people walk through the doors of the cancer center with a history of mental health challenges or other significant life stressors. This experience can be a lot to manage if you are vulnerable, and it is important to note if you are feeling distressed, depressed or anxious, and seek help.

While online support groups and blogs exist, Borstelmann and Khairallah both agree that nothing can replace one-on-one, in-person support. At Yale Medicine, clinical social workers focus on listening, Khairallah says. “We start where the patient is at and listen to them.”

Perhaps surprisingly, this advice also applies to cancer survivors after treatment, Khairallah says. “The levels of anxiety and depression that I’ve seen in some survivors have been far higher than what I saw with patients in treatment,” she says. The key is to find support, no matter where you are in your journey.

“Just because you have a cancer diagnosis doesn't mean life has to stop,” Khairallah says. It can help young adults to focus on what they can do and go on with their life as much as possible, even if it means making adjustments.

For instance, dating can cause a lot of nervousness and anxiety in young patients, Khairallah says. “They want to know, ‘How much do I share? What do I tell and when do I tell?’” She remembers a young woman who, after much fear, put her diagnosis in her dating app profile. She was matched with a supportive person who wanted to continue seeing her. “She was very surprised by that,” Khairallah says.

The final takeaway is to not worry alone. “Whatever feelings, worries, or concerns you have, find a way to talk about them with somebody you trust,” Borstelmann says. This can be a friend, a family member, a counselor, nurse, or doctor. “Not only does this help you to share your experience, it also helps set you up to figure out your next steps to feeling better," she adds.