Navigating Survivorship: Exploring Self-Management and Developmental Processes in Adolescent and Young Adult Cancer Survivors

Abstract

Adolescent and young adult (AYA) cancer survivors face unique post-treatment challenges, including disrupted developmental trajectories and limited engagement in survivorship care. While self-management is essential for long-term wellness, it remains ambiguously defined and inconsistently supported in this population. This dissertation explores self-management as a developmental construct shaped by identity, autonomy, and evolving goals, and examines how peer support contributes to that process. Across four integrated studies, this work clarifies the relationship between self-management and patient activation, identifies the self-management roles and responsibilities and their alignment with developmental indicators of Positive Youth Development (PYD), and analyzes goal pursuit and coaching interactions within a peer support intervention. Findings demonstrate that self-management and patient activation are interrelated processes, with survivors’ roles and responsibilities aligning closely with Positive Youth Development indicators. AYA cancer survivors pursued layered, personally meaningful goals that reflected broader developmental aims and identity formation. Peer support interactions varied in style and type over time, responding to survivors’ evolving needs and developmental context, and were associated with outcomes in self-management and mental health-related quality of life. These findings contribute to a more nuanced understanding of self-management as a developmental achievement and underscore the value of developmentally responsive, survivor-led peer interventions. They also inform future research and practice aimed at optimizing peer support models and promoting resilient survivorship in AYA populations.