In the complex journey of adolescent and young adult (AYA) cancer patients, navigating sexual and reproductive health care remains an overlooked yet critical aspect. Recent research sheds light on the multifaceted factors that influence the accessibility and quality of sexual and reproductive health services for this unique population. Published in the journal BMC Cancer, a novel serial focus group study conducted in Canada offers unprecedented insights into how both identity and systemic influences shape experiences and outcomes for AYA cancer survivors, aged 15 to 39.
The study’s core premise revolves around understanding disparities in sexual and reproductive health care experienced at the time of diagnosis and throughout treatment. It recognizes that these disparities are not random but are deeply embedded within patient characteristics—such as gender identity, sexual orientation, socioeconomic status—and interaction with healthcare systems. By unpacking these complexities, the research aims to inform more inclusive policy-making and patient-centered care strategies.
Employing serial focus groups that mimicked supportive community spaces, the researchers created a dynamic environment where participants could share evolving experiences and perspectives. This method provided a longitudinal depth rarely achieved in qualitative research, allowing for nuanced changes, reflections, and adaptations to emerge across three sequential sessions per cohort. Patient research partners actively participated in designing the study’s focus topics, ensuring authenticity and relevance in discussions relating to sexual and reproductive health challenges.
Central to the analytical framework were two conceptual models: PROGRESS-Plus and Andersen’s model of access to medical care. PROGRESS-Plus identifies structural determinants of health inequity including place of residence, race, occupation, gender, education, and more. This framework helped reveal how layered social identities affect patient experiences and access disparities. Andersen’s model further contextualizes these findings by exploring predisposing characteristics, enabling resources, and need factors influencing healthcare utilization.
The study included 48 participants ranging in age from 21 to 48, all diagnosed with cancer during their adolescent or young adult years. The sample displayed diverse representation, notably including underrepresented groups such as nonbinary and gender fluid individuals, a significant number of non-heterosexual orientations, and various racial backgrounds. This inclusivity strengthened the study’s validity regarding intersectional influences on sexual and reproductive health care.
Throughout the focus groups, recurring themes emerged highlighting a pervasive lack of adequate information and support concerning sexual and reproductive health. Many participants expressed frustration over healthcare providers’ failure to address these critical aspects during treatment discussions. This neglect extended to insufficient consideration of patients’ cultural beliefs, gender identities, and sexual orientations, which compounded feelings of isolation and marginalization.
Eight identity factors were identified as primary influencers at the patient level. These included geographical location, which affects access and availability of specialized care; the capacity for self-advocacy, tied closely to patients’ educational background and occupational status; socioeconomic status impacting affordability and prioritization of health needs; and social capital, reflecting support networks and community resources. Gender and biological sex also significantly shaped experiences, given the variability in service provision and societal attitudes.
Age was another complex factor, influencing not just the physical realities of treatment but also psychosocial needs and perceptions of sexual education. Relationship status and sexual orientation further complicated care dynamics, with some participants noting that heteronormative frameworks dominated clinical interactions, sidelining their lived realities. These nuanced identity facets underline the importance of personalized, culturally competent care in oncology settings.
Beyond patient-level factors, healthcare system-level influences were elucidated in two main contextual enablers: inefficiencies within the system and the nature of patient-provider interactions. Inefficiencies included fragmented service delivery, lack of specialized training among healthcare professionals, and inadequate integration of sexual and reproductive health within oncology protocols. Patients often encountered bureaucratic hurdles that delayed or denied access to necessary services.
Interactions with healthcare providers emerged as a crucial determinant, with findings emphasizing the role of communication quality, provider empathy, and cultural sensitivity. Positive encounters fostered a sense of inclusion and validation, while negative experiences left patients feeling dismissed or misunderstood. These interactional dynamics significantly affected trust and willingness to seek or adhere to sexual and reproductive health care recommendations.
The implications of this research are profound. It challenges existing paradigms that often separate cancer treatment from sexual and reproductive health considerations, advocating instead for an integrated holistic approach. Treatment plans must account for the complex interplay between identity-based needs and systemic factors to optimize care outcomes. This means healthcare providers require enhanced training and resources to address these aspects proficiently.
Moreover, research studies focusing on cancer in AYA populations need to incorporate these identity and contextual determinants in their design and evaluation processes. Without such inclusivity, interventions risk perpetuating disparities and failing to fulfill the diverse needs of this group. Likewise, care programs must develop flexible, patient-centered models that validate sexuality and reproductive concerns as integral to overall well-being.
The study also calls attention to policy implications. Health systems should prioritize equity-oriented frameworks that dismantle barriers rooted in socioeconomic and cultural distinctions. Improving health literacy around sexual and reproductive matters, expanding access to specialists, and fostering multidisciplinary collaborations represent essential steps toward this goal. Policymakers must ensure that funding and guidelines reflect these priorities.
In conclusion, the sexual and reproductive health experiences of adolescent and young adult cancer patients are shaped by a constellation of identity and systemic factors. Recognizing and addressing these elements is not merely about improving clinical outcomes but about respecting the full humanity of patients navigating the complexities of cancer in their formative years. Future directions will involve translating these qualitative insights into practical changes that make care more responsive, inclusive, and empowering for AYA cancer survivors worldwide.
This groundbreaking work opens conversations previously sidelined in oncology care, emphasizing that sexual and reproductive health is inseparable from comprehensive cancer treatment. As healthcare advances, the embrace of holistic, intersectional approaches promises a future where every AYA cancer patient’s unique needs are met with dignity and expertise.
Article Title: What factors influence sexual and reproductive health care among adolescent and young adult cancer patients?: a novel serial focus group study.
Article References:
Oveisi, N., Cheng, V., Taylor, D. et al. What factors influence sexual and reproductive health care among adolescent and young adult cancer patients?: a novel serial focus group study. BMC Cancer 25, 1134 (2025). https://doi.org/10.1186/s12885-025-14380-w
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14380-w
