"I felt as though my life had come to an end": lived experiences of adolescents and young adults with cancer in Nepal.
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BACKGROUND: Adolescents and young adults (AYAs) diagnosed with cancer face distinctive physical, emotional, and social challenges during a critical developmental period marked by identity formation, pursuit of education, and establishment of social roles. In Nepal, the absence of age-specific oncology services and structured psychosocial support may further compound these experiences; however, qualitative evidence describing the lived experiences of AYAs with cancer in low- and middle-income countries (LMICs) remains notably scarce. OBJECTIVE: This study aimed to explore the lived experiences of AYAs diagnosed with cancer in Nepal, focusing on psychological and social challenges, coping strategies, support systems, and healthcare experiences. METHODS: A qualitative exploratory design was employed. In-depth, semi-structured interviews were conducted with 14 AYAs aged 15 to 39 years receiving cancer care at a tertiary cancer center in Kathmandu, Nepal. Participants were recruited using purposive sampling to capture diverse experiences across age, gender, cancer type, and treatment stage. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke's (2006) six-phase approach. RESULTS: Thematic analysis revealed six interrelated themes: (1) physical and treatment-related challenges affecting daily functioning, (2) emotional and psychological distress characterized by fear, anxiety, and uncertainty, (3) social disruption and changes in identity, including reduced peer interaction and educational or occupational interruption, (4) centrality of family support alongside concerns about burdening relatives, (5) coping strategies such as self-counseling, hope, acceptance, meditation, and spiritual practices, and (6) generally positive healthcare experiences tempered by a desire for greater emotional engagement from providers and inadequate AYA-specific services. Participants navigated cancer with limited formal psychosocial support, relying predominantly on personal and familial resources. CONCLUSION: AYAs with cancer in Nepal experience interconnected physical, emotional, and social challenges that extend well beyond medical treatment. While family support and personal coping strategies play a vital role in adjustment, significant gaps in psychosocial and age-appropriate supportive care remain evident. Integrating routine psychological screening, strengthening patient-centered communication, and developing AYA-responsive care models may improve care experiences and psychosocial well-being for this underserved population.