Relations in young adults with cancer: Acknowledging partners and friends as informal caregivers – A Danish National study

Relations in young adults with cancer: Acknowledging partners and friends as informal caregivers – A Danish National study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relations in young adults with cancer: Acknowledging partners and friends as informal caregivers – A Danish National study Marie Ernst Christensen, Helle Enggaard, Helle Pappot, Lise Bjerrum Thisted, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8834415/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Purpose This study explored relational experiences among young adults with cancer and their self-chosen informal caregivers (friends and partners) across the cancer trajectory. Methods A national, multicentre qualitative study was conducted in oncology and haematology settings at all five Danish University Hospitals. Individual semi-structured interviews were undertaken with young adults with cancer (diagnosed when aged 18–39 years) and their self-chosen friends or partners as informal caregivers. Data were analysed using reflexive thematic analysis and reported in accordance with COREQ. Results Nine young adults with cancer and 13 informal caregivers participated (partners n = 7, friends n = 6). Three themes were identified: (1) Holding on to Normality in a Youth Life on Pause, young adult with cancer and informal caregiver dyads created “breathing spaces” through everyday routines while navigating disruptions in body, mood, and participation in youth contexts; (2) Navigating Help, Needs, and Boundaries, young adults with cancer and their informal caregiver balanced requesting and offering support, preferred concrete help, and engaged in mutual protection, with professional support rarely accessed; and (3) Shifting Roles in the Relationship, relationships evolved toward “love and logistics,” and support was organised in changing circles of closeness, with friends often occupying an “in-between” position. Conclusions Cancer in young adulthood emerges as a relational phenomenon. Acknowledging partners and friends as informal caregivers, and fostering communication, boundary setting, and role negotiation, may reinforce dyadic coping processes and support the continuity of everyday life. Young adults cancer informal caregivers cancer trajectory relational experiences Introduction Young adults, aged 18–39 years, face crucial challenges as they develop their identities, often accompanied by a natural process of detachment from their parents, and begin to build significant relationships in education, career, and romance, and establishing their own family life [ 1 – 4 ]. This period of exploration and personal growth is profoundly disrupted by a cancer diagnosis [ 5 ]. Cancer adds significant stress, impacting not only health-related quality of life but also interferes with the young adults’ emerging independence and need for support [ 4 , 6 ]. Like in paediatric oncology, research focus on the impact of cancer on young adults and their familial relationships, particularly highlighting the role of parents as primary caregivers [ 7 , 8 ]. This emphasis on parents has provided valuable insights into the psychosocial effects of cancer within families. However, this perspective may overlook the broader social support network of young adults, which includes friends and partners [ 9 , 10 ]. Despite their increasing importance in young adults´ everyday lives, there remains limited knowledge about the role of informal caregivers such as friends and partners and how they contribute to the provision of emotional and practical support. These relationships are increasingly central to young adults’ lives, offering emotional support and helping maintain their identity and sense of normalcy despite their cancer experience [ 11 ]. There is a significant gap in understanding the challenges faced by friends and partners who are key supportive persons for young adults with cancer. For instance, young adult cancer patients and their partners reported difficulties such as changes in communication, disruptions in expected life milestones, and challenges related to intimacy and body image during the cancer trajectory [ 12 , 13 ]. Moreover, a scoping review on caregiver burden among adolescents and young adults with cancer found that caregivers beyond parents (including partners and friends) are indeed involved [ 5 ]. Thereby, caregivers are often treated as a homogeneous group in research, which may blur the distinct challenges faced by different caregiver populations. This limits insights into the unique dynamics of non-parental and non-sibling caregivers. Finally, another scoping review underscored both the value of friends’ support and the challenges they encounter, while also emphasizing the lack of studies specifically examining friends’ perspectives and needs [ 13 ]. To understand the challenges young adult cancer patients and their close informal caregivers (friends and partners) face, a nuanced exploration is needed. This may inform a more holistic and person-centred care. Thus, this study aimed to explore the relational experiences of young adults with cancer and their self-chosen informal caregivers throughout the cancer trajectory. Materials and methods Study design This study used a qualitative design with individual semi-structured interviews and reflexive thematic analysis involving young adults with cancer and their self-chosen informal caregivers (hereafter referred only to informal caregivers) [ 14 – 16 ]. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 17 ]. Setting and patient representative involvement The study was initiated within the Danish Research Network National Adolescents and Young Adults Cancer Research in Denmark (NAYACareDK) [ 18 ] and informed by experiences from patient representatives in the network, who emphasised the importance of partners and friends during the cancer trajectory while also recognising challenges faced by the informal caregivers. This national, multicentre study was conducted in oncology and haematology settings at all five Danish University Hospitals. The project group, formed within NAYACareDK, was multidisciplinary (nurses, physicians, psychologist, nutritionist) with both research and clinical backgrounds. The patient representative contributed to the study design, refinement of interview guides and written materials, and discussions of findings to support relevance and trustworthiness. Participants and recruitment Purposeful sampling was applied [ 19 ]. Young adults with cancer were eligible if they at diagnosis were between 18–39 years and diagnosed with a haematological or oncological cancer within the past five years and at least six months prior to recruitment - either in active or palliative treatment (chemotherapy, radiotherapy, immunotherapy, or targeted therapy) or in follow-up. Participants had to be able to read, understand, and speak Danish and provide informed consent and were excluded if they had received surgical treatment only or had a life expectancy of less than six months. The informal caregivers were identified by the young adults with cancer as significant persons (partner, spouse, or friend) involved in their cancer trajectory. They had to be aged ≥ 18 years, able to read, understand, and speak Danish, and provide informed consent. The informal caregivers were excluded if they were healthcare professionals involved in the patient’s cancer care or family members other than spouses (e.g., parent, sibling, child, other relatives). The recruitment aim was two young adults with cancer from each university hospital, ensuring variation in cancer type (haematological/oncological), age, gender, and geographical variation. Clinicians at the hospitals approached eligible patients during visits and provided written and oral study information. Patients who expressed interest were contacted by a researcher from the NAYACareDK project group. Participating young adults with cancer were asked to invite one or two informal caregivers. If an informal caregiver was interested, the young adult with cancer forwarded the informal caregiver’s contact details to the researcher, who then provided written and oral information. Data collection Data were collected from March to September 2025 through individual semi-structured interviews at a time and location chosen by participants (hospital office, online, or by telephone). Separate interview guides were developed for young adults with cancer and the informal caregivers and pilot tested with an eligible young adult with previous cancer and an eligible informal caregiver (not parent or sibling); guides were subsequently adjusted to ensure clarity and relevance. Interviews were conducted by experienced qualitative researchers (LB, TL, AKHS, HE, LBT, MLKJ). Interview questions were flexibly adapted in response to participants’ answers to support a natural conversational flow [ 17 , 20 ]. Interviews were audio-recorded and transcribed verbatim. Data analysis Interviews were transcribed verbatim by LB, TL, AKHS, HE, LBT, MLKJ using a shared transcription guide to ensure uniformity [ 21 ]. Transcripts were analysed using reflexive thematic analysis inspired by Braun and Clarke’s six steps [ 14 ]. The analytic process involved iterative reading, initial coding, development and refinement of themes, and interpretative synthesis. To capture contextual nuances and strengthen credibility, researchers (LB, KP, MJ, MKFI, MEC, AKHS, HE, MKJ, LBT, MBB, ER) initially coded transcripts independently within their respective sites. NVivo (version 14) supported data management in three of five university hospitals. Preliminary codes were then presented and discussed in the full author group to reconcile interpretations and agree on final themes. To support reflexivity during theme development, the team engaged in ongoing collaborative discussions and peer debriefing. These practices were used to reflect on assumptions, positionalities, and potential biases and to strengthen the credibility and depth of the thematic findings. These discussions were not aimed at achieving inter-coder reliability, but rather at deepening interpretative engagement with the data through reflexive dialogue across disciplinary and clinical perspectives, in line with reflexive thematic analysis [ 14 ]. Although the study draws on a dyadic perspective, interviews were conducted individually with young adults with cancer and their self-chosen informal caregivers. The term “dyadic” is therefore used conceptually to capture relational processes, shared meaning-making, and mutual influence across perspectives, rather than as a formal dyadic analytic design. Analytically, themes were developed across accounts from both parties to illuminate relational dynamics over the cancer trajectory, rather than to compare or match paired interviews. The researchers’ clinical backgrounds were treated as an analytic resource, informing sensitivity to relational processes in supportive cancer care, while reflexive dialogue was used to interrogate assumptions and maintain analytic openness. Ethical considerations The project was reported to local Data Protection authorities at all five sites, and a national collaboration agreement was signed from all participating sites. Under Danish legislation, the study did not require approval from a scientific ethical committee because it involved interviews without further intervention [ 22 ]. In accordance with the Helsinki Declaration [ 23 ], all participants received written and oral information about voluntary participation, pseudonymity, and the right to withdraw at any time without consequences for current or future contact with the Danish healthcare system prior to providing written informed consent. Results Interviews were audio-recorded and lasted 31–80 minutes (mean 56 minutes). Out of 11 invited young adults with cancer, 9 consented to participate; Five young adults with cancer participated with one informal caregiver and four with two informal caregivers (each relation defined as dyads). All 13 invited informal caregivers participated. The ages of the young adults with cancer ranged from 23 to 36 years (mean 29.2), and informal caregiver were age ranged from 22 to 34 years (mean 28.7). The informal caregivers were partners (n = 6), friends (n = 6), or a spouse (n = 1). Participant characteristics are presented in Table 1 a (young adults with cancer) and 1b (informal caregivers). Table 1 a Demographic and cancer related clinical data of the young adults with cancer (n = 9) N Gender Female 4 Male 5 Mean age at interview, y (range) 29,2 (23–36) Highest educational degree a Secondary (vocational) education or less 3 University college 3 University 3 Cancer type Oncological cancer b 4 Haematological cancer c 5 Time since diagnosis 0–1 year 2 2–5 years 7 Treatment received d Chemotherapy 8 Radiation 4 Surgery 4 Bone marrow transplantation 3 Other e 4 a The classification is based on International Standard Classification of Education (ISCED 97) b E.g., mesothelia tunica vaginalis testis, brain tumor, breast cancer c E.g., leukaemia, lymphoma d Multiple answers possible e Targeted therapy, antihormonal therapy, immune therapy Table 1 b Demographic data of the informal caregivers (n = 13) N Relation Partner/spouse 7 Friend 6 Gender Female 10 Male 3 Mean age at interview, y (range) 28,7 (22–34) Highest educational degree a Secondary (vocational) education or less 7 University college 3 University 3 The interviews lasted 31–80 minutes (mean 56 minutes). Three overarching themes with associated subthemes were identified: (1) Holding on to Normality in a Youth Life on Pause, (2) Navigating Help, Needs, and Boundaries, and (3) Shifting Roles in the Relationship. The three themes are described below and quotations linked to each theme are presented in Table 2 . Holding on to Normality in a Youth Life on Pause Normality was continuously redefined in everyday interactions and renegotiated as roles and perspectives shifted. While informal caregivers broadly shared a commitment to “keeping things normal,” partners and friends differed in expectations and ways of being involved. Co-constructing normality in a disrupted daily life Across the relationship between the young adults with cancer and their informal caregiver, ordinary routines were used to create “breathing spaces” where cancer did not define daily life. Walks, shared meals, TV series, and seeing friends helped affirm the young adults with cancer as more than a patient. Young adults with cancer described relief in being treated as a young person with everyday concerns, while informal caregivers described deliberate efforts to sustain positivity and protect the relationship from being overshadowed by illness (Table 2 , quote 1). A difference appeared among informal partner caregivers versus informal friend caregivers. Partners often experienced an expectation, also from family and healthcare professionals, of continuous hands-on involvement. They assumed logistical and practical tasks while trying to preserve a sense of “us”. Friends typically provided more episodic support, reintroducing pre-illness activities and social outings without daily caregiving obligations. Friends experienced the ongoing puzzle of wanting to help without overstepping (Table 2 , quote 2). Normality was repeatedly challenged by physical, emotional, and social changes. Bodily changes (e.g., hair loss, weight changes, fatigue) made the private visible and complicated self-presentation in youth contexts such as study, work, and nightlife (Table 2 , quote 3). Young adults with cancer described feeling exposed, while the informal caregivers adjusted to fluctuating mood and energy, particularly around follow-up cycles (Table 2 , quote 4). Work and study were central markers of “getting back,” but returning also required redistribution of everyday responsibilities. Resuming full-time work could signal moving forward, yet practical burdens often shifted: partners more frequently took over household tasks, whereas friends maintained social connection and discretion without requiring disclosure (Table 2 , quote 5). Young adults described the “double work” of being both “the sick one” and a whole person in youth settings, sometimes performing strength to protect others, sometimes withdrawing to manage exposure. Partners described arriving at a “new normal” after periods of feeling “less partner, more organiser,” before gradually finding their way back to couple hood (Table 2 , quote 6). Anticipating and fearing the future at the same time Looking beyond treatment, futures were drafted and redrafted. Young adults with cancer described a lasting “before and after” shaping decisions about study, work, holidays, and moving. Follow-up appointments reintroduced uncertainty, and late effects or fluctuating energy required contingency. Partners more often anticipated shared timelines and joint decision-making, which intensified the weight of planning, while friends tended to support belonging and near-term goals without expectations of long-term life plans (Table 2 , quote 7). For some young adults with cancer, living more in the present became a way of coping, while partners and friends often remained oriented toward established adult aspirations (Table 2 , quote 8). Friends also described the future as containing both worry and hope, making it easier to focus on the present rather than plan too far ahead (Table 2 , quote 9). Fertility concerns emerged as part of future-oriented thinking. Some dyads described sustained wishes for children alongside uncertainty about recurrence and treatment effects. Partners sometimes held worries back to protect the other, while young adults with cancer at times postponed fertility conversations to avoid straining the relationship (Table 2 , quote 10). In one case, ambivalence about the future was intensified by a newer relationship; imagining solitude appeared as a seemingly simpler alternative, reflecting the strain of both needing support and not wanting to burden the partner (Table 2 , quote 11). Navigating needs, boundaries, and mutual protection Across relationships, the dyads described ongoing negotiation between expressing needs, setting boundaries, and protecting each other. Asking for help could feel exposing and burdensome, especially when requests were unmet (Table 2 , quote 12). Young adults with cancer found concrete, proactive offers easier to accept than open-ended invitations such as “let me know if I can help” (Table 2 , quotes 13–14). Informal caregivers were strongly motivated to assist, yet uncertainty about when and how to act could make even well-intended support feel pressuring. Friends more often set limits, for example by not attending hospital appointments, whereas partners typically provided daily practical and logistical support. Practical needs were most pronounced when the young adults with cancer’s energy was low and often eased over time. Several described a “team” approach, distributing tasks among partners and family to avoid overburdening a single informal caregiver (Table 2 , quote 15). However, when responsibilities were assumed to be covered by “someone else,” support could fall through (Table 2 , quote 16). Mutual protection frequently meant down-prioritising one’s own needs. Some informal caregivers described setting aside their well-being to support the young adults with cancer, which felt understandable but difficult to sustain alongside work, family, and household duties (Table 2 , quote 17). Similarly, young adults with cancer described trying to protect their informal caregivers by maintaining morale and consideration even when depleted. Both sides regulated emotions and effort to avoid overburdening the other; this was often experienced as protective but could be emotionally taxing and sometimes create distance (Table 2 , quotes 18–19). Some informal caregivers also described needing boundaries to protect their own well-being while staying present (Table 2 , quote 20). During hospital stays, periods of separation could be distressing for both young adults with cancer and partner, highlighting tensions between caregiving demands and everyday life (Table 2 , quote 21). Informal caregivers primarily sought support from family or friends to release frustration without burdening the young adults with cancer; professional or organisational support was rarely used (Table 2 , quote 22). Shifting Roles in the Relationship Across the cancer trajectory, roles shifted in ways that could feel meaningful yet challenging in the context of young adult life. Between love and logistics The dyads described how the original relationship role (partner/close friend) became insufficient as care responsibilities expanded. Young adults with cancer noted a visible shift from being “the friend” to becoming “the one with cancer,” making ordinary social situations harder to navigate (Table 2 , quote 23). Some consciously downplayed symptoms and performed strength to protect partners and friends from the full weight of illness (Table 2 , quote 24). Partners described how partnership increasingly merged with practical caregiving: cooking, cleaning, medication management, coordinating hospital appointments, and providing care (Table 2 , quote 25). Some described being “used as a nurse” for wound care, which prompted deliberate reminders of relational boundaries (Table 2 , quote 26). When one person became the primary “fixer,” informal caregivers could feel isolated and sometimes set emotional limits, for example by not absorbing every existential worry (Table 2 , quote 27). Circles of closeness Support was typically organised as a layered and shifting network around the young adults with cancer. Partners were often positioned in the innermost circle and expected to attend hospital visits and participate in decisions, while friends tended to occupy a supportive role with fewer obligations (Table 2 , quote 28). In some dyads, a friend moved into the inner circle, particularly when a friendship developed into a romantic relationship during the trajectory and could begin joining consultations and sometimes “take over” from a parent (Table 2 , quote 29). Placement also depended on the maturity of the couple relationship; newer relationships did not automatically supersede parental involvement (Table 2 , quote 30). Friends often supported from a respectful distance, offering emotional support, distraction, and everyday normality while deferring to parents or partners, creating an “in-between” position of being “very close and yet far away” (Table 2 , quotes 31–32). From this position, friends continually balanced being present with not overstepping the inner circle. Table 2 Themes, subthemes, and quotes. Quotes are not presented in dyads Themes Subthemes Quotes Holding on to Normality in a Youth Life on Pause Co-constructing normality in a disrupted daily life Quote 1: “…it was important just to forget about it once in a while, to have that kind of free space” [Female, informal caregiver, partner] Quote 2: “It was hard to strike a balance between doing too much and doing too little” (Female, informal caregiver, friend) Quote 3: “…I was the bald one… something private suddenly became public” [Female, young adult with cancer, dyadic with friends] Quote 4: “…he becomes a slightly different person when he has to go for a check-up” [Female, informal caregiver, partner] Quote 5: “…it costs that I work full-time now… I need to relax more, so [my partner] takes the lead on cooking” [Male, young adult with cancer, dyadic with partner] Quote 6: “Periods where you have been a little less like a couple and a little more… [practical]… but… we have stood by it” [Female, informal caregiver, partner] Anticipating and fearing the future at the same time Quote 7: “…I feel there is a before and after… I spend an incredible amount of energy on illness and hospital” [Male, young adult with cancer, dyadic with partner] Quote 8: “I have more of the approach that I don’t know if I have tomorrow – so I just need to get everything out of it(…) she [the informal caregiver] is moving into a more established adult life, whereas I am still more like ‘Okay, now something else needs to happen’” [Female, young adult with cancer, dyadic with friends] Quote 9: “Well… I am always worried about how long we will get to have her… I think I try to remember to enjoy it as long as we have each other – to focus on creating good memories and great experiences together” [Female, informal caregiver, friend] Quote 10: “…we quickly agreed that we want to have children… but it is still a concern” [Female, informal caregiver, partner] Quote 11: “…sometimes I have thought that it would be easier if I didn’t have [a partner]…” [Female, young adult with cancer dyadic with partner] Navigating needs, boundaries, and mutual protection Quote 12: “It is hard enough to ask for help… when you experience that your request are not met” [Female, young adult with cancer, dyadic with friend] Quote 13: “…I can feel a bit like a burden… it is just really hard for me to ask for help… can you make a lasagna?” [Male, young adult with cancer, dyadic with partner] Quote 14: “The worst thing people can do is say ‘just let me know’… the best is simply to call and ask: how about Thursday?” [Male, young adult with cancer, dyadic with partner] Quote 15: “…it was kind of like a team… everyone sort of stepped up” [Male, young adult with cancer, dyadic with partner] Quote 16: “Everyone thinks others are doing something… [it becomes/I felt] lonely” [Female, young adult with cancer, dyadic with friend] Quote 17: “Well, you have probably somehow had to put yourself a bit more aside… during the cancer course, you probably put it a bit aside, your own things I mean…” [Female, informal caregiver, partner] Quote 18: “I think it would be somewhat unnecessary for F to have to deal with that (the friends concerns) when she already had enough to think about” [Female, young adult with cancer, dyadic with friends] Quote 19: “…bring the good mood along… I am proud of how I have handled the whole process… to be decent towards… family and friends.” [Male, young adult with cancer, dyadic with partner] Quote 20: “The fact that she could, as far as possible, still live a life and still do things with friends […] I don’t think that has been negative, but I simply think that is just to take care of oneself.” [Male, young adult with cancer, dyadic with partner] Quote 21: “[My partner] also had a hard time letting go of me […] it’s strange, you know, that you’re just left at a hospital. I can just go home and live my life, and [my partner’s] life has just come to a standstill, right?” [Female, YA informal caregiver, partner] Quote 22: “Nothing more than just talking about it with my family… that has also been difficult; many of my closest friends are also colleagues with him, so there had to be a boundary… things that are private… I haven’t sought any help from anywhere.” [Female, YA informal caregiver, partner] Shifting Roles in the Relationship Between love and logistics Quote 23: “…it was hard to have to sit in a room and be her friend, when I was also the one who was ill with cancer” [Female, YA with cancer, single]. Quote 24: “…I felt I was protecting them by staying positive and continuing to contribute to everyday life, even if I could not perform an entirely ‘equal’ relationship” [Female, YA with cancer, in relation with partner] Quote 25: “She, after all, had to be there after my surgeries, where she has been a caregiver and, yes, a cook and had to do the cleaning, while I have just been lying completely still… she has had to manage everything alone” [Male, YA with cancer, in relation with partner] Quote 26: “I am a relative, not a health professional” [RH3a] Quote 27: “I can’t have that conversation… to give that awful thought space… feels like the thing that could get me down” (Female, YA informal caregiver, partner). Circles of closeness Quote 28: “My family… was closer… [but the friend] was also a relative” [Male, YA with cancer, in relation with partner] Quote 29: “Now… [she is] coming along to all the check-ups… before, my mother came along a lot” [Male, YA with cancer, in relation with partner] Quote 30: “It depends on where you are in the relationship… back then it was most natural that it was my parents who were the closest” [Male, YA with cancer, in relation with partner] Quote 31: “You do come from far away, even though the feelings are strong… you are at a distance. I also think that’s how we should be. But get as close as possible…” [Female, YA informal caregiver, friend] Quote 32: “Hard to find that balance between how much and how little one could do” [Female, YA informal caregiver, friend] Discussion This study illustrates how young adults with cancer and their self-chosen informal caregivers jointly navigate cancer during a formative life phase. When cancer interrupts a life phase characterised by identity formation and relational change, both parties may face responsibilities they feel only partially prepared for. Across dyads, our findings point to a shared cancer trajectory of holding on to normality in a changed daily life. Creating “breathing spaces” through ordinary routines helped keep the relationship anchored in everyday youth life rather than being dominated by illness, supporting previous findings [ 12 ]. Efforts to maintain normality were repeatedly tested by treatment consequences, fluctuating energy, and shifting participation in youth contexts. Returning to work or study was experienced as both a marker of moving forward and a trigger for redistributing practical responsibilities in the network, typically with partners absorbing day-to-day tasks while friends maintained connection and discretion. This duality resonates with previous studies documenting high rates of return to work among young adult cancer survivors alongside reduced hours, role renegotiations, and financial strain; it also aligns with emerging survivorship literature framing disability-related barriers and accommodations as part of young adults with cancer’ post-treatment identity work [ 24 – 26 ]. Looking beyond treatment, both young adults with cancer and their informal caregivers described futures that were continually revised. Follow-up appointments and concerns about late effects meant that uncertainty persisted beyond treatment, rendering future planning tentative rather than stable. This resonates with survivorship literature describing ongoing health-related risk and fragmented follow-up in AYAs with cancer, and the resulting need for structured, developmentally appropriate survivorship care [ 27 , 28 ]. Dyads also navigated different temporalities: some young adults with cancer leaned toward living in the present, whereas partners often oriented to longer-term couple timelines. Previous research indicates that future-oriented concerns, such as fear of recurrence, fertility, and financial insecurity, may conflict with a more present-focused coping approach, creating ambivalence and misalignment within close relationships [ 29 ]. Fertility concerns were emblematic of this future-work: several dyads postponed or protected fertility conversations to avoid adding strain, mirroring qualitative studies where AYAs describe hope for future parenthood amid rushed decisions at diagnosis and ongoing uncertainty about reproductive potential [ 30 – 32 ]. Another key finding concerns the ongoing negotiation of help, needs, and boundaries. Young adults with cancer expressed ambivalence about asking for support and fears of burdening others, while the informal caregivers described uncertainty about when and how to step in. Our findings align with dyadic coping research and meta-analytic evidence: supportive dyadic coping is linked with better emotional functioning and relationship quality, whereas negative dyadic coping and protective buffering (hiding one’s worries to shield the other) are associated with poorer adjustment [ 6 , 33 ]. A previous study described how informal caregivers often found it emotionally difficult to step back for work, study, or everyday obligations. Although the practical necessity was generally acknowledged, doing so could feel painful, especially when it underscored the contrast between a life “on pause” and a life that continues [ 34 ]. This mirrors our findings where informal caregivers primarily sought support from family or friends, while professional or organisational support was rarely accessed, consistent with reports of limited formal support options for young adults with cancer and their informal caregivers [ 35 , 36 ]. Finally, our findings show how changed needs were embedded in shifting relational roles and circles of closeness. Partners were often positioned in the innermost circle with expectations of near-constant availability and involvement, while friends occupied a supportive role that was emotionally close yet often more flexible. Friends described an “in-between” position, close but holding back when parents or partners were present, reflecting nuanced relational work across the trajectory. Our results also suggest that newer romantic relationships may coexist with strong parental involvement, complicating expectations about who is “closest” and who takes on which tasks. These shifting roles are not only burdensome; they also highlight the capacity for support and resilience within young adult relationships [ 9 , 10 ]. Clinically, our findings together with others suggest that healthcare professionals should recognise and, where relevant, engage the broader social network around young adults with cancer, validating both partners and friends as important caregivers and attending to the relational work required to keep relationships from being reduced to care alone [ 37 , 38 ]. Supporting clarity around boundaries, practical coordination, and communication may help transform role shifts from hidden strain into a shared resource for coping [ 39 ]. In practice, this may involve explicitly asking young adults with cancer whom they consider significant supporters, inviting partners or friends into consultations when appropriate, and briefly addressing how support is organized and negotiated in everyday life. Simple, structured questions about boundaries, unmet needs, and role expectations may help identify relational strain early, particularly as professional support was rarely accessed despite substantial caregiving demands. Strengths and limitations This national, multicentre qualitative study included participants across Denmark’s university hospitals, supporting variation and transferability [ 40 ]. A strength was the collaboration with a patient representative in the development of the study, and that the interview guide was pilot tested with a young adult cancer survivor and a self-chosen informal caregiver. Also strengthen the study was that the data collection and reporting followed COREQ-32, and analysis involved a multidisciplinary author group. Limitations include the involvement of five interviewers, which may have introduced variation in interviewing style. However, shared preparation and the use of a common interview guide helped promote consistency across interviews. To ensure pseudonymity, findings were not presented by hospital, diagnosis, or treatment context, limiting contextual detail. In addition, the involvement of multiple researchers may have led to an emphasis on overarching patterns at the expense of finer nuances, despite iterative discussions throughout the analytic process. Conclusion Young adults with cancer and their self-chosen informal caregivers described their relational experiences during the cancer trajectory. Rather than individual experiences, the illness was experienced as something lived together , influencing roles, responsibilities, and emotional responses within the relationship. Across dyads, both the young adults with cancer and the informal caregivers worked to hold on to normality through “breathing spaces” in everyday life, negotiated help, needs and boundaries, and adapted to shifting roles between love and logistics within changing circles of closeness. Professional support was rarely accessed, leaving much coordination to relationships and informal networks. Clinically, recognising partners and friends as involved in the cancer trajectory and supporting communication and role negotiation may strengthen dyadic coping in a vulnerable life phase for all involved. Declarations Conflict of interest The authors declare they have no conflict of interest. Ethics approval The project was reported to and granted permission at the local Data Protection authorities at the Northern region of Denmark, the Central region of Denmark, the Southern Region of Denmark, Region Zealand and the Capitol Region of Denmark. In accordance with Danish law, a national collaboration agreement was signed from all participating sites. Under Danish legislation, the study did not require approval from a scientific ethical committee because it involved interviews without further intervention. Acknowledgments We are grateful to the young adults and their young adult informal caregivers who generously dedicated their time and participated in the interviews. We would also like to express our appreciation to the youth support centres in Denmark, for their valuable assistance in facilitating the recruitment process. This study is conducted on behalf of the Network for Adolescents and Young Adults with cancer’ research in Denmark (NAYACareDK). Funding disclosures This research received no external funding. Author contributions Conceptualization of the research project: MEC, HE, LBT, HP, LIBC, MBB and LB; methodology and formal analysis: MEC, HE, LBT, HP, MBB, LHJ, MH, AKHS, TL, KP, MLKJ, ER, ABS and LB; writing, original draft preparation, MEC and LB; writing, review and editing, HE, LBT, HP, MBB, LHJ, MH, AKHS, KP, TL, MLKJ, ABS and ER; supervision, LB; project administration, MEC and LB; All authors have read and agreed to the published version of the manuscript. 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Int J Qual Health Care 2007;19:349–57. https://doi.org/10.1093/intqhc/mzm042 . Danish Comprehensive Cancer Centre D. Network for AYA cancer research in Denmark – NAYAcare DK n.d. https://www.dccc.dk/english/projectsandnetwork/network-for-aya-cancer-research-in-denmark--nayacare-dk/ (accessed January 14, 2025). Andrade C. The Inconvenient Truth About Convenience and Purposive Samples. Indian Journal of Psychological Medicine 2021;43:86–8. https://doi.org/10.1177/0253717620977000 . Brinkmann S. Unstructured and Semistructured Interviewing. In: Leavy P, editor. The Oxford Handbook of Qualitative Research. 2nd ed., Oxford University Press; 2020, p. 424–56. https://doi.org/10.1093/oxfordhb/9780190847388.013.22 . Kvale S, Brinkmann S. InterViews: an introduction to qualitative research interviewing. Nachdr. Thousand Oaks [u.a]: Sage; 2005. Ministry of the Interior and Health of Denmark[Indenrigs- og Sundhedsministeriet]. Announcement of law on science ethics treatment of projects in health research and health data research [Bekendtgørelse af lov om videnskabsetisk behandling af sundhedsvidenskabelige forskningsprojekter og sundhedsdatavidenskabelige forskningsprojekter]. 2020. Gandevia B, Tovell A. DECLARATION OF HELSINKI. Med J Aust 1964;2:320–1. Leuteritz K, Friedrich M, Sender A, Richter D, Mehnert-Theuerkauf A, Sauter S, et al. Return to Work and Employment Situation of Young Adult Cancer Survivors: Results from the Adolescent and Young Adult-Leipzig Study. J Adolesc Young Adult Oncol 2021;10:226–33. https://doi.org/10.1089/jayao.2020.0055 . Braun I, Friedrich M, Morgenstern L, Sender A, Geue K, Mehnert-Theuerkauf A, et al. Changes, challenges and support in work, education and finances of adolescent and young adult (AYA) cancer survivors: A qualitative study. Eur J Oncol Nurs 2023;64:102329. https://doi.org/10.1016/j.ejon.2023.102329 . Vongthavaravat LR, Chang LM, Steele NZR, McArthur AR. Disability experiences and quality of life in adolescent and young adult cancer survivors: a scoping review. J Cancer Surviv 2026. https://doi.org/10.1007/s11764-025-01964-5 . Tindle D, Windsor C, Yates P. Centralizing Temporality in Adolescent and Young Adult Cancer Survivorship. Qual Health Res 2019;29:173–83. https://doi.org/10.1177/1049732318797087 . Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, et al. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017;26:1659–72. https://doi.org/10.1007/s11136-017-1520-x . L Sampson R, McDonald FEJ, O Mancini V, M McEvoy P, L Finlay-Jones A. The Role of Friends in Supporting Young People With Cancer: A Scoping Review. Psychooncology 2025;34:e70107. https://doi.org/10.1002/pon.70107 . Bentsen L, Pappot H, Hjerming M, Hanghøj S. Thoughts about fertility among female adolescents and young adults with cancer: a qualitative study. Support Care Cancer 2023;31:421. https://doi.org/10.1007/s00520-023-07887-0 . Bentsen L, Aagesen M, Hjerming M, Jørgensen N, Pappot H. Navigating an uncertain future: a qualitative study exploring thoughts about fertility and oncofertility counseling among young men with cancer. Support Care Cancer 2024;33:28. https://doi.org/10.1007/s00520-024-09066-1 . Benedict C, Shuk E, Ford JS. Fertility Issues in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2016;5:48–57. https://doi.org/10.1089/jayao.2015.0024 . Liu Y, Yu F, Qiao S, Zhang D, Su Y. Gender differences between dyadic coping and emotional distress in young and middle-aged cancer patients and spouses. Support Care Cancer 2025;33:665. https://doi.org/10.1007/s00520-025-09714-0 . Sodergren SC, Husson O, Rohde GE, Tomaszewska IM, Vivat B, Yarom N, et al. A Life Put on Pause: An Exploration of the Health-Related Quality of Life Issues Relevant to Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2018;7:453–64. https://doi.org/10.1089/jayao.2017.0110 . Sleeman SHE, Reuvers MJP, Van Der Veldt MH, Manten-Horst E, Husson O. ‘What Really Goes on in My Cancer Bubble, They Cannot Understand’: Social Functioning Among Adolescent and Young Adult (AYA) Cancer Patients. Current Oncology 2025;32:501. https://doi.org/10.3390/curroncol32090501 . Reuvers MJP, Burgers VWG, Vlooswijk C, Verhees B, Husson O, van der Graaf WTA. Same Journey, Different Paths: Caregiver Burden among Informal Caregivers of Adolescent and Young Adult Patients with an Uncertain or Poor Cancer Prognosis (UPCP). J Clin Med 2023;13:158. https://doi.org/10.3390/jcm13010158 . Pennant S, C. Lee S, Holm S, Triplett K, Howe-Martin L, Campbell R, et al. The Role of Social Support in Adolescent/Young Adults Coping with Cancer Treatment. Children 2019;7:2. https://doi.org/10.3390/children7010002 . Riis Olsen P, Harder I. Caring for teenagers and young adults with cancer: A grounded theory study of network-focused nursing. European Journal of Oncology Nursing 2011;15:152–9. https://doi.org/10.1016/j.ejon.2010.07.010 . Janssen SHM, Vlooswijk C, Manten-Horst E, Sleeman SHE, Bijlsma RM, Kaal SEJ, et al. Learning from long-term adolescent and young adult (AYA) cancer survivors regarding their age-specific care needs to improve current AYA care programs. Cancer Med 2023. https://doi.org/10.1002/cam4.6001 . Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet 2001;358:483–8. https://doi.org/10.1016/S0140-6736(01)05627-6 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 05 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviews received at journal 27 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviewers invited by journal 18 Mar, 2026 Editor assigned by journal 18 Mar, 2026 Submission checks completed at journal 13 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8834415","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608413966,"identity":"d6b92edb-70ee-4f52-995c-72dc29039a88","order_by":0,"name":"Marie Ernst 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Line","middleName":"","lastName":"Bentsen","suffix":""}],"badges":[],"createdAt":"2026-02-09 21:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8834415/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8834415/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105564530,"identity":"de243875-e5b0-4f8e-80dc-7a66fa0c0dba","added_by":"auto","created_at":"2026-03-27 12:49:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":741617,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8834415/v1/fc327815-b02a-4d13-9a6c-c37ab29141b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relations in young adults with cancer: Acknowledging partners and friends as informal caregivers – A Danish National study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eYoung adults, aged 18\u0026ndash;39 years, face crucial challenges as they develop their identities, often accompanied by a natural process of detachment from their parents, and begin to build significant relationships in education, career, and romance, and establishing their own family life [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This period of exploration and personal growth is profoundly disrupted by a cancer diagnosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cancer adds significant stress, impacting not only health-related quality of life but also interferes with the young adults\u0026rsquo; emerging independence and need for support [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLike in paediatric oncology, research focus on the impact of cancer on young adults and their familial relationships, particularly highlighting the role of parents as primary caregivers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This emphasis on parents has provided valuable insights into the psychosocial effects of cancer within families. However, this perspective may overlook the broader social support network of young adults, which includes friends and partners [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite their increasing importance in young adults\u0026acute; everyday lives, there remains limited knowledge about the role of informal caregivers such as friends and partners and how they contribute to the provision of emotional and practical support. These relationships are increasingly central to young adults\u0026rsquo; lives, offering emotional support and helping maintain their identity and sense of normalcy despite their cancer experience [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is a significant gap in understanding the challenges faced by friends and partners who are key supportive persons for young adults with cancer. For instance, young adult cancer patients and their partners reported difficulties such as changes in communication, disruptions in expected life milestones, and challenges related to intimacy and body image during the cancer trajectory [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, a scoping review on caregiver burden among adolescents and young adults with cancer found that caregivers beyond parents (including partners and friends) are indeed involved [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Thereby, caregivers are often treated as a homogeneous group in research, which may blur the distinct challenges faced by different caregiver populations. This limits insights into the unique dynamics of non-parental and non-sibling caregivers. Finally, another scoping review underscored both the value of friends\u0026rsquo; support and the challenges they encounter, while also emphasizing the lack of studies specifically examining friends\u0026rsquo; perspectives and needs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo understand the challenges young adult cancer patients and their close informal caregivers (friends and partners) face, a nuanced exploration is needed. This may inform a more holistic and person-centred care. Thus, this study aimed to explore the relational experiences of young adults with cancer and their self-chosen informal caregivers throughout the cancer trajectory.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eThis study used a qualitative design with individual semi-structured interviews and reflexive thematic analysis involving young adults with cancer and their self-chosen informal caregivers (hereafter referred only to informal caregivers) [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSetting and patient representative involvement\u003c/p\u003e \u003cp\u003eThe study was initiated within the Danish Research Network National Adolescents and Young Adults Cancer Research in Denmark (NAYACareDK) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and informed by experiences from patient representatives in the network, who emphasised the importance of partners and friends during the cancer trajectory while also recognising challenges faced by the informal caregivers.\u003c/p\u003e \u003cp\u003eThis national, multicentre study was conducted in oncology and haematology settings at all five Danish University Hospitals. The project group, formed within NAYACareDK, was multidisciplinary (nurses, physicians, psychologist, nutritionist) with both research and clinical backgrounds. The patient representative contributed to the study design, refinement of interview guides and written materials, and discussions of findings to support relevance and trustworthiness.\u003c/p\u003e \u003cp\u003eParticipants and recruitment\u003c/p\u003e \u003cp\u003ePurposeful sampling was applied [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Young adults with cancer were eligible if they at diagnosis were between 18\u0026ndash;39 years and diagnosed with a haematological or oncological cancer within the past five years and at least six months prior to recruitment - either in active or palliative treatment (chemotherapy, radiotherapy, immunotherapy, or targeted therapy) or in follow-up. Participants had to be able to read, understand, and speak Danish and provide informed consent and were excluded if they had received surgical treatment only or had a life expectancy of less than six months.\u003c/p\u003e \u003cp\u003eThe informal caregivers were identified by the young adults with cancer as significant persons (partner, spouse, or friend) involved in their cancer trajectory. They had to be aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, able to read, understand, and speak Danish, and provide informed consent. The informal caregivers were excluded if they were healthcare professionals involved in the patient\u0026rsquo;s cancer care or family members other than spouses (e.g., parent, sibling, child, other relatives).\u003c/p\u003e \u003cp\u003eThe recruitment aim was two young adults with cancer from each university hospital, ensuring variation in cancer type (haematological/oncological), age, gender, and geographical variation. Clinicians at the hospitals approached eligible patients during visits and provided written and oral study information. Patients who expressed interest were contacted by a researcher from the NAYACareDK project group. Participating young adults with cancer were asked to invite one or two informal caregivers. If an informal caregiver was interested, the young adult with cancer forwarded the informal caregiver\u0026rsquo;s contact details to the researcher, who then provided written and oral information.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eData were collected from March to September 2025 through individual semi-structured interviews at a time and location chosen by participants (hospital office, online, or by telephone). Separate interview guides were developed for young adults with cancer and the informal caregivers and pilot tested with an eligible young adult with previous cancer and an eligible informal caregiver (not parent or sibling); guides were subsequently adjusted to ensure clarity and relevance.\u003c/p\u003e \u003cp\u003eInterviews were conducted by experienced qualitative researchers (LB, TL, AKHS, HE, LBT, MLKJ). Interview questions were flexibly adapted in response to participants\u0026rsquo; answers to support a natural conversational flow [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Interviews were audio-recorded and transcribed verbatim.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eInterviews were transcribed verbatim by LB, TL, AKHS, HE, LBT, MLKJ using a shared transcription guide to ensure uniformity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Transcripts were analysed using reflexive thematic analysis inspired by Braun and Clarke\u0026rsquo;s six steps [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The analytic process involved iterative reading, initial coding, development and refinement of themes, and interpretative synthesis.\u003c/p\u003e \u003cp\u003eTo capture contextual nuances and strengthen credibility, researchers (LB, KP, MJ, MKFI, MEC, AKHS, HE, MKJ, LBT, MBB, ER) initially coded transcripts independently within their respective sites. NVivo (version 14) supported data management in three of five university hospitals. Preliminary codes were then presented and discussed in the full author group to reconcile interpretations and agree on final themes. To support reflexivity during theme development, the team engaged in ongoing collaborative discussions and peer debriefing. These practices were used to reflect on assumptions, positionalities, and potential biases and to strengthen the credibility and depth of the thematic findings. These discussions were not aimed at achieving inter-coder reliability, but rather at deepening interpretative engagement with the data through reflexive dialogue across disciplinary and clinical perspectives, in line with reflexive thematic analysis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the study draws on a dyadic perspective, interviews were conducted individually with young adults with cancer and their self-chosen informal caregivers. The term \u0026ldquo;dyadic\u0026rdquo; is therefore used conceptually to capture relational processes, shared meaning-making, and mutual influence across perspectives, rather than as a formal dyadic analytic design. Analytically, themes were developed across accounts from both parties to illuminate relational dynamics over the cancer trajectory, rather than to compare or match paired interviews.\u003c/p\u003e \u003cp\u003eThe researchers\u0026rsquo; clinical backgrounds were treated as an analytic resource, informing sensitivity to relational processes in supportive cancer care, while reflexive dialogue was used to interrogate assumptions and maintain analytic openness.\u003c/p\u003e \u003cp\u003eEthical considerations\u003c/p\u003e \u003cp\u003eThe project was reported to local Data Protection authorities at all five sites, and a national collaboration agreement was signed from all participating sites. Under Danish legislation, the study did not require approval from a scientific ethical committee because it involved interviews without further intervention [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In accordance with the Helsinki Declaration [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], all participants received written and oral information about voluntary participation, pseudonymity, and the right to withdraw at any time without consequences for current or future contact with the Danish healthcare system prior to providing written informed consent.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eInterviews were audio-recorded and lasted 31\u0026ndash;80 minutes (mean 56 minutes). Out of 11 invited young adults with cancer, 9 consented to participate; Five young adults with cancer participated with one informal caregiver and four with two informal caregivers (each relation defined as dyads). All 13 invited informal caregivers participated. The ages of the young adults with cancer ranged from 23 to 36 years (mean 29.2), and informal caregiver were age ranged from 22 to 34 years (mean 28.7). The informal caregivers were partners (n\u0026thinsp;=\u0026thinsp;6), friends (n\u0026thinsp;=\u0026thinsp;6), or a spouse (n\u0026thinsp;=\u0026thinsp;1). Participant characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea (young adults with cancer) and 1b (informal caregivers).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea Demographic and cancer related clinical data of the young adults with cancer (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGender\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMean age at interview, y (range)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,2 (23\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHighest educational degree\u003c/em\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary (vocational) education or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCancer type\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOncological cancer\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaematological cancer\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTime since diagnosis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTreatment received\u003c/em\u003e\u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone marrow transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e The classification is based on International Standard Classification of Education (ISCED 97)\u003c/p\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003e E.g., mesothelia tunica vaginalis testis, brain tumor, breast cancer\u003c/p\u003e \u003cp\u003e\u003csup\u003ec\u003c/sup\u003e E.g., leukaemia, lymphoma\u003c/p\u003e \u003cp\u003e\u003csup\u003ed\u003c/sup\u003e Multiple answers possible\u003c/p\u003e \u003cp\u003e\u003csup\u003ee\u003c/sup\u003e Targeted therapy, antihormonal therapy, immune therapy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb Demographic data of the informal caregivers (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eRelation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartner/spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGender\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMean age at interview, y (range)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28,7 (22\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHighest educational degree\u003c/em\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary (vocational) education or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe interviews lasted 31\u0026ndash;80 minutes (mean 56 minutes). Three overarching themes with associated subthemes were identified: (1) Holding on to Normality in a Youth Life on Pause, (2) Navigating Help, Needs, and Boundaries, and (3) Shifting Roles in the Relationship. The three themes are described below and quotations linked to each theme are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eHolding on to Normality in a Youth Life on Pause\u003c/p\u003e \u003cp\u003eNormality was continuously redefined in everyday interactions and renegotiated as roles and perspectives shifted. While informal caregivers broadly shared a commitment to \u0026ldquo;keeping things normal,\u0026rdquo; partners and friends differed in expectations and ways of being involved.\u003c/p\u003e\n\u003ch3\u003eCo-constructing normality in a disrupted daily life\u003c/h3\u003e\n\u003cp\u003eAcross the relationship between the young adults with cancer and their informal caregiver, ordinary routines were used to create \u0026ldquo;breathing spaces\u0026rdquo; where cancer did not define daily life. Walks, shared meals, TV series, and seeing friends helped affirm the young adults with cancer as more than a patient. Young adults with cancer described relief in being treated as a young person with everyday concerns, while informal caregivers described deliberate efforts to sustain positivity and protect the relationship from being overshadowed by illness (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 1).\u003c/p\u003e \u003cp\u003eA difference appeared among informal partner caregivers versus informal friend caregivers. Partners often experienced an expectation, also from family and healthcare professionals, of continuous hands-on involvement. They assumed logistical and practical tasks while trying to preserve a sense of \u0026ldquo;us\u0026rdquo;. Friends typically provided more episodic support, reintroducing pre-illness activities and social outings without daily caregiving obligations. Friends experienced the ongoing puzzle of wanting to help without overstepping (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 2).\u003c/p\u003e \u003cp\u003eNormality was repeatedly challenged by physical, emotional, and social changes. Bodily changes (e.g., hair loss, weight changes, fatigue) made the private visible and complicated self-presentation in youth contexts such as study, work, and nightlife (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 3). Young adults with cancer described feeling exposed, while the informal caregivers adjusted to fluctuating mood and energy, particularly around follow-up cycles (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 4).\u003c/p\u003e \u003cp\u003eWork and study were central markers of \u0026ldquo;getting back,\u0026rdquo; but returning also required redistribution of everyday responsibilities. Resuming full-time work could signal moving forward, yet practical burdens often shifted: partners more frequently took over household tasks, whereas friends maintained social connection and discretion without requiring disclosure (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 5). Young adults described the \u0026ldquo;double work\u0026rdquo; of being both \u0026ldquo;the sick one\u0026rdquo; and a whole person in youth settings, sometimes performing strength to protect others, sometimes withdrawing to manage exposure. Partners described arriving at a \u0026ldquo;new normal\u0026rdquo; after periods of feeling \u0026ldquo;less partner, more organiser,\u0026rdquo; before gradually finding their way back to couple hood (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 6).\u003c/p\u003e\n\u003ch3\u003eAnticipating and fearing the future at the same time\u003c/h3\u003e\n\u003cp\u003eLooking beyond treatment, futures were drafted and redrafted. Young adults with cancer described a lasting \u0026ldquo;before and after\u0026rdquo; shaping decisions about study, work, holidays, and moving. Follow-up appointments reintroduced uncertainty, and late effects or fluctuating energy required contingency. Partners more often anticipated shared timelines and joint decision-making, which intensified the weight of planning, while friends tended to support belonging and near-term goals without expectations of long-term life plans (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 7).\u003c/p\u003e \u003cp\u003eFor some young adults with cancer, living more in the present became a way of coping, while partners and friends often remained oriented toward established adult aspirations (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 8). Friends also described the future as containing both worry and hope, making it easier to focus on the present rather than plan too far ahead (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 9).\u003c/p\u003e \u003cp\u003eFertility concerns emerged as part of future-oriented thinking. Some dyads described sustained wishes for children alongside uncertainty about recurrence and treatment effects. Partners sometimes held worries back to protect the other, while young adults with cancer at times postponed fertility conversations to avoid straining the relationship (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 10). In one case, ambivalence about the future was intensified by a newer relationship; imagining solitude appeared as a seemingly simpler alternative, reflecting the strain of both needing support and not wanting to burden the partner (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 11).\u003c/p\u003e \u003cp\u003eNavigating needs, boundaries, and mutual protection\u003c/p\u003e \u003cp\u003eAcross relationships, the dyads described ongoing negotiation between expressing needs, setting boundaries, and protecting each other. Asking for help could feel exposing and burdensome, especially when requests were unmet (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 12). Young adults with cancer found concrete, proactive offers easier to accept than open-ended invitations such as \u0026ldquo;let me know if I can help\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quotes 13\u0026ndash;14). Informal caregivers were strongly motivated to assist, yet uncertainty about when and how to act could make even well-intended support feel pressuring. Friends more often set limits, for example by not attending hospital appointments, whereas partners typically provided daily practical and logistical support.\u003c/p\u003e \u003cp\u003ePractical needs were most pronounced when the young adults with cancer\u0026rsquo;s energy was low and often eased over time. Several described a \u0026ldquo;team\u0026rdquo; approach, distributing tasks among partners and family to avoid overburdening a single informal caregiver (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 15). However, when responsibilities were assumed to be covered by \u0026ldquo;someone else,\u0026rdquo; support could fall through (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 16).\u003c/p\u003e \u003cp\u003eMutual protection frequently meant down-prioritising one\u0026rsquo;s own needs. Some informal caregivers described setting aside their well-being to support the young adults with cancer, which felt understandable but difficult to sustain alongside work, family, and household duties (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 17). Similarly, young adults with cancer described trying to protect their informal caregivers by maintaining morale and consideration even when depleted. Both sides regulated emotions and effort to avoid overburdening the other; this was often experienced as protective but could be emotionally taxing and sometimes create distance (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quotes 18\u0026ndash;19). Some informal caregivers also described needing boundaries to protect their own well-being while staying present (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 20). During hospital stays, periods of separation could be distressing for both young adults with cancer and partner, highlighting tensions between caregiving demands and everyday life (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 21). Informal caregivers primarily sought support from family or friends to release frustration without burdening the young adults with cancer; professional or organisational support was rarely used (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 22).\u003c/p\u003e \u003cp\u003eShifting Roles in the Relationship\u003c/p\u003e \u003cp\u003eAcross the cancer trajectory, roles shifted in ways that could feel meaningful yet challenging in the context of young adult life.\u003c/p\u003e\n\u003ch3\u003eBetween love and logistics\u003c/h3\u003e\n\u003cp\u003eThe dyads described how the original relationship role (partner/close friend) became insufficient as care responsibilities expanded. Young adults with cancer noted a visible shift from being \u0026ldquo;the friend\u0026rdquo; to becoming \u0026ldquo;the one with cancer,\u0026rdquo; making ordinary social situations harder to navigate (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 23). Some consciously downplayed symptoms and performed strength to protect partners and friends from the full weight of illness (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 24).\u003c/p\u003e \u003cp\u003ePartners described how partnership increasingly merged with practical caregiving: cooking, cleaning, medication management, coordinating hospital appointments, and providing care (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 25). Some described being \u0026ldquo;used as a nurse\u0026rdquo; for wound care, which prompted deliberate reminders of relational boundaries (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 26). When one person became the primary \u0026ldquo;fixer,\u0026rdquo; informal caregivers could feel isolated and sometimes set emotional limits, for example by not absorbing every existential worry (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 27).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCircles of closeness\u003c/h2\u003e \u003cp\u003eSupport was typically organised as a layered and shifting network around the young adults with cancer. Partners were often positioned in the innermost circle and expected to attend hospital visits and participate in decisions, while friends tended to occupy a supportive role with fewer obligations (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 28). In some dyads, a friend moved into the inner circle, particularly when a friendship developed into a romantic relationship during the trajectory and could begin joining consultations and sometimes \u0026ldquo;take over\u0026rdquo; from a parent (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 29). Placement also depended on the maturity of the couple relationship; newer relationships did not automatically supersede parental involvement (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quote 30). Friends often supported from a respectful distance, offering emotional support, distraction, and everyday normality while deferring to parents or partners, creating an \u0026ldquo;in-between\u0026rdquo; position of being \u0026ldquo;very close and yet far away\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, quotes 31\u0026ndash;32). From this position, friends continually balanced being present with not overstepping the inner circle.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes, subthemes, and quotes. Quotes are not presented in dyads\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eHolding on to Normality in a Youth Life on Pause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eCo-constructing normality in a disrupted daily life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 1: \u0026ldquo;\u0026hellip;it was important just to forget about it once in a while, to have that kind of free space\u0026rdquo; [Female, informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 2:\u003c/p\u003e \u003cp\u003e\u0026ldquo;It was hard to strike a balance between doing too much and doing too little\u0026rdquo; (Female, informal caregiver, friend)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 3: \u0026ldquo;\u0026hellip;I was the bald one\u0026hellip; something private suddenly became public\u0026rdquo; [Female, young adult with cancer, dyadic with friends]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 4: \u0026ldquo;\u0026hellip;he becomes a slightly different person when he has to go for a check-up\u0026rdquo; [Female, informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 5: \u0026ldquo;\u0026hellip;it costs that I work full-time now\u0026hellip; I need to relax more, so [my partner] takes the lead on cooking\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 6: \u0026ldquo;Periods where you have been a little less like a couple and a little more\u0026hellip; [practical]\u0026hellip; but\u0026hellip; we have stood by it\u0026rdquo; [Female, informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAnticipating and fearing the future at the same time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 7: \u0026ldquo;\u0026hellip;I feel there is a before and after\u0026hellip; I spend an incredible amount of energy on illness and hospital\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 8: \u0026ldquo;I have more of the approach that I don\u0026rsquo;t know if I have tomorrow \u0026ndash; so I just need to get everything out of it(\u0026hellip;) she [the informal caregiver] is moving into a more established adult life, whereas I am still more like \u0026lsquo;Okay, now something else needs to happen\u0026rsquo;\u0026rdquo; [Female, young adult with cancer, dyadic with friends]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 9: \u0026ldquo;Well\u0026hellip; I am always worried about how long we will get to have her\u0026hellip; I think I try to remember to enjoy it as long as we have each other \u0026ndash; to focus on creating good memories and great experiences together\u0026rdquo; [Female, informal caregiver, friend]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 10: \u0026ldquo;\u0026hellip;we quickly agreed that we want to have children\u0026hellip; but it is still a concern\u0026rdquo; [Female, informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 11: \u0026ldquo;\u0026hellip;sometimes I have thought that it would be easier if I didn\u0026rsquo;t have [a partner]\u0026hellip;\u0026rdquo; [Female, young adult with cancer dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"10\" nameend=\"c2\" namest=\"c1\" rowspan=\"11\"\u003e \u003cp\u003eNavigating needs, boundaries, and mutual protection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 12: \u0026ldquo;It is hard enough to ask for help\u0026hellip; when you experience that your request are not met\u0026rdquo; [Female, young adult with cancer, dyadic with friend]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 13: \u0026ldquo;\u0026hellip;I can feel a bit like a burden\u0026hellip; it is just really hard for me to ask for help\u0026hellip; can you make a lasagna?\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 14: \u0026ldquo;The worst thing people can do is say \u0026lsquo;just let me know\u0026rsquo;\u0026hellip; the best is simply to call and ask: how about Thursday?\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 15: \u0026ldquo;\u0026hellip;it was kind of like a team\u0026hellip; everyone sort of stepped up\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 16: \u0026ldquo;Everyone thinks others are doing something\u0026hellip; [it becomes/I felt] lonely\u0026rdquo; [Female, young adult with cancer, dyadic with friend]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 17: \u0026ldquo;Well, you have probably somehow had to put yourself a bit more aside\u0026hellip; during the cancer course, you probably put it a bit aside, your own things I mean\u0026hellip;\u0026rdquo; [Female, informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 18: \u0026ldquo;I think it would be somewhat unnecessary for F to have to deal with that (the friends concerns) when she already had enough to think about\u0026rdquo; [Female, young adult with cancer, dyadic with friends]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 19: \u0026ldquo;\u0026hellip;bring the good mood along\u0026hellip; I am proud of how I have handled the whole process\u0026hellip; to be decent towards\u0026hellip; family and friends.\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 20: \u0026ldquo;The fact that she could, as far as possible, still live a life and still do things with friends [\u0026hellip;] I don\u0026rsquo;t think that has been negative, but I simply think that is just to take care of oneself.\u0026rdquo; [Male, young adult with cancer, dyadic with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 21: \u0026ldquo;[My partner] also had a hard time letting go of me [\u0026hellip;] it\u0026rsquo;s strange, you know, that you\u0026rsquo;re just left at a hospital. I can just go home and live my life, and [my partner\u0026rsquo;s] life has just come to a standstill, right?\u0026rdquo; [Female, YA informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 22: \u0026ldquo;Nothing more than just talking about it with my family\u0026hellip; that has also been difficult; many of my closest friends are also colleagues with him, so there had to be a boundary\u0026hellip; things that are private\u0026hellip; I haven\u0026rsquo;t sought any help from anywhere.\u0026rdquo; [Female, YA informal caregiver, partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eShifting Roles in the Relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eBetween love and logistics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 23: \u0026ldquo;\u0026hellip;it was hard to have to sit in a room and be her friend, when I was also the one who was ill with cancer\u0026rdquo; [Female, YA with cancer, single].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 24: \u0026ldquo;\u0026hellip;I felt I was protecting them by staying positive and continuing to contribute to everyday life, even if I could not perform an entirely \u0026lsquo;equal\u0026rsquo; relationship\u0026rdquo; [Female, YA with cancer, in relation with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 25: \u0026ldquo;She, after all, had to be there after my surgeries, where she has been a caregiver and, yes, a cook and had to do the cleaning, while I have just been lying completely still\u0026hellip; she has had to manage everything alone\u0026rdquo; [Male, YA with cancer, in relation with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 26: \u0026ldquo;I am a relative, not a health professional\u0026rdquo; [RH3a]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 27: \u0026ldquo;I can\u0026rsquo;t have that conversation\u0026hellip; to give that awful thought space\u0026hellip; feels like the thing that could get me down\u0026rdquo; (Female, YA informal caregiver, partner).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eCircles of closeness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 28: \u0026ldquo;My family\u0026hellip; was closer\u0026hellip; [but the friend] was also a relative\u0026rdquo; [Male, YA with cancer, in relation with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 29: \u0026ldquo;Now\u0026hellip; [she is] coming along to all the check-ups\u0026hellip; before, my mother came along a lot\u0026rdquo; [Male, YA with cancer, in relation with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 30: \u0026ldquo;It depends on where you are in the relationship\u0026hellip; back then it was most natural that it was my parents who were the closest\u0026rdquo; [Male, YA with cancer, in relation with partner]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 31: \u0026ldquo;You do come from far away, even though the feelings are strong\u0026hellip; you are at a distance. I also think that\u0026rsquo;s how we should be. But get as close as possible\u0026hellip;\u0026rdquo; [Female, YA informal caregiver, friend]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuote 32: \u0026ldquo;Hard to find that balance between how much and how little one could do\u0026rdquo; [Female, YA informal caregiver, friend]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study illustrates how young adults with cancer and their self-chosen informal caregivers jointly navigate cancer during a formative life phase. When cancer interrupts a life phase characterised by identity formation and relational change, both parties may face responsibilities they feel only partially prepared for. Across dyads, our findings point to a shared cancer trajectory of holding on to normality in a changed daily life. Creating \u0026ldquo;breathing spaces\u0026rdquo; through ordinary routines helped keep the relationship anchored in everyday youth life rather than being dominated by illness, supporting previous findings [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEfforts to maintain normality were repeatedly tested by treatment consequences, fluctuating energy, and shifting participation in youth contexts. Returning to work or study was experienced as both a marker of moving forward and a trigger for redistributing practical responsibilities in the network, typically with partners absorbing day-to-day tasks while friends maintained connection and discretion. This duality resonates with previous studies documenting high rates of return to work among young adult cancer survivors alongside reduced hours, role renegotiations, and financial strain; it also aligns with emerging survivorship literature framing disability-related barriers and accommodations as part of young adults with cancer\u0026rsquo; post-treatment identity work [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLooking beyond treatment, both young adults with cancer and their informal caregivers described futures that were continually revised. Follow-up appointments and concerns about late effects meant that uncertainty persisted beyond treatment, rendering future planning tentative rather than stable. This resonates with survivorship literature describing ongoing health-related risk and fragmented follow-up in AYAs with cancer, and the resulting need for structured, developmentally appropriate survivorship care [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Dyads also navigated different temporalities: some young adults with cancer leaned toward living in the present, whereas partners often oriented to longer-term couple timelines. Previous research indicates that future-oriented concerns, such as fear of recurrence, fertility, and financial insecurity, may conflict with a more present-focused coping approach, creating ambivalence and misalignment within close relationships [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Fertility concerns were emblematic of this future-work: several dyads postponed or protected fertility conversations to avoid adding strain, mirroring qualitative studies where AYAs describe hope for future parenthood amid rushed decisions at diagnosis and ongoing uncertainty about reproductive potential [\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother key finding concerns the ongoing negotiation of help, needs, and boundaries. Young adults with cancer expressed ambivalence about asking for support and fears of burdening others, while the informal caregivers described uncertainty about when and how to step in. Our findings align with dyadic coping research and meta-analytic evidence: supportive dyadic coping is linked with better emotional functioning and relationship quality, whereas negative dyadic coping and protective buffering (hiding one\u0026rsquo;s worries to shield the other) are associated with poorer adjustment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA previous study described how informal caregivers often found it emotionally difficult to step back for work, study, or everyday obligations. Although the practical necessity was generally acknowledged, doing so could feel painful, especially when it underscored the contrast between a life \u0026ldquo;on pause\u0026rdquo; and a life that continues [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This mirrors our findings where informal caregivers primarily sought support from family or friends, while professional or organisational support was rarely accessed, consistent with reports of limited formal support options for young adults with cancer and their informal caregivers [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinally, our findings show how changed needs were embedded in shifting relational roles and circles of closeness. Partners were often positioned in the innermost circle with expectations of near-constant availability and involvement, while friends occupied a supportive role that was emotionally close yet often more flexible. Friends described an \u0026ldquo;in-between\u0026rdquo; position, close but holding back when parents or partners were present, reflecting nuanced relational work across the trajectory. Our results also suggest that newer romantic relationships may coexist with strong parental involvement, complicating expectations about who is \u0026ldquo;closest\u0026rdquo; and who takes on which tasks. These shifting roles are not only burdensome; they also highlight the capacity for support and resilience within young adult relationships [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically, our findings together with others suggest that healthcare professionals should recognise and, where relevant, engage the broader social network around young adults with cancer, validating both partners and friends as important caregivers and attending to the relational work required to keep relationships from being reduced to care alone [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Supporting clarity around boundaries, practical coordination, and communication may help transform role shifts from hidden strain into a shared resource for coping [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn practice, this may involve explicitly asking young adults with cancer whom they consider significant supporters, inviting partners or friends into consultations when appropriate, and briefly addressing how support is organized and negotiated in everyday life. Simple, structured questions about boundaries, unmet needs, and role expectations may help identify relational strain early, particularly as professional support was rarely accessed despite substantial caregiving demands.\u003c/p\u003e \u003cp\u003eStrengths and limitations\u003c/p\u003e \u003cp\u003eThis national, multicentre qualitative study included participants across Denmark\u0026rsquo;s university hospitals, supporting variation and transferability [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A strength was the collaboration with a patient representative in the development of the study, and that the interview guide was pilot tested with a young adult cancer survivor and a self-chosen informal caregiver. Also strengthen the study was that the data collection and reporting followed COREQ-32, and analysis involved a multidisciplinary author group.\u003c/p\u003e \u003cp\u003eLimitations include the involvement of five interviewers, which may have introduced variation in interviewing style. However, shared preparation and the use of a common interview guide helped promote consistency across interviews. To ensure pseudonymity, findings were not presented by hospital, diagnosis, or treatment context, limiting contextual detail. In addition, the involvement of multiple researchers may have led to an emphasis on overarching patterns at the expense of finer nuances, despite iterative discussions throughout the analytic process.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eYoung adults with cancer and their self-chosen informal caregivers described their relational experiences during the cancer trajectory. Rather than individual experiences, the illness was experienced as something lived \u003cem\u003etogether\u003c/em\u003e, influencing roles, responsibilities, and emotional responses within the relationship.\u003c/p\u003e \u003cp\u003e Across dyads, both the young adults with cancer and the informal caregivers worked to hold on to normality through \u0026ldquo;breathing spaces\u0026rdquo; in everyday life, negotiated help, needs and boundaries, and adapted to shifting roles between love and logistics within changing circles of closeness. Professional support was rarely accessed, leaving much coordination to relationships and informal networks. Clinically, recognising partners and friends as involved in the cancer trajectory and supporting communication and role negotiation may strengthen dyadic coping in a vulnerable life phase for all involved.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eConflict of interest\u003c/h3\u003e\n\u003cp\u003eThe authors declare they have no conflict of interest.\u003c/p\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003eThe project was reported to and granted permission at the local Data Protection authorities at the Northern region of Denmark, the Central region of Denmark, the Southern Region of Denmark, Region Zealand and the Capitol Region of Denmark. In accordance with Danish law, a national collaboration agreement was signed from all participating sites. Under Danish legislation, the study did not require approval from a scientific ethical committee because it involved interviews without further intervention.\u003c/p\u003e\n\u003ch3\u003eAcknowledgments\u003c/h3\u003e\n\u003cp\u003eWe are grateful to\u0026nbsp;the young adults and their young adult informal caregivers who generously dedicated their time and participated in the interviews. We would also like to express our appreciation to the youth support centres in Denmark, for their valuable assistance in facilitating the recruitment process.\u003c/p\u003e\n\u003cp\u003eThis study is conducted on behalf of the Network for Adolescents and Young Adults with cancer’ research in Denmark (NAYACareDK).\u003c/p\u003e\n\u003ch3\u003eFunding disclosures\u003c/h3\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003ch3\u003eAuthor contributions\u003c/h3\u003e\n\u003cp\u003eConceptualization of the research project: MEC, HE, LBT, HP, LIBC, MBB and LB; methodology and formal analysis: MEC, HE, LBT, HP, MBB, LHJ, MH, AKHS, TL, KP, MLKJ, ER, ABS and LB; writing, original draft preparation, MEC and LB; writing, review and editing, HE, LBT, HP, MBB, LHJ, MH, AKHS, KP, TL, MLKJ, ABS and ER; supervision, LB; project administration, MEC and LB; All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch3\u003eData availability statement\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe data generated and analysed in this study is not publicly available due to the Danish data protection rules but could be available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArnett JJ. 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Qualitative research: standards, challenges, and guidelines. Lancet 2001;358:483\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(01)05627-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(01)05627-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Young adults, cancer, informal caregivers, cancer trajectory, relational experiences","lastPublishedDoi":"10.21203/rs.3.rs-8834415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8834415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study explored relational experiences among young adults with cancer and their self-chosen informal caregivers (friends and partners) across the cancer trajectory.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA national, multicentre qualitative study was conducted in oncology and haematology settings at all five Danish University Hospitals. Individual semi-structured interviews were undertaken with young adults with cancer (diagnosed when aged 18\u0026ndash;39 years) and their self-chosen friends or partners as informal caregivers. Data were analysed using reflexive thematic analysis and reported in accordance with COREQ.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNine young adults with cancer and 13 informal caregivers participated (partners n\u0026thinsp;=\u0026thinsp;7, friends n\u0026thinsp;=\u0026thinsp;6). Three themes were identified: (1) Holding on to Normality in a Youth Life on Pause, young adult with cancer and informal caregiver dyads created \u0026ldquo;breathing spaces\u0026rdquo; through everyday routines while navigating disruptions in body, mood, and participation in youth contexts; (2) Navigating Help, Needs, and Boundaries, young adults with cancer and their informal caregiver balanced requesting and offering support, preferred concrete help, and engaged in mutual protection, with professional support rarely accessed; and (3) Shifting Roles in the Relationship, relationships evolved toward \u0026ldquo;love and logistics,\u0026rdquo; and support was organised in changing circles of closeness, with friends often occupying an \u0026ldquo;in-between\u0026rdquo; position.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCancer in young adulthood emerges as a relational phenomenon. Acknowledging partners and friends as informal caregivers, and fostering communication, boundary setting, and role negotiation, may reinforce dyadic coping processes and support the continuity of everyday life.\u003c/p\u003e","manuscriptTitle":"Relations in young adults with cancer: Acknowledging partners and friends as informal caregivers – A Danish National study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-23 19:51:16","doi":"10.21203/rs.3.rs-8834415/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"175694878748785802780451290319280622375","date":"2026-05-05T14:22:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97514798034911058054758701316478475259","date":"2026-05-01T05:37:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-27T14:01:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33419207100229128837095769980540337884","date":"2026-03-18T16:19:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-18T16:15:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-18T16:11:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-14T03:11:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-02-09T21:16:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"27a712ee-5dcb-4827-985b-cf2b042797e8","owner":[],"postedDate":"March 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"175694878748785802780451290319280622375","date":"2026-05-05T14:22:05+00:00","index":24,"fulltext":""},{"type":"reviewerAgreed","content":"97514798034911058054758701316478475259","date":"2026-05-01T05:37:41+00:00","index":22,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T19:51:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-23 19:51:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8834415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8834415","identity":"rs-8834415","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}