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cancer survivorship; employment; quality of life; reintegration; schooling
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Algeo N, Mockler D, Braddish S et al. Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.12688/hrbopenres.14096.2)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Study Protocol
Revised
Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol
[version 2; peer review: 1 approved, 1 approved with reservations]
PUBLISHED 16 Jan 2026
OPEN PEER REVIEW
REVIEWER STATUS
Abstract
Corresponding author:
Naomi Algeo
Competing interests:
No competing interests were disclosed.
Grant information:
This work is funded by the Irish Cancer Society Research Grant AHP22ALG. The opinions, findings and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of the Irish Cancer Society.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2026 Algeo N et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Algeo N, Mockler D, Braddish S et al. Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.12688/hrbopenres.14096.2)
First published: 24 Mar 2025, 8:44 (https://doi.org/10.12688/hrbopenres.14096.1)
Latest published: 16 Jan 2026, 8:44 (https://doi.org/10.12688/hrbopenres.14096.2)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Revised Amendments from Version 1
Please find a revised manuscript for our scoping review protocol, 'Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol' following reviewer feedback.
See the authors' detailed response to the review by Suja Somanadhan
See the authors' detailed response to the review by Jennifer Kelleher and Meghan E. McGrady
Introduction
Internationally, the considered age range of Adolescent and Young Adult (AYA) cancer survivors is 15–39 years (at diagnosis) (Desandes & Stark, 2016). The number of newly diagnosed AYA cancers is increasing and so too is the number of AYA living with and beyond cancer, resulting in heightened focus on survivorship needs. This recent paradigm shift in survivorship care has focused on optimising quality of life for those living with and beyond cancer, including reintegration into education and employment (Vaz-Luis et al., 2022).
Physical and psychosocial sequalae experienced by AYA cancer survivors during and after cancer treatment include fatigue, cognitive dysfunction, anxiety, and depression (Baker & Syrjala, 2018; Ikonomidou, 2018; LaRosa et al., 2017; Lea et al., 2020; Mittal et al., 2022; van Deuren et al., 2020; Zebrack, 2011). It is commonly reported that this cohort will face ‘overwhelming’ physical and cognitive demands on their re-entry to education and employment (Brauer et al., 2017). Challenges associated with education reintegration include expedited return to keep up with peers, limited training for educators on how to best support reintegration, and the impact of altered body image during this adolescent stage (Brauer et al., 2017; Fardell et al., 2018; Thompson et al., 2015). While there remains partial overlap of physical and psychosocial barriers to employment reintegration for AYAs, other factors can influence this transition including returning to dependency on parents, fear of potential workplace discrimination, and workplace accommodations (Fardell et al., 2018; Husson et al., 2018; Ketterl et al., 2019), although these can vary depending on societal context (e.g., country-specific legislation/entitlements).
In line with missed schooling and long-term side-effects of treatment, it is unsurprising that this group may under-perform academically in comparison to their peers, which in turn can lead to employment and financial difficulties in later life (Elsbernd et al., 2018). Furthermore, an international report for survivors of children, adolescents and young adults (CAYA) cancer highlighted evidence that this cohort are at higher risk of lower educational achievement and unemployment in later life (Devine et al., 2022). Return to education and employment is therefore often cited as challenging by AYA cancer survivors (Barrett et al., 2018; Ikonomidou, 2018).
The European Code of Cancer recently identified the right of all cancer survivors to fully resume educational, economic, and social roles (Lawler et al., 2021). However, a gap in current research includes education and employment reintegration, where AYAs self-identified research on return to education and work as a top priority in a UK research priority-setting exercise (Aldiss et al., 2019). This has also been recognised internationally where the need to focus on education and career development for AYA cancer survivors has been cited as a core priority (Altherr et al., 2023; National Cancer Control Programme, 2022). Therefore, supports to empower AYAs who have had cancer to stay or return to education and/or work is an important issue for both AYAs and society. With the view to developing education and work-related supports for AYAs with cancer in the Republic of Ireland, a scoping review of relevant interventions in relation to type, content, evaluation and impact, will be completed.
Methods
The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2020). This scoping review protocol was registered on the Open Science Framework (OSF) database on 21st February 2025 and reporting will be guided in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement (Moher et al., 2015). This protocol will be conducted in accordance with the JBI methodology for scoping reviews to ensure a systematic methodology that can be replicated. In addition, the scoping review framework proposed by Arksey and O’Malley (2005) is used to structure this protocol, which suggests five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selecting studies, (iv) charting the data, and (v) collating, summarising, analysing, and presenting results. The planned scoping review will be reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018).
Stage one: Identifying the research question
The main research question, guided using the Population-Concept-Context framework (Peters et al., 2020), is: What is the available evidence regarding non-pharmacological interventions that support education and/or employment outcomes for AYAs? In this instance, population refers to AYAs who were diagnosed with cancer (diagnosed aged 15–39 years inclusive) who have had a cancer diagnosis, context refers to interventions that support education and/or employment outcomes for AYAs, and context refers to any setting (acute/primary care/workplace/school/etc.) in any geographical location. The scoping review protocol has been reviewed by a patient and public involvement representative (who is also a co-author) on the research steering committee who has also informed objectives of this review.
The primary aim of this scoping review is to identify and summarise the core elements (i.e., content, delivery, resources, length, and format) of non-pharmacological interventions/supports for adolescents and young adults who have had a cancer diagnosis to support return to education and/or work.
Secondary objectives include:
1. To identify and summarise measures used to test the impact of these type of interventions on education and/or work and other outcomes.
2. To identify the most commonly used theoretical frameworks underpinning programmes that support return to education and/or work for AYAs.
3. To identify and describe the range of outcomes reported for non-pharmacological interventions and support programmes/services that support return to education and/or employment for AYAs.
The aim of this scoping review is to explore and chart the evidence relating to non-pharmacological interventions that support education and/or employment for AYAs.
Eligibility criteria: Inclusion criteria will be limited to peer-reviewed and non-peer reviewed studies and programmes that focus on interventions/programmes that support education and/or employment (concept) for AYAs after a cancer diagnosis (population), across any setting (acute/primary care/workplace/school/etc.) (context) (Table 1). This scoping review will consider both experimental and quasi-experimental study designs including randomised control trials, non-randomised control trials, before and after studies, and interrupted time series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs, including case series, individual case reports, and descriptive cross-sectional studies for inclusion. Qualitative studies will also be considered that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, and action research. Systematic reviews that meet the inclusion criteria will also be considered, depending on the research question. Text and opinion papers will also be considered for inclusion in this scoping review. While some study designs (e.g., cross-sectional, qualitative, etc.) do not allow assessment of intervention effectiveness over time, they may provide valuable information on the types of interventions offered to AYAs and the range of outcomes measured. Therefore, we will include these studies to capture descriptive data on interventions and outcomes.
Table 1. Eligibility Criteria.
| Category | Inclusion Criteria |
|---|---|
| Population | • Adolescents and young adults (AYAs) aged 15–39 years at time of cancer diagnosis • Age range selected to reflect internationally recognised definitions (e.g., Desandes & Stark, 2016). • Studies including AYAs during or after cancer treatment. |
| Concept | • Non-pharmacological interventions designed to support education and/or employment outcomes for AYAs. • Interventions may be group-based, individual, online, vocational, psychosocial, physical, educational, or multidisciplinary. • Outcomes may include school reintegration (e.g., e.g., binary yes/no for education status, academic performance, etc.), return-to-work (e.g., binary yes/no for working status; work satisfactions etc.), or employability. |
| Context | • Any setting, including acute care, primary care, community, workplace, or school. • Studies from any geographical region. |
| Types of Evidence Sources | Peer-reviewed and non–peer-reviewed sources, including: Experimental and quasi-experimental: • Randomised controlled trials • Non-randomised controlled trials • Before-and-after studies • Interrupted time series Analytical observational: • Prospective and retrospective cohort studies • Case–control studies • Analytical cross-sectional studies Descriptive observational: • Case series • Case reports • Descriptive cross-sectional studies Qualitative research: • Phenomenology, grounded theory, ethnography, qualitative description, action research, etc. Other sources: • Systematic reviews (where relevant) • Text and opinion papers • Programme descriptions or evaluations |
Population: This scoping review will consider studies of non-pharmacological interventions and support programmes that include AYAs who were diagnosed with a cancer diagnosis (aged 15–39 years inclusive). The age range considered for AYAs can vary from country to country. For example, in the Republic of Ireland, the recognised age range for this cohort is 16–24 years (Alken et al., 2020). However, for the purpose of this review and to yield a breadth of supports, the age range of 15–39 years which is recognised internationally will be considered (Desandes & Stark, 2016). Intervention eligibility will only be considered if age range falls within 15–39 years (e.g. study focusing on ages 12–24 would be excluded).
Concept: The proposed scoping review is designed to explore non-pharmacological interventions that support education and/or employment outcomes for AYAs. Interventions can be group-based, individual, and/or online in format, and can be vocational, psychosocial, physical, educational or multidisciplinary in nature. Pharmacological or medical interventions are excluded, as the focus of this review is on behavioural, psychosocial, vocational, educational, and rehabilitation-oriented strategies. From here on in, we will refer to these approaches simply as interventions.
Context: The aim of this scoping review is to explore the breadth of current literature published on interventions that measure education and/or employment outcomes for AYAs. Therefore, studies conducted in any setting (acute/primary care/workplace/school/etc.) in any geographical location will be considered.
Patient and Public Involvement: A patient and public involvement (PPI) contributor, who is also a co-author on this protocol (SB), was involved in the development of the review objectives, refinement of the research question, and identification of key concepts relevant to AYAs following a cancer diagnosis. The PPI member provided feedback on the scope of the review, the relevance of outcomes relating to education and employment, and contributed to ensuring that the planned review reflects patient priorities. No additional consultation stage is planned beyond their ongoing involvement in interpreting findings during the analysis and dissemination stages.
Stage two: Identifying relevant studies
The search strategy will aim to locate both published and unpublished sources. As recommended in the JBI guidelines, a three-step search strategy will be used. First, a broad search of databases (including EMBASE, Medline (OVID), and CINAHL), using keywords for cancer, education, employment, rehabilitation, adolescents and young adults will be completed. Second, words contained in the titles and abstracts of relevant manuscripts and index terms used to describe these will be used to inform a full search strategy. The medical librarian (DM) will develop a search strategy in collaboration with the lead author (NA) (Appendix 1). The search strategy will be adapted for each database and information source. Databases that will be searched as part of this scoping review include EMBASE, Web of Science, Medline (OVID), CINAHL, and PsycInfo. Google Scholar will be searched for grey literature, limited to the first 100 searches (e.g., organisation and institutional reports, theses and dissertations, conference materials, programme descriptions/evaluations, etc.). Third, the reference list of all included sources of evidence will be screened for additional studies. The searches will be conducted by NA and DM. Studies published in English will be included, as the resources for translation are not available and no limitation will be set on date. In addition, the lead author will consult the research steering committee, of whom all are key AYA stakeholders, regarding their knowledge on any additional grey literature. The definitive search strategy and results will be reported in detail in the published scoping review.
Stage three: Selecting studies
Following the search, all identified citations will be collated and uploaded to Covidence and duplicates removed. Prior to screening, two independent reviewers will complete pilot testing of eligibility criteria. A sample of 25 titles/abstracts selected at random will be selected and screened. The team will meet to discuss any discrepancies and amend eligibility criteria as needed. Screening will commence when at least 75% agreement is achieved (Peters et al., 2020). Titles and abstracts will be screened by the first author for assessment against inclusion criteria. The full texts of selected studies will then be reviewed for inclusion by two reviewers. Where uncertainty occurs, a third reviewer will be consulted and resolved through discussion. Full text studies will be excluded if they do not meet the inclusion criteria and reasons for exclusion recorded. The search results will be reported in a PRISMA flow diagram (Page et al., 2021).
Step four: Charting the data
Data extraction will focus on identifying and charting data relating to interventions that support education and/or employment outcomes for AYAs following a cancer diagnosis. A data charting form will be developed using Microsoft Excel. This will be developed using the JBI data extraction tool and will be guided by the Intervention Development and Replication (TIDieR) checklist (Hoffmann et al., 2014) (Appendix 2), which systematically describes interventions and their characteristics to support future replication. Two reviewers will pilot the data charting form by independently extracting data from the first ten included studies. They will then meet to confirm consistency in their approach in data extraction as well as establishing suitability of the data charting form. The form may be subject to amendment as familiarity with selected studies necessitates a need for capturing further information. Where uncertainty occurs, a third reviewer will be consulted and resolved through discussion.
The data extraction tool will collect the following data related to included studies/resources:
1. Author
2. Title
3. Year of publication
4. Evidence source details
5. Country of origin
6. Study/programme aims/objectives/purpose
7. Research design (if applicable)
8. Inclusion/exclusion criteria
9. Demographic details of participants included (if applicable) (e.g., cancer type, age)
10. Sample size (if applicable)
11. Intervention format (online, in-person, written)
12. Frequency of intervention delivery (once-off, six-weeks, etc.)
13. Intervention duration (e.g., one-hour/session, 30 minutes etc.)
14. Intervention content
15. Intervention facilitator(s) (if applicable)
16. Theoretical framework (if applicable)
17. Outcomes measured (if applicable)
18. Comparator (if applicable)
19. Caregiver/Partner involvement (if applicable)
Data will be extracted by the lead author and verified by a second. Our objective is to map the existing literature rather than assess the methodological quality of included studies. Therefore, we do not plan to conduct a formal quality appraisal. This approach is consistent with scoping review guidance, which considers quality assessment optional.
Step five: Collating, summarising, analysing and presenting the data
The PRISMA-ScR checklist will be used to guide the reporting of this review (Tricco et al., 2018). Literature search findings and the study screening process will be presented in a PRISMA flow diagram. Extracted data will be charted in tabular format using the TIDieR checklist to ensure comprehensive and consistent reporting of intervention characteristics. Following data charting, findings will be synthesised using both a descriptive narrative summary and the PAGER framework (Patterns, Advances, Gaps, Evidence for practice, and Research recommendations) (Bradbury-Jones et al., 2022). PAGER will provide a structured approach to analysing and presenting the results, enabling clearer identification of key themes, developments in the field, gaps in the evidence base, and implications for research and practice. This will ensure that the synthesis aligns with and supports the scoping review’s objectives and questions. Any deviation from the protocol will be clearly explained in the complete scoping review report.
Discussion
Globally the number of newly diagnosed AYA cancers is increasing and so too is the number of AYA living with and beyond cancer. Physical and psychosocial sequalae of cancer and its treatment can impact on AYAs reintegrating back to education and/or employment following cancer treatment. A gap in current research includes education and employment reintegration, where AYAs self-identified research on return to education and work as a top priority in a UK research priority-setting exercise (Aldiss et al., 2019). Therefore, the exploration of factors impacting on successful return to education and employment for AYA cancer survivors is warranted.
To our knowledge, this scoping review will be the first to focus on interventions that support return to education and/or employment for AYAs following a cancer diagnosis. This protocol will include a comprehensive search of peer reviewed and grey literature and will identify, map and summarise existing literature describing supports programmes for AYAs that measure an education or employment outcome.
Ethical considerations
As scoping review methodology involves reviewing and collecting data from publicly accessible material, this study does not require ethical approval.
Ethics and consent
Ethical approval and consent were not required.
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Algeo N, Mockler D, Braddish S et al. Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.12688/hrbopenres.14096.2)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 2
VERSION 2
PUBLISHED 16 Jan 2026
Revised
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How to cite this report:
Somanadhan S. Reviewer Report For: Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.21956/hrbopenres.15768.r52901)
The direct URL for this report is:
https://hrbopenresearch.org/articles/8-44/v2#referee-response-52901
https://hrbopenresearch.org/articles/8-44/v2#referee-response-52901
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 19 Jan 2026
Approved
VIEWS 0
Thank you for the opportunity to review the updated version of this review protocol. The protocol reads very well, and I thank the authors for addressing all of my comments.
I have only a minor edit regarding ... Continue reading
I have only a minor edit regarding ... Continue reading
CITE
HOW TO CITE THIS REPORT
Somanadhan S. Reviewer Report For: Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.21956/hrbopenres.15768.r52901)
The direct URL for this report is:
https://hrbopenresearch.org/articles/8-44/v2#referee-response-52901
https://hrbopenresearch.org/articles/8-44/v2#referee-response-52901
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Version 1
VERSION 1
PUBLISHED 24 Mar 2025
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How to cite this report:
Kelleher J and McGrady ME. Reviewer Report For: Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.21956/hrbopenres.15487.r50280)
The direct URL for this report is:
https://hrbopenresearch.org/articles/8-44/v1#referee-response-50280
https://hrbopenresearch.org/articles/8-44/v1#referee-response-50280
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 10 Oct 2025
Jennifer Kelleher,
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Meghan E. McGrady,
Cincinnati Children's Hospital Medical Center, Cincinnati, USA
Approved with Reservations
VIEWS 7
Study Rationale and Objectives
The authors clearly outline the impacts of cancer and its treatment on educational and occupational outcomes, highlighting the need to identify interventions with the potential to support AYAs in these domains. While the rationale for ... Continue reading
The authors clearly outline the impacts of cancer and its treatment on educational and occupational outcomes, highlighting the need to identify interventions with the potential to support AYAs in these domains. While the rationale for ... Continue reading
CITE
HOW TO CITE THIS REPORT
Kelleher J and McGrady ME. Reviewer Report For: Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.21956/hrbopenres.15487.r50280)
The direct URL for this report is:
https://hrbopenresearch.org/articles/8-44/v1#referee-response-50280
https://hrbopenresearch.org/articles/8-44/v1#referee-response-50280
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Author Response 16 Jan 2026Naomi Algeo, Discipline of Occupational Therapy, Trinity College Dublin School of Medicine, Trinity Centre for Health Sciences, Ireland16 Jan 2026Author ResponseDear Reviewers,
Many thanks for your feedback on our scoping review protocol. Please find below our responses in how we have addressed your helpful feedback:
(1) The authors ... Continue reading
COMMENTS ON THIS REPORT
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Author Response 16 Jan 2026Naomi Algeo, Discipline of Occupational Therapy, Trinity College Dublin School of Medicine, Trinity Centre for Health Sciences, Ireland16 Jan 2026Author ResponseDear Reviewers,
Many thanks for your feedback on our scoping review protocol. Please find below our responses in how we have addressed your helpful feedback:
(1) The authors ... Continue reading
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15
How to cite this report:
Somanadhan S. Reviewer Report For: Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.21956/hrbopenres.15487.r47030)
The direct URL for this report is:
https://hrbopenresearch.org/articles/8-44/v1#referee-response-47030
https://hrbopenresearch.org/articles/8-44/v1#referee-response-47030
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 27 May 2025
Approved with Reservations
VIEWS 15
Thank you for the opportunity to review this scoping review protocol. This is a strong and well-structured paper with clear relevance to the field. However, I have highlighted several areas where further clarification or refinement could strengthen the overall quality
... Continue reading
CITE
HOW TO CITE THIS REPORT
Somanadhan S. Reviewer Report For: Non-pharmacological interventions to support return to education and work for adolescent and young adults (AYAs) following a cancer diagnosis: a scoping review protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2026, 8:44 (https://doi.org/10.21956/hrbopenres.15487.r47030)
The direct URL for this report is:
https://hrbopenresearch.org/articles/8-44/v1#referee-response-47030
https://hrbopenresearch.org/articles/8-44/v1#referee-response-47030
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Author Response 16 Jan 2026Naomi Algeo, Discipline of Occupational Therapy, Trinity College Dublin School of Medicine, Trinity Centre for Health Sciences, Ireland16 Jan 2026Author ResponseDear Reviewer One, Many thanks for your manuscript feedback. Please see below for clarity in how we have addressed each point of feedback:
(1) 'The listed keywords—cancer survivorship, employment, ... Continue reading
COMMENTS ON THIS REPORT
-
Author Response 16 Jan 2026Naomi Algeo, Discipline of Occupational Therapy, Trinity College Dublin School of Medicine, Trinity Centre for Health Sciences, Ireland16 Jan 2026Author ResponseDear Reviewer One, Many thanks for your manuscript feedback. Please see below for clarity in how we have addressed each point of feedback:
(1) 'The listed keywords—cancer survivorship, employment, ... Continue reading
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations -
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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