Contextual analysis of adolescents and young adult cancer care in Belgium: balancing national strategies with flexible local solutions

Adolescents and young adults (AYAs) with cancer face specific challenges requiring an integrated, tailored approach throughout the entire care trajectory, supported by system-level coordination. Despite increasing European and national efforts, tailored services for AYAs aged 16–35 years in Belgium remain fragmented. Understanding how AYA cancer care is organised and which contextual factors shape its implementation is essential for developing a sustainable, harmonised care program. Accordingly, this study examined factors influencing the implementation of AYA‑dedicated cancer care in Belgium and the contextual and organisational characteristics shaping this process. A mixed-method design was used. Stakeholders ( n = 78) at macro- (policy), meso- (healthcare delivery), and micro-levels (patients) participated through interviews, focus groups or a workshop. Additionally, participants completed either a hospital ( n = 68) or general practitioner questionnaire ( n = 27). Data collection and analysis were guided by the Consolidated Framework for Implementation Research, enabling systematic exploration of contextual determinants and implementation barriers and facilitators. Data were analysed using a combined deductive-inductive framework approach. AYA cancer care was described as holistic, addressing physical, psychosocial and emotional needs, and including fertility and genetic counselling, clinical trial access, and practical or administrative support. Participants emphasised the need for developmentally adapted, multidisciplinary care. Effective care was seen to rely on structured collaboration within and between hospitals, including paediatric haemato-oncology, supported by dedicated multidisciplinary teams and designated points-of-contact. National AYA policy, including harmonised care pathways, was viewed as important to reduce variability in practice. Primary care was identified as important but insufficiently integrated in the care trajectory. The results enabled the identification of implementation recommendations at policy and hospital levels. Effective implementation of AYA care in Belgium requires a coherent organisational framework with clear national and regional guidance, harmonised referral pathways organised through a hub-and-spoke hospital network, and flexibility for local adaptation. Implementation will depend on strengthening collaboration across the care continuum and meaningfully integrating primary care. More broadly, AYA cancer care illustrates a needs-based, trans-age approach applicable to chronic diseases and rare cancers, requiring specialised expertise. These findings support informed decision-making by policymakers and healthcare professionals in implementing a harmonised national AYA care program.