While cancers in young adults are rare, they have a huge impact. Compared with older patients the untimeliness of the diagnosis and potential long-term impacts, for example on relationships, fertility and occupational achievement can undermine confidence and lead to isolation and a sense of not really being understood by family, friends, and even health professionals. The development of second cancers and treatment-related toxicities including cardiotoxicity pose particular communication challenges as these adversely impact quality of life and are associated with increased mortality. There is minimal data to guide communication about these challenges and this presentation focuses on core communication strategies including the impact for the clinician.