Background: Adult P-AYA cancer survivors report numerous LLEs, as well as potential decrements in psychological well-being. The relationship between LLEs and psychological well-being, however, has not been well described in this population. We examined this relationship and predictors of LLEs and well-being in a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer > 2 years from end of treatment completed the Hospital Anxiety and Depression Scale (HADS) and a measure of presence and severity of 11 common LLEs following a survivorship visit. LLEs included fatigue, pain, insomnia, numbness, joint or muscle pain, difficulties with concentration or memory, body image concerns, decreased sexual interest, and weight. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of > $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were generally low and below the cutpoint of 8 (all t < -7.8; all p < .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. 91% of participants reported at least 1 LLE (M = 4.8, SD = 3.1), most commonly fatigue (73%), concentration (57%) and memory difficulties (53%), and body image problems (48%). Total number LLEs was associated with elevations in both anxiety and depression, as was severity for each individual LLE (all p < 0.001). Only one LLE, difficulty with body image, produced large effects for both anxiety and depression. Low income status were associated with both LLEs and elevations in anxiety and depression (all p < 0.01). Conclusions: Most P-AYA survivors report LLEs. Although anxiety and depression are modest, elevations occur in a substantial number of survivors. Presence of LLEs is associated with worse psychosocial outcomes, particularly difficulties with body image. Lower income individuals and those with body image concerns may be at particular risk of poorer psychosocial outcomes.