USC medical student Arthur Bookstein rides for young adult cancer patients

On a rain-slick road somewhere in Japan, Arthur Bookstein, a fourth-year medical student at the Keck School of Medicine of USC, is pedaling. His ride began at 6 a.m., and he will push himself into the afternoon or evening, depending on the weather, terrain and energy left in his legs. There are no rest days. By his journey’s end, he will have biked for 36 consecutive days and covered around 2,000 miles.

Bookstein is riding raise funds and increase awareness for AYA@USC, the Adolescent and Young Adult Program, and is already about 75% of the way toward his $10,000 goal. Housed in the USC Norris Comprehensive Cancer Center, AYA@USC aims to improve health outcomes and quality of life for adolescents and young adults with cancer through holistic care, education, research and community building initiatives. It also works to promote awareness among patients and survivors, families, health care providers and professionals, and community organizations, and to establish a peer support community in Southern California and beyond.

Bookstein started his ride on April 5 from Cape Sata, the southernmost point of mainland Japan, and his destination is Cape Soya, the country’s northernmost tip. His trip will end on May 15 — timed so he can make it back to Los Angeles in time for commencement.

Along the way, he stays at guesthouses and small hotels. He fuels himself on protein shakes, katsu bentos, and his personal favorite of kitsune udon, a simple bowl of noodles in broth topped with fried tofu. Bookstein rides 50 to 60 miles a day on average, sometimes with stretches of up to 100 miles.

“Arthur Bookstein’s solo cycling journey across Japan in support of young adults with cancer reflects the spirit of a new generation of health care providers — driven by compassion, purpose and a deep commitment to those most in need,” said Shu Li, program administrator for AYA@USC. “His 40-day challenge is a powerful testament to the determination and resilience required to advance medicine in the face of any obstacle.”

Bookstein views his long-distance journey as a metaphor for what many adolescent and young adult patients face after receiving their diagnosis.

“You have a giant road ahead of you, or even a giant mountain that you’re suddenly staring up at,” he says. “It looks like 2,000 miles of climbing uphill in front of you, and you don’t know if you’re going to make it.”

A gap in the middle

Each year, nearly 90,000 Americans between the ages of 15 and 39 are diagnosed with cancer, which is the leading cause of disease-related death in this age group. This patient age group often falls in between medical systems designed for children or older adults. There’s less research and lower clinical trial participation for adolescents and young adults compared to other age groups.

Yet certain cancers, like gastric cancer — once considered a disease of older adults — are showing up more often in adolescents and young adults. Bookstein was part of a research team at Children’s Hospital Los Angeles building a multi-institutional database to study it.

There is also often a gap in specialized care that considers the developmental needs of adolescent and young adult cancer patients, such as fertility preservation protocols. In addition, a diagnosis can arrive at a stage in life when patients may not have social support systems in place.

“For adolescents and young adults in particular, there’s a unique aspect to their situation,” Bookstein said. “They’re still trying to figure out their identity, their support networks, their careers. It’s a very vulnerable stage in life.”

AYA@USC helps close the gap in care and support. Its programs lean heavily on community — bringing adolescent and young adult patients together so they can recognize themselves in each other through an annual Getaway Retreat, year-round self-expression workshops, music and sport events and more.

“We have defined our program as a ‘Third Space’ — a dedicated network separate from hospital/medical care and home/career that provides a safe, supportive environment for those going through similar experiences faced with a cancer diagnosis,” said Aura Kuperberg, LCSW, PhD, project administrator for AYA@USC. “For the AYA population, community is not just a social perk; it is a clinical necessity that helps these individuals navigate their transition into adulthood.”

Finding and forging community

Biking across Japan is especially meaningful to Bookstein, who is half Japanese. He was awarded a Fulbright fellowship at Japan’s National Cancer Center in 2024–25, and during that year he immersed himself in Japanese language and culture.

He has now studied Japanese on his own for almost five years, with a nearly 2,000-day flashcard streak to show for it. The reconnection with his heritage, he says, “felt a lot like I found another home that I had been always yearning for” — the same yearning, he points out, that adolescent and young adult patients describe when they finally find a community that understands them.

His trip so far has been filled with memorable encounters, including a recent stay in Kamakura at a guesthouse run by a host called Bushi-san, who dresses in full samurai attire. The hostel doubles as free lodging for children with special needs, elderly guests and people with disabilities. Bookstein sat with the other guests on the tatami floor, singing and playing games into the night.

A daily dedication

This is Bookstein’s second long-distance fundraising ride for adolescents and young adults. In the summer of 2019, he rode 4,500 miles in 70 days from Baltimore to San Francisco as part of a 28-person cycling team raising funds for the Ulman Foundation, a Baltimore nonprofit dedicated to creating a community of support for adolescents and young adults and their loved ones impacted by cancer. This time, his journey is shorter, but he’s biking alone, with only his support van driver, Kazu, for company.

Kazu helps him film a special dedication every morning. Each day’s ride honors a different person in Bookstein’s life: family members, friends, patients and people he’s met on the road.

One of those dedications was to a grandmother that he never met. His maternal grandparents were on the outskirts of Hiroshima when the atomic bomb was dropped in August 1945. They were exposed to radiation when they entered the city to look for friends who lived closer to the center. Both later developed cancer in their 50s and died before Bookstein was born.

“I think of people like my grandma when I’m riding,” he says. “It gives me a lot of strength.”

The road ahead

In June, Bookstein will start an Internal Medicine–Pediatrics residency at Tulane University in New Orleans. He plans to pursue a combined adult and pediatric hematology/oncology fellowship that would qualify him to care for adolescent and young adult cancer patients across the full age range and spectrum of their needs.

Having now completed two cross-country fundraising rides for adolescent and young adult cancer patients, Bookstein intends to continue distance cycling during residency.

“I guess it’s going to have to be a tradition at this point,” he says, laughing. “I’ll have to do one at the end of residency, too.”

To learn more about Bookstein’s ride and support AYA@USC, visit: https://ignite.usc.edu/p/nihon-judan-cycling or contact [email protected].