Contraception Counseling and Use Among Adolescent and Young Adult Women Undergoing Cancer Treatment [11I

Abstract

INTRODUCTION: Adolescent and young adult women undergoing cancer treatment face unique reproductive health risks. The objectives of this study were to assess the prevalence of pregnancy prevention counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes. METHODS: After institutional review board approval, a retrospective chart review was conducted of female patients ages 15-25 receiving cancer treatment, excluding those treated with only surgery, at Yale New Haven Hospital from 2013-2018. Univariate and multivariate logistic regression were used to assess the relationship between patient variables and the outcomes of counseling and contraception use. RESULTS: 157 patients were included in this analysis; the median age was 20, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Treatments received included various combinations of surgery, chemotherapy, radiation, hormone therapy, targeted or biologic agents, and bone marrow transplant. 33.1% were documented as receiving reproductive health counseling and 48.4% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P=.005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P=.009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P=.001) were significantly associated with contraception use. CONCLUSION: Reproductive health counseling was documented infrequently during oncologic care for adolescent and young adult women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a clear need to improve rates of counseling in this high-risk setting, especially with adolescents who may be more vulnerable when it comes to reproductive health.