Disordered Eating Behaviors in Young Adult Cancer Survivors: A Cross-Sectional Analysis.

The incidence of childhood, adolescent, and young adult (AYA) cancers have been increasing since 1975.[1][1] In 2014, an estimated 10 450 and 5330 new cancers will be diagnosed among children aged birth–14 and adolescents aged 15 to 19 years old, respectively.[2][2] For young adults aged 20 to 34

Introduction: We examined the relationship between financial burden, quality of life (QOL), and physical functioning for young adult (YA) cancer survivors under 40 years of age in comparison to their healthy peers and older cancer survivors ages 40-64 while adjusting for demographic factors, utilization, and access to care. Methods: Data from the Medical Expenditures Panel Survey (MEPS) from 2011 to 2018 household component survey were used. We examined differences in 1) out-of-pocket expenditures (first modeled as a binary outcome of any expenditures; then modeled as the sum of office/outpatient visits, emergency department use, inpatient stays, and prescriptions expenditures with log base 10 adjusted to 2018 dollars), 2) quality of life (measured with the VR-12 mental component score or MCS), and 3) physical functioning (measured with the VR-12 physical component score or PCS). Outcomes were compared among 1) YA cancer survivors to YAs without a cancer history (<40) and 2) YA survivors (<40) to older adult cancer survivors (40-64). Multivariable generalized linear models with a log link function were adjusted for demographics (sex, annual household income), utilization (any prescriptions and any outpatient, inpatient, and emergency department visits), and access to care (delayed medical care because of cost and insurance). MEPS sampling weights, stratum, and clusters were used. Results: YA cancer survivors were not more likely to have any expenditures in comparison to their non-cancer peers. However, if YA survivors did have expenditures, their total out-of-pocket expenditures in the multivariable model were 1.3 times more than their non-cancer peers annually. YA survivors were 2.7 times less likely to have expenditures in comparison to older adult cancer survivors. If YA survivors did have expenditures, they were 1.6 times less than older survivors annually. YA survivors experienced an annual decrease in MCS when compared to their healthy peers by 2.3 points and by 1.2 points when compared to older adult survivors. YA survivors experienced an annual decrease in PCS in comparison to their healthy peers by 3.2 points. YA survivors experienced an annual increase in PCS in comparison to older adult survivors by 4.8 points. Conclusion: If YA cancer survivors did have expenditures, they were significantly more than their non-cancer peers. In comparison to older adult survivors, YA survivors were less likely to have any expenditures and if they did have expenditures, they were less. MCS scores were lower among YA cancer survivors, indicating lower QOL in comparison to both healthy peers and older adult survivors. PCS scores were lower among YA survivors in comparison to their healthy peers, indicating decreased physical functioning, and higher than older adult survivors. The findings underscore the need for appropriate access to high-quality care for cancer survivors and interventions associated with improving MCS and PCS, particularly among those most vulnerable. Citation Format: Erin M. Mobley, Gerard Garvan, Daniel Norez, Halle Mitchell, Ramzi Salloum, Michael S. Gutter, Ziad T. Awad, Dejana Braithwaite, Stephen Anton, Matthew Gurka, Alexander S. Parker. Inequities in financial burden, quality of life, and physical functioning among cancer survivors: A nationally-representative Medical Expenditures Panel Survey (MEPS) study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A051.

Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study.

Adolescents and young adults with gynecology cancer are unique, especially in terms of their reproductive and sexual aspects. This systematic review aimed to identify reproductive problems in adolescent and young adult survivors of gynecology cancer. Articles from five databases were reviewed. PubMed, Taylor & Francis, Scopus, Science Direct, and Proquest, which were published in 2012-2023, 15-39 years of age, who had gynecology cancer and had completed cancer treatment. Biased risk assessment using Joanna Briggs Institute (JBI) tools. From the 1.167 articles, 12 were reviewed in this systematic review. Based on the results of the study, there were 4479 adolescent and young adult cancer survivors and 990 with gynecology cancer (cervical, ovarian, endometrial, pelvic, and vulva). The average age at diagnosis of cancer was 33,58 years old. Reproductive problems that occur in adolescents and young adults are sexual dysfunction, sexual activity, fertility, and psychosocial problems as a result of reproductive problems. Adolescent and young adult cancer survivors need information on reproductive issues and fertility maintenance after completing cancer treatment. Health professionals must focus on reproductive problems and counselling about long-term reproductive health among adolescent and young adult gynecology cancer survivors. Abstrak: Remaja dan dewasa awal dengan kanker ginekologi punya keunikan khususnya berkaitan dengan aspek seksual dan kesehatan reproduksi. Tinjauan sistematis ini bertujuan untuk mengidentifikasi masalah reproduksi penyintas kanker ginekologi berusia remaja dan dewasa awal. Artikel dari lima database yaitu PubMed, Taylor & Francis, Scopus, Science Direct, dan Proquest yang dipublikasi tahun 2012-2023 dengan rentang usia responden 15-39 tahun, memiliki sampel kanker ginekologi dan telah menyelesaikan pengobatan kanker. Penilaian risiko bias menggunakan tools Joanna Briggs Institute (JBI). Jumlah artikel yang didapatkan dari pencarian adalah 1.167 artikel dan sebanyak 12 artikel ditinjau dalam telaah sistematis ini. Berdasarkan hasil telaah didapatkan sebanyak 4479 penyintas kanker berusia remaja dan dewasa awal dengan jenis kelamin perempuan sebanyak 990 penyintas dengan jenis kanker ginekologi (serviks, ovarium, endometrium, pelvis, dan vulva). Rata-rata usia saat diagnosis kanker yaitu 33,58 tahun. Masalah reproduksi yang terjadi pada remaja dan dewasa awal yaitu disfungsi seksual, mengalami gangguan pada aktivitas seksual, masalah fertilitas, dan masalah psikososial sebagai dampak dari gangguan reproduksi. Penyintas kanker remaja dan dewasa awal membutuhkan informasi terkait masalah reproduksi dan persiapan untuk menjaga fertilitas setelah terapi aktif kanker selesai. Tenaga kesehatan harus fokus pada masalah reproduksi penyintas dengan kanker ginekologi dan membutuhkan konseling terkait kesehatan reproduksi jangka panjang.

12117 Background: Due to disruptions in education, workforce entry, and career development caused by cancer and its treatment, young adult (YA) cancer survivors face financial toxicity (i.e., cancer-related financial distress) at rates higher than older survivors. Financial toxicity in YA survivors is associated with avoiding care and diminished psychosocial well-being, but enduring effects on employment, personal finances, and healthcare use and the association with YA’s financial capability are not well studied. Methods: This was a cross-sectional survey of a national sample of YAs with cancer (n = 214) recruited online and via mailing lists. It included the Comprehensive Score for Financial Toxicity (COST), demographic/clinical self-report, and questions on medical cost-coping and healthcare use. Financial capability questions considered respondents’ knowledge about finances, self-efficacy for managing health expenses, and attitudes and behaviors regarding tracking expenses, budgeting, saving, investing, and bill paying. Multiple linear regression assessed associations among financial toxicity, financial capability, and cost-coping. Results: Mean respondent age was 35.4 years ( sd= 5.40) at survey and 27.5 years ( sd= 7.23) at diagnosis. Breast cancer (28%) and lymphoma (17%) were the most common diagnoses; most respondents were white (79%) women (87%) with college degrees (74%). Financial toxicity, as measured by COST, was high (mean = 13.9, sd= 9.3; possible range 0-44, scores < 26 indicate severe financial toxicity). Nearly all of the sample (96%) had health insurance, but 30% said their insurance does not meet their needs. One-half of the sample lacked confidence to manage health expenses. Cost-coping strategies included skipping/delaying: treatment (23%), survivorship care (35%), or medications (39%); 65% relied on a family member to pay for some/all medical bills. Negative events related to medical expenses included using money from savings (58%), taking on credit card debt (45%), post-cancer credit score decrease (44%), borrowing money to pay bills (42%), debt collection contact (37%), lacking money to pay for basic necessities (23%), loan denial (20%), and thoughts about and/or filing for bankruptcy (15%). In multivariate analyses, greater financial toxicity was associated with lower self-efficacy for managing health expenses (β = -0.88, p =.01), poorer financial behaviors (β = -0.54, p =.001), lower income (β = -5.27, p =.001), and skipping/delaying: treatment (eβ= 1.16, p <.001), survivorship care (eβ= 1.13, p <.001), or prescribed medication (eβ= 1.10, p =.001). Conclusions: Our findings illustrate the profound enduring impact of financial toxicity among YAs after cancer treatment. Multilevel interventions are needed to provide YAs the tools to navigate financial aspects of the healthcare system and connect them with resources toward gaining financial independence.

Female childhood, adolescent, and young adult cancer survivors have an increased risk of adverse pregnancy outcomes related to their cancer- or treatment-associated sequelae. Optimal care for childhood, adolescent, and young adult cancer survivors can be facilitated by clinical practice guidelines that identify specific adverse pregnancy outcomes and the clinical characteristics of at-risk subgroups. However, national guidelines are scarce and vary in content. Here, the International Late Effects of Childhood Cancer Guideline Harmonization Group offers recommendations for the counseling and surveillance of obstetrical risks of childhood, adolescent, and young adult survivors. A systematic literature search in MEDLINE database (through PubMed) to identify all available evidence published between January 1990 and December 2018. Published articles on pregnancy and perinatal or congenital risks in female cancer survivors were screened for eligibility. Study designs with a sample size larger than 40 pregnancies in childhood, adolescent, and young adult cancer survivors (diagnosed before the age of 25 years, not pregnant at that time) were eligible. This guideline from the International Late Effects of Childhood Cancer Guideline Harmonization Group systematically appraised the quality of available evidence for adverse obstetrical outcomes in childhood, adolescent, and young adult cancer survivors using Grading of Recommendations Assessment, Development, and Evaluation methodology and formulated recommendations to enhance evidence-based obstetrical care and preconception counseling of female childhood, adolescent, and young adult cancer survivors. Healthcare providers should discuss the risk of adverse obstetrical outcomes based on cancer treatment exposures with all female childhood, adolescent, and young adult cancer survivors of reproductive age, before conception. Healthcare providers should be aware that there is no evidence to support an increased risk of giving birth to a child with congenital anomalies (high-quality evidence). Survivors treated with radiotherapy to volumes exposing the uterus and their healthcare providers should be aware of the risk of adverse obstetrical outcomes such as miscarriage (moderate-quality evidence), premature birth (high-quality evidence), and low birthweight (high-quality evidence); therefore, high-risk obstetrical surveillance is recommended. Cardiomyopathy surveillance is reasonable before pregnancy or in the first trimester for all female survivors treated with anthracyclines and chest radiation. Female cancer survivors have increased risks of premature delivery and low birthweight associated with radiotherapy targeting the lower body and thereby exposing the uterus, which warrant high-risk pregnancy surveillance.

This study aimed to (1) develop TOGETHER-YA, an e-Health-delivered and group-based health-related quality of life (HRQOL) intervention for young adult (YA) cancer survivors aged 18-39 (Part 1), and (2) determine its initial feasibility and acceptability in a single-arm pilot trial (Part 2). TOGETHER-YA is a manualized, 10-week intervention for YA survivors that includes elements of relaxation training, cognitive-behavioral therapy, and health education. In Part 1, content was adapted from existing evidence-based interventions with feedback from YAs (N = 22) in four iterative focus groups. In Part 2, YA survivors (N = 11) participated in a single-arm pilot trial of TOGETHER-YA. Intervention groups were led by a trained facilitator over videoconference. Primary outcomes were feasibility (i.e., recruitment, session attendance, retention) and acceptability (i.e., participant satisfaction). Focus groups reacted positively to TOGETHER-YA and provided actionable recommendations for enhancing its relevance and acceptability, which were implemented. In initial testing, all feasibility and acceptability benchmarks were met; 58% of eligible YAs were recruited, participants attended M = 6 intervention sessions (SD = 3), and 82% of participants were retained post-intervention. On average, participants "agreed" to "strongly agreed" with positive statements about the weekly sessions and the overall program. TOGETHER-YA was developed in collaboration with YA cancer survivors and found to be feasible and acceptable in initial testing. TOGETHER-YA is the first HRQOL intervention for a broad range of YA survivors that is eHealth-delivered for convenience and group-based for peer support. Future large-scale trials should test its efficacy for improving HRQOL. NCT05048316, September 17, 2021; NCT05054569, September 23, 2021.

Given the growing population of young adult (YA) cancer survivors, understanding their different quality of life (QOL) profiles is important for informing interventions to promote QOL, which may target constructs like hope or psychological flexibility. This study assessed YA survivors' QOL profiles and their associations with these 2 constructs. Latent class analysis (LCA) was conducted on PROMIS QOL measures (physical functioning, social functioning, fatigue, sleep disturbance, pain interference, anxiety, depression) among 155 YA survivors (ages 18-39; Mage = 32.89, 87.7% female, 8.4% Hispanic, 22.6% racial minority) within 3years post-treatment. Multivariable regressions assessed sociodemographic and cancer-related factors in relation to class (multinomial logistic), and class in relation to scores on Snyder's Hope Scale and the Acceptance and Action Questionnaire-II assessing psychological inflexibility (linear). LCA identified 4 classes: (1) low physical/social functioning with high symptoms (i.e., fatigue, sleep disturbance, pain interference, anxiety, depression; 43.2%); (2) high physical/social functioning with high symptoms (23.9%); (3) high physical/social functioning with low symptoms (17.4%); and (4) low physical functioning, moderate social functioning and physical symptoms, and low mental health symptoms (15.5%). Compared to class 3 (referent), classes 1 and 4 more likely had chemotherapy (aOR = 6.54, CI 1.22-34.48; aOR = 12.82, CI 1.05-28.67), and class 2 had higher monthly income (≥ vs. < $4,200: aOR = 1.16, CI 1.02-1.54). Additionally, classes 1 and 2 had lower hope (B = -10.95, CI -14.42, -7.48; B = -5.50, CI -9.28, -1.71) and higher psychological inflexibility (B = 12.41, CI 9.06, 15.76; B = 8.21, CI 4.57, 11.86). YA survivors demonstrated varied QOL profiles, often with considerable symptoms. Interventions targeting hope and/or psychological flexibility may promote QOL. NCT05905250.

Young adult (YA) cancer survivors have specific needs because of their age and life stage. The authors investigated the challenges and resource needs of YA survivors, exploring the influence of age at diagnosis (i.e., diagnosis during childhood vs. young adulthood) and the diagnosis of a brain tumor. The authors conducted four focus groups with YA survivors (N = 22, age 18–35), treated for brain tumors or other cancers in childhood (mean age at diagnosis ± SD: brain, 10.7 ± 2.86; other cancers, 10.5 ± 3.51) or as YAs (brain, 23.5 ± 4.04; other cancers, 25.6 ± 4.10). Transcripts of audiotaped sessions were coded using thematic analysis. Common challenges across the groups included physical appearance, fertility, late effects, social relationships, and changing priorities. Childhood cancer survivors struggled with identity formation, social isolation, and health care transitions. Concerns specific to survivors diagnosed as YAs included financial independence and protecting parents. Childhood brain tumor survivors struggled with cognitive deficits, limited career options, and poor social skills, whereas brain tumor survivors diagnosed as YAs emphasized cognitive decline, loss of autonomy, and living with an incurable disease. Despite the unique challenges identified, all groups described similar resource needs including peer support, age-specific information, and having health care providers proactively raise salient issues. Young adult cancer survivors have many similar psychosocial and information needs regardless of age at or type of diagnosis that differ from those of pediatric and older adult survivors. With improved survival rates, the small number of YA in any one institution will grow. It will become increasingly important to create comprehensive, age-appropriate YA programs that address overlapping and unique needs of survivors at this life stage.

Purpose/objective To examine the context of relationship status on the link between friends/family social constraints (SCff) and cancer-related quality-of-life (QOL) among young adult testicular cancer survivors. Design/research approach Participants completed the Functional Assessment of Cancer Therapy (general version), the Social Constraints Scale (friends/family), and demographic questions. Sample/participants The sample included 162 young adult testicular cancer survivors. Findings SCff, but not relationship status, significantly predicted QOL when controlling for age, time since diagnosis, education, and income. The SCff X relationship status interaction was significant such that SCff were more strongly related to lower QOL for single survivors than for partnered survivors. Implications Focusing on friends and family support of young adult survivors, findings highlight the vulnerability of single survivors to social constraints within their diffuse social network. Interventions that target supportive exchanges in friends and family networks may be useful in improving QOL in single young adult cancer survivors.

Although cancer experiences and health-related quality of life (HRQOL) differ by sex, little is known about how sex affects comorbid conditions, health behaviors, health service utilization, and HRQOL in young adult (YA) cancer survivors. We sought to determine the relationship of sex to these factors in this population. This matched case-control, cross-sectional study used data from the Texas Behavioral Risk Factor Surveillance System for 2015-2019. YA survivors aged 18-39years, were matched to controls. Chi-square and multiple logistic regressions were used to assess the relationship between sex and the measured factors. The analysis included 276 YA survivors and 828 controls. Male survivors were more likely than male controls to have a depressive disorder (OR = 3.06, p = 0.007), smoke (OR = 3.87, p < 0.001), and forgo health care because of cost (OR = 5.60, p < 0.001). Female survivors were more likely than female controls to have at least one comorbidity (OR = 3.52, p < 0.001), forgo health care because of cost (OR = 3.03, p < 0.001), and report poorer HRQOL (aORs = 1.52-2.22, p < 0.05). Female survivors were more likely to have at least one comorbid condition (aOR = 1.70, p = 0.02) than male survivors. YA cancer survivors differed in their health outcomes from both the general population and by sex. Tailored, sex-based interventions are needed to decrease long-term morbidity and improve HROQL in this population.

Young adult (YA) cancer survivors aged 18-39 years face increased chronic disease risk. Although YA survivors prioritize health, structural barriers may limit their ability to maintain healthy lifestyles, particularly in culturally and geographically diverse regions. This mixed-methods study explored health priorities, social determinants of health (SDoH)-related barriers and facilitators to maintaining a healthy lifestyle, and intervention preferences for YA cancer survivors in New Mexico (NM) to inform future interventions. Descriptive statistics and thematic analysis were conducted on surveys and semistructured interviews with 17 YA cancer survivors and 11 YA cancer care providers in NM. Surveys assessed demographics and, for survivors, SDoH, and intervention preferences. Social isolation was the most prevalent adverse SDoH, affecting 47% of YAs. YAs expressed interest in diet/physical activity-related programs (82%) and were flexible about group/one-on-one (59%) and in-person/online (71%) program formats. YA themes included: physical and mental health are priorities post-treatment; multilevel barriers and facilitators shape health behaviors; there is a lack of YA-specific resources; community building is key for peer support; support strategies to address psychosocial, behavioral, and health care navigation concerns are needed. Provider themes included: YAs have specific care needs during the survivorship transition to long-term wellness; collaborative, innovative organizational solutions are critical, peer and community support is effective, and integrating psychosocial and culturally informed care enhances outcomes; there is a need for empowering support tailored to the needs of YA survivors in NM. Physical, mental, and social health are priorities for YA cancer survivors post-treatment. Findings highlight the need for flexible, community-informed interventions that support holistic health and long-term survivorship.

Treatment gaps in meeting the neuropsychological needs of young adult (YA) cancer survivors can be attributed to several clinical and systemic reasons. Access to neurocognitive care can be increased through the effective integration of neuropsychological monitoring and intervention in survivorship care. In this brief report, we aim to compare the efficacy of a brief neuropsychological screener (DIVERGT) in meeting the assessment and referral needs of pediatric and YA cancer survivors (n = 40) as part of a wellness and survivorship clinic. Participants (n = 40) were patients who presented to a pediatric oncology survivorship clinic over the span of 15 months.

This study compared the unmet needs, quality of life, and health behaviors (smoking, alcohol, and physical activity) of young adult cancer survivors to their older counterparts and age-related peers. We conducted a subset analysis of the Cancer Survival Study baseline data collected from participants surveyed at approximately 6-7 months post-diagnosis. All 58 young adults aged 18-40 years at the time of first primary cancer diagnosis and participating in the study were included. Their responses to the self-administered SCNS-SF34, EORTC QLQ-C30, and standard items assessing smoking, alcohol consumption, and physical activity were compared to a random sample (n = 58) of gender and cancer-type matched older adults (64+ years) participating in the same study. Young adult survivors' health behaviors were also compared to previously published data for age-related peers from the Australian general population. Young adult cancer survivors reported significantly lower levels of social functioning; higher levels of financial difficulties, sexuality needs, health systems and information needs; and better physical functioning than their older counterparts. A significantly higher percentage of young cancer survivors were current smokers compared to older survivors (16.1% vs. 3.7%, p = 0.03), but is lower than that reported by age-related peers (24.8%). Compared to young cancer survivors (27.3%), significantly fewer older cancer survivors (8.3%, p = 0.046) and more age-related peers (53.6%) engaged in sufficient levels of physical activity. The impact of cancer on young adults seems to be specific. Future research should verify the unique concerns of young adult cancer survivors in large and diverse samples.

Many adolescent and young adult (AYA) cancer survivors place great importance on fertility. This study explored AYAs' discussions of fertility in the context of discussing their survivorship experiences. Secondary analyses of a qualitative study of young adult survivors of adolescent cancers ("AYA survivors") was performed using semistructured individual interviews and focus groups. Analyses were conducted using grounded theory using thematic content analysis with an inductive data-driven approach. Participants (n = 43) were 16-24 years old, diagnosed with cancer between ages 14 and 18 years, and were at least 6 months post-treatment. Before treatment, 5 males banked sperm and no females preserved fertility. More males (50%) than females (39%) reported uncertainty about their fertility. Three major categories emerged from the data: fertility concerns, emotions raised when discussing fertility, and strategies used to manage fertility concerns. Fertility concerns focused on dating/partner reactions, health risks, and what potential infertility would mean for their life narrative. Emotions included distress, feeling overwhelmed and hopeful/wishful thinking. Females were more likely to feel distressed and overwhelmed than males. Strategies to manage concerns included acceptance/"making do," desire to postpone concerns, and reliance on assisted reproductive technology. Most AYAs in our study reported a number of reproductive concerns and fertility-related distress after treatment, which may affect other areas of psychosocial functioning. Females may be more at-risk for distress than males, particularly in situations of uncertainty and limited knowledge. Future work should explore how to best incorporate fertility-related informational and support services more fully into survivorship care. Implications for survivorship care are discussed.