Incidental Colorectal Adenomas in Adolescents: Clinical Management, Genetic Evaluation, and Surveillance.

TPS1598 Background: In the US, many of the 90,000 adolescents and young adults (AYAs) (i.e., individuals ages 15-39) diagnosed with cancer each year do not receive services to address the range of needs they experience during cancer treatment. AYAs’ unmet needs are associated with higher distress, poorer health-related quality of life, and higher physical symptom burden. However, AYAs often do not use services available to them through their cancer programs, even when they face no access issues (e.g., cost, insurance status, local service capacity). AYAs report barriers to service use including lack of awareness, challenges navigating large volumes of information and complex health systems, and hesitance to broach needs with providers without prompting. To facilitate a systematic and patient-centered approach to addressing AYAs' unmet needs, we leveraged user-centered design to develop the AYA Needs Assessment & Service Bridge (NA-SB). NA-SB includes a patient-reported outcome measure assessing AYAs’ physical, psychosocial, and practical needs, and a collection of referral pathways for connecting AYAs to services based on the needs they report. In this feasibility pilot study, we are evaluating the implementation of NA-SB in the University of North Carolina Lineberger Comprehensive Cancer Center (UNC) AYA Cancer Program. Methods: Eligible participants include AYAs ages 18-39 currently undergoing cancer treatment at UNC (n = 25-50). The needs assessment portion of NA-SB is administered electronically through REDCap during routine clinical encounters with the AYA team. After an AYA completes the needs assessment, an AYA provider (i.e., social worker/nurse practitioner) reviews their responses and initiates referral pathways. Six weeks following their completion of the needs assessment, AYAs complete a survey assessing their perceptions of (1) the usability of the NA-SB needs assessment, (2) the feasibility, acceptability, and appropriateness of implementing NA-SB, and (3) the extent to which their needs have been met. We are also assessing participating providers’ perceptions of NA-SB’s implementation through periodic check-in calls. Results: We will report descriptive statistics on participant demographics, needs reported, and quantitative outcomes. We will analyze data from provider check-in calls inductively to further elaborate on implementation experiences and determinants. Conclusion: By harnessing patient-reported data to facilitate care coordination for AYAs, NA-SB has the potential to improve processes of care and subsequent outcomes for AYAs, an underserved and understudied population. This pilot study represents a critical first step towards translating NA-SB into routine cancer care for AYAs. Clinical trial information: NCT04586127.

While the incidence of colorectal cancer (CRC) in the US has declined at a pace of 3% annually between 2003 and 2012, there has been an increase in the incidence of early-onset colorectal cancer (EOCRC). The reasons for this increase are unclear. Diet, the environment, the microbiome and alcohol consumption have all been proposed as contributing factors. There is the possibility that EOCRC has a unique biology. Overlapping with the EOCRC age range is CRC in adolescent and young adults (AYA) that share many molecular characteristics with EOCRC. The purpose of this review is to cover current progress in our understanding of the biology of CRC in the context of adolescent and young adult CRC and EOCRC and discuss future directions.

Purpose: Adolescents and young adults (AYAs) with cancer are at increased risk for inherited cancer predisposition syndromes. Genetic counseling (GC) is important for accurate risk assessment, diagnosis, and management of inherited cancers. Numerous barriers prevent AYA access to genetic services. This study describes outcomes of a genetic evaluation initiative (GEI) regarding utilization of genetic services among AYAs. Methods: To improve AYA access to GC, the AYA program at UT MD Anderson Cancer Center implemented GEI, a process for identifying and referring eligible patients for GC. We collected retrospective electronic medical record data between July 12, 2018 and July 12, 2019 to capture AYA's clinical characteristics, genetic referral, scheduled appointments, counseling, testing, and results. Results: In total, 516 AYAs were referred to the AYA clinic during the study period with a median age of first cancer diagnosis of 17 years. One hundred sixty-six AYAs were identified who would benefit from genetic evaluation, 57 (34.3%) of whom had previously undergone counseling. One hundred nine patients were recommended for referral to GC, and 64.2% (70/109) were referred by the AYA team. To date, 58.6% (41/70) met with a genetic counselor and 75.6% (31/41) completed genetic testing, which yielded 1 pathogenic, 2 uncertain, and 29 benign results. Conclusion: The GEI resulted in a 72.0% relative increase in the rate of GC utilization and represents a novel approach to increasing AYA patient access to cancer genetic services in this population.

Polygenic Risk Scores for Follow Up After Colonoscopy and Polypectomy: Another Tool for Risk Stratification and Planning Surveillance?

Presence of small sessile serrated polyps increases rate of advanced neoplasia upon surveillance compared with isolated low-risk tubular adenomas

Diminutive Polyps With Advanced Histologic Features Do Not Increase Risk for Metachronous Advanced Colon Neoplasia

Previous studies have called for further research to explore adolescent and young adult (AYA) decision-making in the context of advanced cancer to understand the perspectives of this understudied population. We conducted a qualitative study with patients and providers to better understand the decision-making experience of AYA patients with advanced stages of cancer. Semistructured qualitative telephone interviews were conducted from April 2016 to October 2016. English-speaking AYAs and healthcare providers were recruited through the social media sites Twitter and Facebook. AYAs were eligible if they were aged 18-39 years at diagnosis and self-reported having metastatic cancer; any provider who worked with AYAs with metastatic cancer was eligible. Researchers with expertise in qualitative methods conducted inductive thematic content analysis of transcribed interviews. The analyzed data were used to formulate recommendations for clinicians. Twelve AYA patients with self-reported stage IV cancer and five clinicians who care for AYAs with advanced stages of cancer were enrolled and shared their experience about AYA medical decision-making. Four primary themes emerged: (1) AYAs describe receiving unclear prognosis, (2) AYAs balance concepts of hope and risk, (3) AYAs choose aggressive treatment options, and (4) AYAs want support facing mortality. Recommendations for clinicians include clear communication about prognosis and side effects and concerted efforts to elicit patient values. AYA patients and clinicians provided insights into the experiences and decision-making processes of AYA patients choosing to continue or discontinue treatment and into the areas for improvement in patient-centered oncology care. Taken together, these data provide important suggestions for clinicians caring for this vulnerable population.

BACKGROUND The adolescent and young adult (AYA) population (15-39 years) is a unique and understudied population within neuro-oncology, and their care requires expertise across pediatric and adult-type brain tumors. Current challenges in AYA neuro-oncology include fragmented care across pediatric and adult hospitals, low inclusion in clinical trials, unique survivorship considerations and a lack of standard-of-care therapies for this population. MATERIAL AND METHODS We report on a two-year national effort from the Canadian AYA Neuro-Oncology Network (CANON) to implement national AYA rounds. The aims of the rounds are to discuss challenging cases, encourage and review the utility standardized molecular testing, and provide point-of-care multidisciplinary recommendations benefiting from the expertise of pediatric and adult providers across several tertiary and community centers. RESULTS Since April 2021, the Canadian national AYA rounds have occurred biweekly on a virtual secure platform. Over 2 years, 138 cases have been discussed; 23% of patients were 15-20 years old, 33% were 21-30 years old and 26% were 31-40 years old. Cases discussed included low grade gliomas (39%), followed by high grade gliomas (33%), ependymomas (6.5%), medulloblastomas (6.5%) and others (9.4%). A total of 240 participants across 25 institutions across Canada have attended the rounds, spanning adult and pediatric neurosurgery, neuro-pathology, neuro-oncology, radiation oncology and radiology. A prospective database of cases presented at our AYA rounds, matching molecular characterization, choice of therapies and relevant clinical outcomes has been initiated and interim data will be presented at the meeting. CONCLUSION Virtual national AYA-neuro-oncology multi-disciplinary rounds have raised awareness of current gaps and possible nation-wide solutions to improve the care of AYA brain tumors. Leveraging this network, our group has published guidelines for molecular testing in AYA brain tumors and is employing this platform for ongoing research and clinical collaborations.

BACKGROUND The adolescent and young adult (AYA) population (15-39 years) is a unique and understudied population and their care requires multidisciplinary expertise. Current challenges in AYA neuro-oncology include fragmented care across pediatric and adult hospitals, low inclusion in clinical trials, unique survivorship considerations and a lack of standard-of-care therapies for this population. METHODS We will report on a two-and-a-half-year national effort from the Canadian AYA Neuro-Oncology Network (CANON) to implement national clinical and molecular AYA rounds. The aims of the rounds are to provide a platform for standardized diagnostics and multidisciplinary recommendations benefiting from the expertise of pediatric and adult providers across several tertiary and community centers. RESULTS Since April 2021, the Canadian national AYA rounds have occurred biweekly on a virtual secure platform. As of April 2023, 132 cases have been discussed from 25 sites; 15 cases (11%) involved pediatric patients and 117 (89%) were patients aged > 18 and treated at adult hospitals. Cases discussed included adult (n =34, 26%) and pediatric type (n = 22, 17%) low-(n=25, 19%) and high-grade (n=30, 23%) glioma, medulloblastoma (n=14, 10.5%), ependymoma (n=6, 5%) and other tumors (glioneuronal tumors, pineal tumors, germinoma). A total of 175 providers and 70 trainees across 32 Canadian institutions have attended the rounds, spanning adult and pediatric neurosurgery, neuropathology, neuro-oncology, radiation oncology and radiology. The updated results of an ongoing prospective database of cases presented at our AYA rounds, outlining themes around molecular characterization, choice of therapies and relevant clinical outcomes will be presented at the meeting. CONCLUSIONS Virtual national AYA-neuro-oncology multi-disciplinary rounds is an effective platform that has raised awareness of current gaps and has facilitated nation-wide solutions to improve the care of AYA brain tumors, leveraging research and clinical collaborations.

Adolescents and Young Adults (AYA) with Acute Myeloid Leukemia (AML) Have Increased Treatment-Related Mortality with Similar Outcomes – a Report from the Children’s Oncology Group Trials AAML03P1 and AAML0531

Patient involvement and engagement (PI&E) in health care and research has gained prominence, shifting towards person-centred approaches and shared decision making. Patients actively participating in health care design and research lead to better quality and efficiency of care. However, implementing meaningful PI&E is challenging and requires adequate resources and evaluation frameworks so that it does not result in tokenism. This is particularly important when considering niche areas like adolescents and young adults (AYAs) with cancer. As AYAs' unique needs continue to gain recognition, it is becoming increasingly important to incorporate their expertise and diverse perspectives in navigating care. Large-scale European consortia that focus specifically on AYAs offer opportunities to establish successful partnerships with AYAs in the design and creation of the next generation of equitable, diverse, and inclusive cancer care. Concrete actions for meaningful AYA PI&E are discussed.

Effective Treatment of Ph-Negative Acute Lymphoblastic Leukemia for Uninsured Hispanic Adolescents and Young Adults with a Low-Cost Outpatient Regimen

Adolescents and young adults (AYAs) represent a unique patient cohort, straddling the realms of paediatric and adult medicine. AYA cancers may include traditionally “paediatric” cancers occurring at older than expected ages, or conversely, adult-onset cancers occurring at unusually young ages. Cancer incidence in AYAs (aged 15–39) is increasing, and disappointingly, survival data are worse than those in paediatric or older adult settings. Early recognition of underlying cancer predisposition syndromes (CPS) in AYAs may facilitate individualised therapies, initiation of tumour surveillance strategies and cascade testing in at-risk relatives. Increasingly, physicians together with the wider AYA multidisciplinary team recognise AYAs as a unique group that merit special considerations, particularly regarding the psychosocial impact of cancer and genetic diagnoses on self-identity, fertility and family planning. AYA referral rates for genetic evaluation are suboptimal, but are improving with expanded access to testing, increasing clinician awareness and increasing public demand for genomic investigation. Herein, we outline recent developments in CPS testing in the AYA cohort. We highlight clinical tools useful in identifying patients that may warrant genetic counselling and/or genetic testing. We also discuss AYA-specific ethical and psychosocial challenges of genetic testing.

Purpose: Rates of obesity and obesity-related health consequences, including type 2 diabetes (T2D) and cancer, continue to rise. While cancer patients are at an increased risk of developing T2D, the prevalence of T2D and insulin prescription among young patients with cancer remains unknown. Methods: Using the Total Cancer Care Study cohort at Huntsman Cancer Institute (Salt Lake City, UT), we identified individuals age 18-39 years at cancer diagnosis between 2009 and 2019. Multivariable logistic regression was used to investigate associations between body mass index (BMI) with insulin prescription within 1 year of cancer diagnosis. Results: In total, 344 adolescents and young adults (AYAs) were diagnosed with primary invasive cancer. Within this cohort, 19 patients (5.5%) were ever diagnosed with T2D, 48 AYAs ever received an insulin prescription (14.0%), and 197 were overweight or obese (BMI: 25+ kg/m2) at cancer diagnosis. Each kg/m2 unit increase in BMI was associated with 6% increased odds of first insulin prescription within 1 year of cancer diagnosis among AYAs, even after adjustment for age, sex, smoking history, marital status, glucocorticoid prescription, and cancer treatments (odds ratio = 1.06, 95% confidence interval 1.02-1.11; p = 0.005). Conclusion: One in every 18 AYAs with cancer ever had T2D, 1 in 7 AYA patients with cancer ever received an insulin prescription, and higher BMI was associated with increased risk of insulin prescription within a year of cancer diagnosis among AYAs. Understanding the incidence of T2D and insulin prescription/use is critical for short-term and long-term clinical management of AYAs with cancer.

Building on scholarship indicating that uncertainty is a fundamental component of the cancer experience, this study focuses on an understudied population: adolescents and young adults (AYAs) with cancer. Because AYAs’ health outcomes lag behind those of older and younger people with cancer, scholars have recommended that the subjective experiences of AYAs be better understood. Using the tripartite model of uncertainty sources as a guiding framework, we analyzed naturally occurring messages from an online discussion forum for AYA cancer survivors. The majority of messages communicating uncertainty expressed medical uncertainty regarding the complexities of understanding treatment options and sequelae. Results indicated that several overarching areas of AYA uncertainty correspond to themes reported by other cancer populations, but that some distinctive concerns arise amid the normative complexities of late adolescence and young adulthood.