Adolescent Cancer Survivors Research Articles

Cancer survivors and cardiovascular diseases: from preventive strategies to treatment.

During the last decades, progress in the treatment of oncological diseases has led to an increase in the survival of cancer patients: cancer survivors (CS). Thus, the incidence of CS has increased enormously, in both adult CS and childhood and adolescent CS. Unfortunately, CS treated with anthracyclines, chest radiotherapy (RT) and other potentially cardiotoxic drugs have a higher risk of cardiovascular (CV) toxicity: heart failure with reduced ejection fraction (HFrEF), valve diseases, coronary artery diseases, vascular diseases and pericardial diseases. In fact, chest irradiation can cause coronary artery diseases that can be latent until at least 10 years after exposure; also, valvular heart diseases can appear after >20 years following irradiation; heart failure may appear later, several years after anticancer drugs or RT. Therefore, it is very important to stratify the CV risk of cancer patients at the end of cardiotoxic drugs, to plan the most appropriate long-term surveillance program, in accordance with 2022 ESC Guidelines on Cardio-Oncology, to prevent late cardiovascular complications. Monitoring of cancer patients must not stop during anticancer treatment but it must continue afterwards, depending on the patient's CV risk. CV toxicity risk should be reassessed 5 years after therapy to organize long-term follow-up. Considering late cardiotoxicity in CS, our review aims to evaluate the incidence of cardiovascular diseases in CS, their mechanisms, surveillance protocols, preventive strategies, diagnosis and treatment.

Health Knowledge in Adolescent Childhood Cancer Survivors at High Risk for Therapy-Related Cardiotoxicity.

Childhood cancer survivors' (CCS) knowledge about late effects can promote positive health behaviors and autonomy. Cardiotoxicity is a major source of morbidity, which can be mitigated through exercise. Descriptive and Fisher's exact statistics were used to characterize health knowledge and physical activity in CCS ≥13 years at high risk for cardiotoxicity. Of 16 CCS (mean age 17.0 ± 2.1 years), 3 (18.8%) identified previous anthracycline exposure, and 5 (31.2%) had adequate physical activity. Of survivors <18 years, 82% had poor late effects knowledge (p = 0.005). Knowledge was not associated with physical activity (p = 0.60). Interventions are needed to improve late effects knowledge in adolescent CCS.

Balancing Fertility Preservation and Treatment Efficacy in (Neo)adjuvant Therapy for Adolescent and Young Adult Breast Cancer Patients: a Narrative Review.

Adolescent and young adult (AYA) breast cancer survivors face a significant risk of infertility due to the gonadotoxic effects of (neo)adjuvant therapy, which complicates their ability to conceive post-treatment. While (neo)adjuvant therapy primarily aims to improve recurrence-free and overall survival, fertility preservation strategies should also be considered for young patients. This narrative review explores recent advancements in fertility preservation techniques, such as oocyte, embryo, and ovarian tissue cryopreservation, and evaluates the feasibility of modifying breast cancer (neo)adjuvant therapy to preserve fertility without compromising survival outcomes. Our review highlights that clinical trials with co-primary endpoints of oncological safety and fertility preservation are limited, and substituting standard treatment regimens solely for fertility preservation is currently not recommended. Nevertheless, new clinical studies have emerged that either exclude highly ovarian-toxic agents, such as cyclophosphamide, or omit adjuvant therapy altogether, even if fertility preservation is not their primary endpoint. Unfortunately, many of these trials have not evaluated ovarian toxicity. Notably, since 2020, major oncology organizations, including the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO) have advocated for the routine assessment of ovarian toxicity in all clinical trials. The review underscores the importance of incorporating ovarian toxicity as a standard endpoint in future trials involving premenopausal breast cancer patients to identify treatment regimens that can effectively balance fertility preservation with treatment efficacy.

Live birth and maternity outcome in childhood and adolescent cancer survivors under 18 years at diagnosis: a 40-year population-based cohort study.

Survival from childhood and adolescent cancer has increased, but the chance of a livebirth in female survivors under 18 years at diagnosis may be reduced. We performed a national population-based analysis, including all female cancer survivors diagnosed in Scotland before the age of 18 years between 1981 and 2012. Scottish Cancer Registry records were linked to Scottish maternity records. Females from the exposed group with no pregnancies before cancer diagnosis (n = 2118) were compared with three general population controls matched for age and year of diagnosis. The cumulative incidence of a livebirth for all diagnoses was reduced to 37% (95% CI 33-40%) for cancer survivors at 30 years of age vs 58% (57-60%) for controls. The deficit varying by diagnosis: for lymphoid leukaemia, the cumulative incidence at 30 years was 29% (23-36%) vs 57% (52-61%) for controls with similar deficits in CNS tumours and retinoblastoma. There was a steady improvement in the chance of livebirth in those diagnosed more recently. We have shown a reduced chance of livebirth in female survivors of cancer diagnosed before age 18. The deficit is present for all diagnoses.

Substance Use in Adolescent and Young Adult Cancer Survivors: An Integrative Review.

The adolescent and young adult (AYA) ages are a time when individuals are susceptible to risky behaviors, including binge drinking, tobacco, marijuana, and illicit drug use. AYAs are at an increased risk for developing chronic health problems compared with their healthy peers, and substance use can pose additional risks. The purpose of this review is to compare substance use in AYAs with their healthy peers and identify contributing factors. A literature search was conducted of PubMed, Scopus, and OVID databases using keywords substance*, adolescent*, adolescence*, teens*, teenager*, young adult*, pediatric*, childhood*, cancer*, and oncology*. The initial search yielded 148 articles. Inclusion criteria specified English language and articles from January 1, 2013, to December 31, 2023. Studies were excluded if they did not include participants aged <18 years and without a noncancer comparison group. Five relevant articles were included after review and appraisal. Substance use was examined by substance use type and contributing factors, including caregiver-AYA relations, age, and depression/coping. Findings were mixed for substance use, including tobacco and alcohol use. Findings indicate no consistent pattern-substance use was both more and less common in AYAs than in their noncancer peers, or substance use did not differ between AYAs and their noncancer peers. With mixed results, each study identified some level of substance use in AYAs. Given this knowledge, when treating AYAs, providers should be diligent about screening for substance use during each visit. AYAs should be educated about the risk of substance use, especially as a vulnerable, at-risk population.

From Real-World Data to Causally Interpretable Models: A Bayesian Network to Predict Cardiovascular Diseases in Adolescents and Young Adults with Breast Cancer.

Background: In the last decades, the increasing number of adolescent and young adult (AYA) survivors of breast cancer (BC) has highlighted the cardiotoxic role of cancer therapies, making cardiovascular diseases (CVDs) among the most frequent, although rare, long-term sequalae. Leveraging innovative artificial intelligence (AI) tools and real-world data (RWD), we aimed to develop a causally interpretable model to identify young BC survivors at risk of developing CVDs. Methods: We designed and trained a Bayesian network (BN), an AI model, making use of expert knowledge and data from population-based (1036 patients) and clinical (339 patient) cohorts of female AYA (i.e., aged 18 to 39 years) 1-year survivors of BC, diagnosed in 2009-2019. The performance achieved by the BN model was validated against standard classification metrics, and two clinical applications were proposed. Results: The model showed a very good classification performance and a clear causal semantic. According to the predictions made by the model, focusing on the 25% of AYA BC survivors at higher risk of developing CVDs, we could identify 81% of the patients who would actually develop it. Moreover, a desktop-based app was implemented to calculate the individual patient's risk. Conclusions: In this study, we developed the first causal model for predicting the CVD risk in AYA survivors of BC, also proposing an innovative AI approach that could be useful for all researchers dealing with RWD. The model could be pivotal for clinicians who aim to plan personalized follow-up strategies for AYA BC survivors.

The Triglycerides - Glucose Index: An independent predictor of late subclinical cardiotoxicity in adult survivors of childhood, adolescent and young adult cancer

Abstract Introduction The Triglycerides - Glucose index (TyG index) has been identified as a reliable alternative for estimating insulin resistance (IR). Numerous recent studies have provided strong statistical evidence suggesting that this index is associated with the development and prognosis of cardiovascular pathologies. Objectives The aim of this study was to investigate the predictive role of the TyG index on the decrease in left ventricular longitudinal global strain (GLS) assessed on two-dimensional echocardiography in asymptomatic adult survivors of childhood, adolescent and young adult cancer. Methods The study included patients aged 18 years and older, asymptomatic cardiovascular survivors of childhood, adolescent and young adult cancer treated with anthracyclines with or without mediastinal radiotherapy. Anthropometric characteristics, cardiovascular risk factors and cancer treatment-related characteristics were collected. The TyG index was calculated using the formula: ln [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. GLS was assessed and expressed as an absolute value. A GLS equal to 17.3% was retained as the threshold value after calculation in a referent group matched to patients according to age and gender. Cardiac biomarkers GDF 15, ultra-sensitive troponin I and NT-proBNP levels were measured in addition to fasting blood glucose and lipid profiles. Multivariate analysis using linear regression was performed to identify associations between these different parameters. Results A total of 105 cancer survivors from childhood, adolescence and young adulthood were included. The sex ratio was 1.3. The mean age of the patients was 25 years, the mean time since completion of cancer treatment was 10.6 years, the mean cumulative doses of anthracyclines and mediastinal radiotherapy were successively 245.75 ± 75.14 mg/m2 and 34.6 ± 6.19 Gy. Mean GLS was 18.5 ± 2.83%, mean LVEF 60.6 ± 5.69%. None of the patients had any known diabetes or treatment to lower blood glucose or triglyceride levels. No patient had a history of cardiovascular disease. In the univariate study, the factors associated with lower GLS were patient age at recruitment (p = 0.03), mean time since completion of cancer treatment when this was greater than ten years (p = 0.005), dyslipidemia (p = 0.012), obesity (p = 0.037) and TyG (p = 0.037). In multivariate analysis, lower GLS was related to mean time since completion of cancer treatment (p = 0.015) and TyG index (p = 0.002). Conclusion Our results suggest that the TyG index, as a simple and inexpensive marker of insulin resistance, could help identify cancer survivors from childhood, adolescence and young adulthood who would be at risk of subclinical cardiac dysfunction. Prospective studies with larger numbers are needed to confirm these findings.

Availability of Adolescent and Young Adult-Specific Sexual and Reproductive Health Programs and Resources: A Review of the Websites of National Cancer Institute-Designated Cancer Centers.

Adolescent and young adult (AYA) cancer survivors often search online for information about cancer-related sexual and reproductive health concerns. A review of the websites of National Cancer Institute-designated cancer centers (n = 9) and comprehensive cancer centers (n = 58) was conducted to identify the presence of AYA-specific sexual and reproductive health programming and resources. No AYA-specific sexual health programs were found. Oncofertility programs were presented on 56% (n = 5) of cancer centers and 50% (n = 29) of comprehensive cancer center websites. As the population grows, it is imperative that cancer centers provide services to meet AYAs' sexual and reproductive health needs and highlight these services on their websites.

Associations Between Characteristics of Adolescent and Young Adult Cancer Survivors and Their Use of Different Social Media Platforms: An Observational Study of Social Media Accounts.

Background: The growing number of adolescent and young adult (AYA) cancer survivors and their unmet needs demand innovative communication and care strategies. This study uses social media data to examine how survivors' demographic and clinical characteristics relate to their social media use. Methods: Data from 300 AYA cancer survivors on six social media sites (YouTube, Instagram, Facebook, TikTok, Reddit, X/formerly Twitter) were collected between August 2022 and March 2023 and analyzed using descriptive statistics and statistical tests (chi-square, Fisher's exact, Welch, Games-Howell post-hoc, logistic regression). Results: Significant differences were observed across platforms for mean current age (p < 0.001) and age at diagnosis (p < 0.001). We also found significant associations between social media type used and current age, age at diagnosis, years since diagnosis, and the timing of social media account creation. AYAs who created their social media account post-diagnosis were less likely to use YouTube (p = 0.003) and more likely to use Facebook (p = 0.009). Treatment completion was associated with increased use of platform X (p = 0.004). Non-White individuals in our sample were less likely to use Facebook (p = 0.008). Significant associations were found between observed sex and platform usage (p < 0.001), with males more likely to use Reddit (p < 0.001) and X (p < 0.001). Conclusions: Significant associations were found between demographic and clinical attributes of AYA cancer survivors and the type of social media they used, suggesting that AYA-specific social media-based interventions should be tailored to subgroup characteristics (e.g., social media type, developmental stage based on age at diagnosis and current age, sex).

Identifying the informational needs and sources of support of Adolescent and Young Adult (AYA) cancer survivors to inform the development of a digital platform.

This study aimed to examine the (age-specific) informational needs and support sources used by Adolescent and Young Adult (AYA) cancer survivors throughout their cancer trajectory and socio-demographic and clinical factors associated with most common AYA-related informational needs. A cross-sectional questionnaire study was conducted among AYA cancer survivors (mean, 10.3 years after diagnosis, SD = 5.6). Informational needs and sources of support were examined via open questions and analyzed via a thematic inductive approach. Responses on informational needs were categorized according to the AYA anamnesis of the Dutch AYA "Young & Cancer" Care Network used in clinical practice. Chi-square and ANOVA tests were performed to assess differences in socio-demographic and clinical characteristics among AYA cancer survivors based on their varying levels of informational needs. In total, 593 AYA cancer survivors were included (mean, 32.2 years at diagnosis, SD = 5.6). Most common informational needs were related to: family and children (23%), fertility and pregnancy (23%), work and reintegration (20%), peers with cancer (13%), and intimacy and sexuality (13%). Females, AYA cancer survivors diagnosed a longer time ago, those with a college/university education, those diagnosed with breast or hematological malignancies, and those treated with chemotherapy were more likely to have AYA-related informational needs. The most often used sources of support were healthcare professionals (76%), family (72%), social life (69%), and websites (47%). AYA cancer survivors have informational needs related to their life stage including topics like family and children, and fertility. Tailored information services and support are needed, including opportunities to connect with peers and support for relatives. By addressing the informational needs and sources of support for AYA cancer survivors, we can improve AYA care programs and empower AYA cancer survivors to better cope with the consequences associated with their disease. This study will help to inform the content of AYA websites and platforms and help AYA cancer survivors, relatives, and healthcare professionals to become more aware of the needs of AYA cancer survivors and facilitate better use of relevant information and support services.

Vaping behavior among adolescent and young adult cancer survivors: A scoping review.

Adolescent and young adult (AYA) cancer survivors are vulnerable to future health complications and engage in risky health behaviors. Vaping or electronic cigarette use is increasing among AYA, yet little is known about the prevalence in AYA cancer survivors and associated morbidities. The objective of this research was to analyze the current state of the literature on vaping among AYA cancer survivors with scoping review methodology. Eligibility criteria included any vaping among people aged 13-39years with cancer or a history of cancer. Database searches from PubMed, Web of Science, PsycINFO, and Scopus yielded eight cross-sectional studies. Results suggest significant variability, with studies finding 2%-46% of AYA survivors have ever or currently vape. Medical (e.g., late effects), psychosocial (e.g., depression), and demographic correlates (e.g., younger age, male gender), as well as other risky health behaviors (e.g., cigarette smoking) were shown to be associated with vaping. Though the extant research is beginning the task of understanding comorbidities with vaping, few research has focused on those most vulnerable to vaping (survivors under age 18). More research is required to understand AYA survivors' vaping behavior to better understand the significance and implications regarding the growing incidence of vaping among this vulnerable population.

ASO Author Reflections: Disparities Exist for Adolescent Young Adult Breast Cancer Survivors.

ASO Author Reflections: Disparities Exist for Adolescent Young Adult Breast Cancer Survivors.

Patient engagement in a community-partnered hybrid health-related social needs navigation intervention for adolescents and young adults with cancer (AYA-NAV).

173 Background: Adolescent and young adult (AYAs) cancer survivors experience high rates of financial toxicity (FT), which is associated with poorer health outcomes. FT may disproportionately affect AYAs with unmet health-related social needs (HRSN), such as food or housing insecurity. Needs navigation may be an effective intervention to reduce financial distress, however, engagement has been a challenge in prior adult-directed interventions. We hypothesize that a hybrid navigation delivery model with community organization support and digital delivery will reduce financial distress and improve health outcomes. In a pilot study of AYA-NAV, an AYA-directed needs navigation intervention, we report patient engagement among participants. Methods: Eligible AYAs were 15-39 years old, Spanish- or English-speaking, receiving curative-intent treatment for cancer, and screened positive for FT (Comprehensive Score of Financial Toxicity &lt; 22) or unmet HRSN (food, housing, transportation, or utilities insecurity). Participants were referred for a consultation with the Patient Advocate Foundation (PAF), a national organization that provides case management and navigation support for people facing life limiting illness. At month 1, participants were referred to findhelp.org, a digital platform of comprehensive resources to facilitate resolution of unmet HRSN. Monthly check-ins were conducted by the study team to assess acceptability, intervention fidelity, and provide additional navigation support. We plan to enroll 30 participants on this study. Results: Of 19 AYAs that completed screening to date, 13 met criteria for FT or unmet HRSN; 13 (100%) agreed to AYA-NAV participation. To date, of 46 check-ins initiated by the study team, 33 (72%) were completed. All AYAs connected with the study team at least once during the 6-month duration of the study by text, phone, and/or in-clinic. Ten out of 13 (77%) participants reported that they spoke with a PAF case manager, and 7 (70%) of those said it was helpful. If the patient was unable to connect with PAF, more than half (55%) requested to be reconnected during a monthly check-in. Eight of the 13 (62%) participants visited findhelp.org; 6 (75%) of those found the digital platform to be helpful. Most patients referenced the high usability of findhelp.org, and 55% stated they connected to community resources via findhelp.org. Patients qualitatively reported challenges to intervention participation including medical complications, scheduling conflicts, and work commitments. Conclusions: Preliminary data demonstrate high patient engagement and intervention fidelity during a pilot feasibility study of AYA-NAV. Flexible modes for data collection and intervention delivery are important to inclusion of and retention of AYAs in hybrid navigation delivery models. Clinical trial information: NCT06072833 .

Feasibility and acceptability of a telehealth, individually-tailored healthy lifestyle intervention for adolescent and young adult pediatric cancer survivors.

Poor nutrition and physical activity pose negative health risks for adolescent and young adult pediatric cancer survivors (AYACS). Our pilot randomized controlled trial (RCT) evaluated feasibility and acceptability of a telehealth intervention (ENHANCE) supporting AYACS' nutrition and physical activity. We randomized 58 AYACS and their adult care partner, when applicable, to the ENHANCE or control condition. Inclusion required an age of 15-25 years, previous chemotherapy or radiation therapy, and no eating disorder history. We utilized a 2:1 (ENHANCE [n = 35]: control [n = 23]) double-blind block randomization protocol in blocks of 6. ENHANCE comprised 12 (60-min) sessions that included education, skill-building, and values-based healthy lifestyle decision-making. The first five sessions included motivational interviewing and the final seven sessions included problem-solving training/goal setting. We evaluated feasibility based on eligibility, enrollment, attrition, and study completion percentages. We assessed fidelity using the Session Content-Fidelity Rating Tool and the Motivational Interviewing Treatment Integrity Coding form. We assessed acceptability using the Abbreviated Acceptability Rating Profile, the Revised Helping Alliance Questionnaire, and participants' exit interviews. ENHANCE was feasible and highly acceptable; all but one participant who started the intervention completed all 12 sessions and all participants reported enjoying the intervention via objective assessment and during exit interviews. Interventionists delivered ENHANCE with high fidelity. ENHANCE was highly acceptable among AYACS and care partners. The telehealth study design was feasible, suggesting benefits and feasibility of a future, larger, multisite RCT. Promising findings support our methodological decisions as important considerations to inform a larger RCT.

Abstract A120: Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer

Abstract Introduction: Advances in treatment have significantly improved the survival rates of adolescent and young adult (AYA) cancer patients, with a five-year survival rate reaching 86%. However, these survivors remain at increased risk for developing secondary cancers later in life. Racial and ethnic minority groups, such as Hispanics, often experience significant healthcare disparities, including lower cancer screening rates. Cancer survivors, particularly those who are Hispanic and diagnosed as AYAs, may face unique barriers in adhering to recommended cancer screening guidelines. This study examines the uptake rates of colon, breast, and cervical cancer screenings among Hispanic survivors of AYA cancer compared to their age- and sex-matched Hispanic non-cancer controls. Methods: The National Health Interview Survey data (years 2000 - 2021) [R1] were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Data on cancer screening, including whether patients were up- to-date and ever screened for colon, breast, and cervical cancers, were assessed. The US Preventive Services Task Force recommendations were used to determine whether survivors were up-to-date for the cancer screening tests. The sample included 92 colon cancer survivors, 113 breast cancer survivors, and 313 cervical cancer survivors, matched with 920, 1130, and 3130 controls, respectively. Weighted percentages and odds ratios (OR) were calculated, adjusting for age at survey, sex, marital status, education, poverty status, and insurance. Results: Colon cancer screening uptake was significantly higher among survivors, with 26.1% up-to-date versus 11.5% of controls (OR=2.49, 95% CI=1.17-5.30, p=0.019). For breast cancer, 14.6% of survivors were up-to-date compared to 5.1% of controls [R2] (OR=2.51, 95% CI=1.33-4.72, p=0.005), and 82.6% of survivors were ever screened versus 38.7% of controls (OR=7.41, 95% CI=4.43-12.41, p&amp;lt;0.001). Cervical cancer screening showed the most pronounced difference, with 40.6% of survivors up-to-date compared to 19.0% of controls (OR=3.36, 95% CI=2.43- 4.65, p&amp;lt;0.001), and 71.2% of survivors ever screened compared to 28.6% of controls (OR=14.16, 95% CI=8.56-23.40, p&amp;lt;0.001). Conclusion: Hispanic AYA cancer survivors exhibit significantly higher cancer screening rates compared to matched controls. Despite these positive findings, the overall low screening rates highlight the need for targeted interventions to ensure that all survivors adhere to recommended screening guidelines. Enhancing access to healthcare and ensuring continuity of care are critical steps toward reducing disparities and improving health outcomes for this vulnerable population. Citation Format: Eunju Choi, Amy M. Berkman, Clark R Andersen, Michael E. Roth. Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A120.

Abstract B147: Avanzando Equidad de Salud: Latino Cancer Health Equity Research Center

Abstract South Texas (STX), spanning from San Antonio to the Texas-Mexico border, includes 25 rural counties, with 96% designated as primary care shortage areas, are notably the nation’s poorest and most medically underserved regions in the United States. Hispanic/Latinos (H/Ls) in the U.S. face challenges related to social determinants of health (SDoH), contributing to disparities in cancer prevention, diagnosis, treatment, and outcomes. H/Ls have higher risks of invasive cancers compared to peers, emphasizing the critical need to address SDoH to mitigate cancer disparities. Addressing these causes can improve access to healthcare, promote early detection, enhance patient education, and provide culturally competent care. The Avanzando Center (AC) aims to reduce health disparities across STX with community-engaged research, training, patient assessment, and advocacy that addresses the SDoH that deter Latinos from equitable access to cancer care, prevention, early detection, treatment, and improve patients’ cancer outcomes. To achieve its mission, the AC will 1) coordinate Research Scholars on SDoH-related cancer control projects, providing leadership, mentoring, and support in SDoH screening, clinical informatics, and outreach dissemination, 2) implement the SDoH Screener to screen patients at UT Health San Antonio’s Mays Cancer Center, Primary Care Center, and clinics across STX, ensuring they receive necessary support, 3) utilize the Salud America! (SA!) Latino health communications network for community education, empowering STX community members to advocate for local system and policy changes addressing structural SDoH, and 4) provide mentoring and career development in health equity (HE) and SDoH fundamentals to enhance cancer patient care and research advancements in the community. Research Scholars are actively employing interventions for 1) adolescent and young adult cancer survivors by establishing training programs for oncology providers to ensure proper guidance on vaccinations against HPV-related cancers, 2) using technology to improve treatment adherence among Latina breast cancer patients, and 3) addressing disparities in colorectal cancer screening and healthcare access among persistently impoverished populations. These studies will result in rigorous evaluation of intervention effectiveness by addressing the specific needs of cancer patients facing barriers related to SDoH and inform policy and practice initiatives to eliminate cancer as a major health concern. In addition, training and mentoring programs will enhance the knowledge and understanding of cancer care and research professionals, while the SA! Latino HE communication program to raise awareness about SDoH and cancer HE that includes blog posts featuring resources, inspirational stories, and promotional HE tools. The efforts focused on SDoH have the potential to significantly impact cancer outcomes and reduce disparities in Latino communities, ultimately advancing HE and improving overall well-being; specifically improving cancer outcomes, survivorship, and quality of life. Citation Format: Amelie G. Ramirez, Derek Rodriguez, Cliff Despres, Rebecca T. Jones, Ramon S. Cancino, Allison C. Grimes, Jonathan Gelfond, Byeongyeob Choi, Edgar Munoz, Patricia Chalela. Avanzando Equidad de Salud: Latino Cancer Health Equity Research Center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B147.

Beyond the battle: A cross-sectional study on cancer-related fatigue and predictors of quality of life in female adolescent and young adult survivors.

The study delves into the intricacies of cancer-related fatigue (CRF), the quality of life (QoL), and other demographic variables of female adolescent and young adult cancer survivors (AYACS) in the landscape of Kerala, India. The cross-sectional study included 288 female AYACS who were selected through purposive sampling and completed self-reported questionnaires on CRF, QoL, and demographic and clinical data. Statistical analyses were applied, including correlation, one-way ANOVA, and regression. and discussion: The temporal dimension is particularly interesting, as individuals three to five years post-treatment report heightened CRF and QoL scores. Furthermore, the research unveils the pivotal role played by predictors such as marital status, educational attainment, and employment status in shaping QoL. Marital status and education emerge as positive predictors of well-being. The study unveils compelling insights into AYA cancer survivorship, revealing a profound impact of CRF on the quality of life dimensions. The role of spirituality, sometimes affecting social connectedness, adds intrigue. The findings provide insights into the complex world of female AYACS, compelling researchers to ponder the significance of addressing CRF and tailoring rehabilitation systems during the critical post-treatment phase, with recognition of gender-specific challenges.

Effectiveness of Family Coping Interventions in Improving Problem-Solving Skills in the Care of Children and Adolescent Cancer Survivors during and after Treatment: A Scoping Review.

(1) Context: Cancer triggers significant changes in family dynamics. It is noteworthy that coping and problem-solving skills, particularly in situations involving cancer in children and adolescents, have not been adequately explored in the context of family adaptation. This study aims to analyze the effectiveness of family interventions in coping to improve problem-solving skills in parents and/or caregivers of children and adolescents during and after oncological treatment. (2) Methods: This is a scoping review following the recommendations of the Joanna Briggs Institute and the Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), from 2014 to 2024, in the databases LILACS, CINAHL, SCOPUS, Web of Science, and PUBMED. (3) Results: Forty-five studies were eligible. Coping strategies were categorized as follows: (1) positive attitudes (including a sense of courage and hope, family support to enhance resilience, and future planning), (2) caregiver empowerment (involving acceptance of diagnosis, emotional distancing, and coping through religiosity), and (3) communication skills (encompassing professional communication, horizontal dialogue with healthcare teams, and sincere communication with friends and family). (4) Conclusions: Over time, families develop coping and problem-solving strategies that influence changes in family functioning patterns, aiding them in accepting, reinterpreting, and reframing ideas and feelings associated with neoplasia.

Understanding the Experience of Cancer Survivorship Among Pediatric and Adolescent Cancer Survivors and Their Parents Through Camera Lenses: A Photovoice Study.

Although the relative survival rate of childhood cancer has increased substantially in recent years, the pursuit of successful outcomes is often accompanied by negative impacts on pediatric and adolescent cancer survivors and their parents' physical and psychological well-being. However, little is known about their experiences during the period of cancer survivorship. This study aimed to gain an understanding of the experience of cancer survivorship among pediatric and adolescent cancer survivors and their parents. This study utilized a descriptive qualitative study employing the photovoice design. From September 2022 to March 2023, 17 pediatric and adolescent cancer survivors (9-18years), who had completed active treatment at least 6months before recruitment, participated in this study. A total of 217 photographs submitted by survivors and their parents and the interview data, were thematically analyzed to identify themes and subthemes. The analysis revealed five prominent themes: indelible marks, struggling with late effects, striving to return to normalcy, the strength of support, and living in the moment and hope for the future. The findings shed light on the experiences of pediatric and adolescent cancer survivors and their parents throughout the cancer journey, elucidating the influence on both negative and positive aspects. Additionally, the study highlighted that photovoice facilitated self-reflection, the discovery of values, and the recognition of strengths and can be a therapeutic strategy for pediatric and adolescent cancer survivors and their parents in further research.

Pregnancy Outcomes in Survivors of Adolescent and Young Adult Breast Cancer: A Population-Based Cohort Study

ObjectivesTo evaluate the association between adolescent and young adult (AYA) breast cancer (BC) and the adverse pregnancy outcomes of preterm birth, small for gestational age birth, cesarean delivery, and preeclampsia, and the effect of fertility treatment on this association. MethodsPopulation-based cohort study with universal coverage health data for Ontario, Canada. BC was identified from the Ontario Cancer Registry. All births >220 weeks gestation between April 2006 to March 2018 were included. Modified Poisson regression generated risk ratios between AYA BC and adverse pregnancy outcomes, adjusted for maternal characteristics. Models were stratified by fertility treatment. ResultsAmong 1 189 980 deliveries, 474 mothers had AYA BC history (exposed), while 1 189 506 had no cancer history (unexposed). AYA BC was associated with cesarean delivery (adjusted risk ratio [aRR] 1.26; 95% CI 1.14–1.39). There was no association between AYA BC and other adverse outcomes. Modelling cesarean delivery subtypes, AYA BC was associated with increased risk of planned (aRR 1.27; 95% CI 1.08–1.49) and unplanned cesarean delivery (aRR 1.41; 95% CI 1.20–1.66). An increased risk of cesarean delivery in exposed persisted among singleton pregnancies (aRR 1.27; 95% CI 1.15–1.41), but not in models stratified by mode of conception (fertility treatment: aRR 1.07; 95% CI 0.84–1.36; unassisted conception: aRR 1.30; 95% CI 1.16–1.46). ConclusionsA history of AYA BC did not confer an elevated risk of adverse pregnancy outcomes, except for planned and unplanned cesarean delivery. The risk of adverse pregnancy outcomes does not appear to be an indication for delayed pregnancy after AYA BC diagnosis.