Young Adult Cancer Research Articles

Long-term oncologic outcomes following breast cancer surgery in adolescents and young adults: a single-center retrospective analysis.

Breast cancer (BC) in adolescents and young adults (AYAs, aged 15-39 years), remains inadequately understood. The incidence of BC in AYAs has been steadily increasing, making it the second leading cause of cancer-related mortality among females aged 0-39 globally. This study aimed to elucidate the clinical characteristics and long-term outcomes of AYAs and older adults (OAs, aged > 39 years) with BC who underwent surgery. From January 2011 to June 2017, BC patients who underwent surgery were enrolled in this study and divided into AYA group and OA group. Clinical characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between these two groups, both before and after propensity score matching (PSM). Univariate and multivariate Cox proportional hazard regression analyses were performed to assess the influence of age on OS and RFS. Compared to the OA group, the AYA group exhibited a younger age at menarche (p < 0.001), a lower prevalence of menopausal status (p < 0.001), a reduced occurrence of comorbid conditions (p < 0.001), fewer instances of undergoing mastectomy (p = 0.031), a higher incidence of Triple-Negative Breast Cancer (TNBC) (p = 0.046), and elevated Ki-67 levels (p = 0.036). In terms of prognostic outcomes, within the study cohort, AYAs had a higher mortality rate and poorer long-term survival compared to OAs, both before and after PSM. In the PSM cohort, AYAs experienced a significantly shorter median OS (p < 0.001) and RFS (p < 0.001). Young age (15-39 years) emerged as an independent risk factor for OS (HR 2.659, 95% CI 1.385-5.106, p = 0.003) and RFS (HR 3.235, 95% CI 2.085-5.022, p < 0.001) in BC patients following surgery. Significant differences were identified in the clinicopathological characteristics between AYA and OA patients with BC. In comparison to OA patients, AYA patients exhibited a less favorable long-term prognosis, with young age emerging as an independent prognostic risk factor for both OS and RFS in BC patients following surgery. Further investigations are warranted to develop age-specific therapeutic approaches for AYA BC patients.

LGG-34. THE LANDSCAPE OF GLIOMAS IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS REVEALS INSIGHTS ON GLIOMAGENESIS: A CANADIAN ADOLESCENTS AND YOUNG ADULTS NEURO-ONCOLOGY NETWORK (CANON) STUDY

Abstract BACKGROUND Gliomas are a heterogenous and common cancer in children, adolescents and young adults (CAYA, ages 0-39 years). Little is known about the biologic and clinical implications of gliomas in AYA limiting our ability to appropriately manage these patients. METHODS We compiled a population-based cohort of patients with glioma aged 0-39 years diagnosed between 2000-2020, performed molecular characterization of the tumors and collected clinical data including therapy and long-term outcome. RESULTS A total of 1456 patients, including 873 AYA patients were included. A pathogenic molecular alteration was found in 98% of AYA samples available. Strikingly, pediatric-type mutations were found in 31% of AYA glioma of which 37% were BRAF V600E and 23% FGFR alterations. Important differences were observed between gliomas in children versus AYAs. First, hemispheric tumors were enriched in AYAs compared to midline tumors in children, especially for RAS/MAPK alterations. Second, increased incidence of high grade tumors in AYA compared to children were observed for BRAF V600E and FGFR mutations (p&amp;lt;0.0001). In contrast, if these alterations were identified in AYA and the tumor was low grade, outcome was improved for BRAF V600E and FGFR mutant tumors in AYAs compared to pediatrics (for BRAF V600E 5 year PFS 55.6% &amp;lt;10 years, 78.1% for 10-20 years and 87.1% for 10-20 years of age, p=0.0002). Third, a specific time window for transformation was observed for each alteration (BRAF, FGFR, IDH). This correlated with different methylation profiles and transcriptional patterns between early midline and late hemispheric tumors. Increased senescence signatures were observed in older patients with low grade RAS/MAPK driven tumors with superior outcome. CONCLUSIONS Different cell of origin and secondary mutations shape tumor behavior and lead to either transformation or senescence during gliomagenesis in CAYA. These can affect early interventions and tailored approaches for gliomas by age and molecular alteration.

Associations with other cancer-related biomarkers might contribute to poor outcomes in RAS-altered, younger patients with colorectal cancer.

Colorectal cancer (CRC) is a common cancer in younger adults. In patients undergoing liver resection with RAS-altered CRCs, there is evidence suggesting younger patients have worse outcomes than older patients. To explain this pattern, differences in associations between RAS status and other cancer-related biomarkers in tumors from younger versus older patients with CRC were evaluated in a cohort of 925 patients with CRC, 277 (30.0%) of whom were ≤50 years old, and 454 (49.1%) who had RAS-altered tumors. For 3 biomarkers, RNF43, APC, and microsatellite instability (MSI), the association with RAS status was significantly modified by age after adjustment for multiple testing. Specifically, younger patients with RAS-altered tumors were more likely to be MSI-high, RNF43 mutated, and APC wild type. These differences might contribute to the observed pattern of diminished survival in younger versus older patients with CRC with RAS-mutated tumors undergoing liver metastasis resection.

Achieving a Brighter Future: A Career-Focused Mentoring Program Designed for Adolescents and Young Adults with Cancer.

Despite high survival rates for many adolescent or young adult (AYA) cancer diagnoses, the psychosocial, academic, and vocational repercussions for survivors are profound and enduring. Hospital systems are able to address many AYA needs, but the ability to provide the human connectedness and knowledge that drive long-term school and career planning is lacking. This study assessed a group of AYAs who have or had cancer (n = 108, 54% female, 71% white, mean age 20.6 ± 4.4) to determine the school, career, medical, emotional, and psychosocial needs that are not currently being met by hospital staff and support networks. We identified the most common unmet needs of AYAs, differences between needs of AYAs in active treatment and survivorship, and the role of a career-focused mentoring program developed by the nonprofit organization Connecting Champions (CC) to address the array of unmet AYA needs. We found that the most commonly reported needs were all related to career and school, and that the top needs did not differ significantly throughout the cancer journey. These findings suggest that career and school-based needs are a high priority for AYAs, yet social isolation can make the necessary people or resources inaccessible. The CC mentoring program was reported as effective in attending to unmet needs (with an average score of 95.1/100) and can be a valuable resource for hospital systems, nonprofit organizations, and health insurers to provide personalized, career-focused support to AYAs during cancer treatment and survivorship.

(117) EVALUATING THE USE OF THE FEMALE SEXUAL HEALTH AFTER CANCER SCREENING CHECKLIST WITH YOUNG ADULT CANCER SURVIVORS

Abstract Introduction Sexual health, a key component of general well-being and quality of life, is often significantly disrupted by cancer treatment. In particular, when patients undergo cancer treatment early in life, disruptions to physical, sexual, and social development can have a considerable impact on sexual health by the time survivors reach young adulthood. However, extant sexual health measures are primarily intended for sexually active adults and do not accurately capture the range of sexual health concerns experienced by young adult cancer survivors (YACS). In order to provide comprehensive sexual health screening and care for this vulnerable population, measures must be developed specifically for young survivors. This study represents a critical next step in measure development for YACS: evaluating the utility and gaps of an existing sexual health screening checklist for cancer survivors. Objective To elicit feedback from female YACS regarding how the Female Sexual Health After Cancer Checklist captures their sexual health concerns as well as how the checklist may be updated for this population. Methods Cognitive interviews were conducted with 17 female YACS (ages 23-39). Participants were presented with the Female Sexual Health After Cancer Checklist and asked to provide feedback on each item. Specifically, Willis’s Concurrent Verbal Probing Technique was used to gather information on relevance of each item to YACS, item comprehension, item acceptability, decision processes, and response processes. For example, participants were asked whether the checklist items accurately captured their sexual health concerns (i.e., response processes). Results Overall, young adult participants reported that checklist items were relevant to their sexual health concerns. However, several participants noted wording for two items seemed to assess change in symptoms after cancer (e.g., “decreased vaginal lubrication”) which is difficult for YACS to answer if their cancer occurred prior to becoming sexually active. More broadly, participants reported that the checklist failed to capture many of their most pressing concerns (e.g., delays in sexual and romantic experience). Additionally, participants felt it would be important to assess barriers to sexual and romantic relationships such as negative body image and difficulty explaining cancer history to a prospective partner. Sexually inactive participants, in particular, noted adding items about barriers to sexual and romantic relationships would make the checklist more applicable to them. Conclusions Findings suggest that existing measures, such as the Female Sexual Health After Cancer Checklist, may be a starting point for a targeted YACS’ sexual health measure. However, revision and addition of items is necessary to fully capture the needs of this younger population. As a next step, we are currently amending items based on participant feedback. For example, items implying change after cancer (e.g., “decreased vaginal lubrication”) will be updated to focus on current symptoms (e.g., “vaginal dryness”) to better apply to YACS who were treated before sexual debut. Items capturing delays in sexual and romantic experience will also be added. Revised and new items will then be gathered into an item pool for further revision by YACS and sexual health experts as part of the process of creating and validating a YACS’ specific sexual health measure. Disclosure No.

CO147 The Potential Long-Term Comparative Effectiveness of Larotrectinib Vs. Entrectinib for Treatment of Metastatic Fusion-Positive Cancers in Children and Young Adults

CO147 The Potential Long-Term Comparative Effectiveness of Larotrectinib Vs. Entrectinib for Treatment of Metastatic Fusion-Positive Cancers in Children and Young Adults

Social Representation of Acupuncture: a Qualitative Study Among Young-Adult Cancer Survivors

Social Representation of Acupuncture: a Qualitative Study Among Young-Adult Cancer Survivors

Time to diagnosis among young patients with cancer.

Sociodemographic and clinical factors associated with diagnostic delays in pediatric, adolescent, and young adult cancers are poorly understood. Using the Optum Labs Data Warehouse's de-identified claims data for commercial health plan enrollees, we identified children (0-14years) and adolescents/young adults (AYAs) (15-39years) diagnosed with one of 10 common cancers from 2001 to 2017, who were continuously enrolled for 6months preceding diagnosis. Time to diagnosis was calculated as days between first medical encounter with possible cancer symptoms and cancer diagnosis date. Median times from first symptom to diagnosis were compared using Wilcoxon rank sum test. Multivariable unconditional logistic regression identified sociodemographic factors associated with longer time (>3months) to cancer diagnosis (from symptom onset). Of 47,296 patients, 87% presented prior to diagnosis with symptoms. Patients with central nervous system (CNS) tumors were most likely to present with symptoms (93%), whereas patients with cervical cancer were least likely (70%). Symptoms varied by malignancy. Of patients with symptoms, thyroid (105days [range: 50-154]) and cervical (104days [range: 41-151]) cancer had the longest median time to diagnosis. Females and patients at either end of the age spectrum were more likely to experience diagnosis delays of more than 3months. In a commercially insured population, time to diagnosis varies by cancer type, age, and sex. Further work is needed to understand the patient, provider, and health system-level factors contributing to time from symptom onset to diagnosis, specifically in the very young children and the young adult patient population going forward.

Feasibility and potential effectiveness of nurse-led video-coaching interventions for childhood, adolescent, and young adult cancer survivors: the REVIVER study

BackgroundChildhood, adolescent, and young adult (CAYA) cancer survivors, at risk for late effects, including cancer-related fatigue, cardiovascular issues, and psychosocial challenges, may benefit from interventions stimulating behaviour adjustments. Three nurse-led eHealth interventions (REVIVER) delivered via video calls and elaborating on person-centred care, cognitive behaviour therapy and/or motivational interviewing were developed. These interventions target: 1) fatigue management, 2) healthier lifestyle behaviours, and 3) self-efficacy and self-management. This study aimed to assess the feasibility and potential effectiveness of the REVIVER interventions for CAYA cancer survivors and healthcare professionals.MethodsIn a single-group mixed methods design, CAYA cancer survivors aged 16–54, more than five years post-treatment, were enrolled. Feasibility, assessed via Bowen's outcomes for feasibility studies, included acceptability, practicality, integration and implementation, demand and adherence. Qualitative data from semi-structured interviews and a focus group interview with survivors and healthcare professionals supplemented the evaluation. Paired sample t-tests assessed changes in self-reported quality of life, fatigue, lifestyle, self-management, and self-efficacy at baseline (T0), post-intervention (T1), and 6-month follow-up (T2).ResultsThe interventions and video consults were generally acceptable, practical, and successfully integrated and implemented. Success factors included the nurse consultant (i.e., communication, approach, and attitude) and the personalised approach. Barriers included sustainability concerns, technical issues, and short intervention duration. Regarding demand, 71.4%, 65.4%, and 100% of eligible CAYA cancer survivors engaged in the fatigue (N = 15), lifestyle (N = 17) and empowerment (N = 3) intervention, respectively, with 5, 5 and 2 participants interviewed, correspondingly. Low interest (demand) in the empowerment intervention (N = 3) and dropout rates of one-third for both fatigue and empowerment interventions were noted (adherence). Improvements in quality of life, fatigue (fatigue intervention), lifestyle (lifestyle intervention), self-efficacy, and self-management were evident among survivors who completed the fatigue and lifestyle interventions, with medium and large effect sizes observed immediately after the intervention and six months post-intervention.ConclusionsOur study demonstrates the feasibility of nurse-led video coaching (REVIVER interventions) despite lower demand for the empowerment intervention and lower adherence to the fatigue and empowerment interventions. The medium and high effect sizes found for those who completed the interventions hold potential clinical significance for future studies investigating the effectiveness of the REVIVER interventions.

Global, regional and national burdens of Nasopharynx cancer in the adolescents and young adults from 1990 to 2019 and its predictions

PurposeTo use data from the Global Burden of Disease (GBD) Study 2019 to report the global, regional and national rates and trends of deaths incidence, prevalence, disability-adjusted life years (DALYs) for Nasopharynx cancer (NPC) in adolescents and young adults (AYAs).MethodsData from the GBD 2019 were used to analyze deaths incidence, prevalence and DALYs due to NPC at global, regional, and national levels. Joinpoint regression analysis was used to calculate the average annual percentage changes (AAPC). The association between incidence, prevalence and DALYs and socioeconomic development was analyzed using the GBD Socio-demographic Index (SDI). Finally, projections were made until 2030 and calculated in Nordpred.ResultsThe incidence, prevalence, death and DALYs rates (95%UI) due to NPC 0.96 (0.85–1.09, 6.31 (5.54–7.20),0.20 (0.19–0.22), and 12.23(11.27–13.29) in 2019, respectively. From 1990 to 2019, the incidence and prevalence rates increased by 1.79 (95% CI 1.03 to 2.55) and 2.97(95% CI 2.13 to 3.82) respectively while the deaths and DALYs rates declined by 1.64(95%CI 1.78 to 1.49) and 1.6(95%CI 1.75 to 1.4) respectively. Deaths and DALYs rates in South Asia, East Asia, North Africa and Middle East decreased with SDI. Incidence and prevalence rates in East Asia increased with SDI. At the national level, the incidence and prevalence rates are high in China, Taiwan(China), Singapore, Malaysia, Brunel Darussalam, Algeria, Tunisia, Libya and Malta. Meanwhile, the deaths and DALYs rates are still high in Malaysia, Brunel Darussalam, Greenland and Taiwan(Province of China). The deaths and DALYs rates are low in Honduras, Finland and Norway. From the 2020 to 2030, ASIR、ASPR and ASDR in most regions are predicted to stable, but DALYs tends to decline.ConclusionNPC in AYAs is a significant global public problem. The incidence, prevalence, and DALYs rates vary widely by region and country. Therefore different regions and countries should be targeted to improve the disease burden of NPC.

Relative risk of second malignant neoplasms highest among young adult cancer patients - a population-based registry study in Finland.

The objective of this study was to explore the incidence of second malignant neoplasms (SMNs) among adult cancer patients in Finland diagnosed with their first primary cancer (FPC) in 1992-2021. The study used data from the population-based Finnish Cancer Registry (FCR). Risk estimates were calculated using the standardised incidence ratio (SIR), the ratio of observed second cancers compared to the expected numbers assuming the same cancer incidence as the corresponding sex-age-calendar year -split of the general population. A total of 573,379 FPCs were diagnosed during 1992-2021. During the follow-up, 60,464 SMNs were diagnosed. Male cancer patients had neither a decreased nor an increased risk (SIR 1.00 [95% CI, 0.99-1.01]) and female patients had an 8% increased risk (SIR 1.08 [95% CI, 1.06-1.09]) of developing any SMN compared to a FPC in the general population. The highest SIR of any SMN was observed in patients aged 20-39 -years at FPC diagnosis, and the SIR decreased by increasing age at diagnosis. Patients with lymphoid and haematopoietic tissue neoplasms, cancers of the mouth and pharynx, endocrine glands, respiratory and intrathoracic organs, skin, and urinary organs had the highest SIRs, while patients with cancers of the male genital organs and the female breast had the lowest SIRs. Elevated SIRs were observed in cancer patients diagnosed at an early age and for FPCs known to be in large part attributable to lifestyle factors, which highlights the importance of monitoring and encouraging lifestyle changes.

Dynamin-1 is a potential mediator in Cancer-Related Cognitive Impairment.

Dynamin-1 (DNM1) consolidates memory through synaptic transmission and modulation and has been explored as a therapeutic target in Alzheimer's disease. Through a two-prong approach, this study examined its role in cancer-related cognitive impairment (CRCI) pathogenesis using human and animal models. The human study recruited newly diagnosed, chemotherapy-naïve adolescent and young adult cancer and non-cancer controls to complete a cognitive instrument (FACT-Cog) and blood draws for up to three time points. Concurrently, a syngeneic young-adult WT (C57BL/6 female) mouse model of breast cancer was developed to study DNM1 expression in the brain. Samples from eighty-six participants with 30 adolescent and young adult (AYA) cancer and 56 non-cancer participants were analyzed. DNM1 levels were significantly lower among cancer participants compared to non-cancer prior to treatment. While receiving cancer treatment, cognitively impaired patients were found with a significant downregulation of DNM1, but not among those without impairment. In murine breast cancer-bearing mice receiving chemotherapy, we consistently found a significant decline in DNM1 immunoreactivity in the hippocampal CA1 and CA3 subregions. Observed in both human and animal studies, the downregulation of DNM1 is linked with the onset of CRCI. Future research should explore the potential of DNM1 in CRCI pathogenesis and therapeutics development.

Neighborhood factors associated with late effects among survivors of adolescent and young adult cancer.

The purpose of this study is to evaluate the associations between neighborhood income, education, and neighborhood racial composition (measured as a low percentage of white residents) and risk of developing cardiovascular diseases (CVD), diabetes (DM), and severe depression among survivors of AYA cancer and matched non-cancer peers. Two-year survivors of AYA cancers diagnosed at age 15-39 yrs at Kaiser Permanente Southern California (diagnosed 2000-2012) and individually matched (1:13) non-cancer subjects were included. The development of CVD, DM, and severe depression was ascertained via electronic health records. Neighborhood characteristics were obtained from census-based geocoded data. Cox regression evaluated associations between neighborhood characteristics and the health outcomes of interest among both the cancer survivors and the non-cancer comparison cohort and effect modification by cancer survivor status on these relationships. Among cancer survivors (n = 6774), living in mostly non-white neighborhoods, was associated with risk of CVD (hazard ratio (HR) = 1.54 (95% CI 1.00-2.36)), while lower education level (HR = 1.41 (95% CI 1.02-1.94)) was associated with risk of severe depression. None of the neighborhood characteristics were associated with risk of DM. Effect modification was found for neighborhood education and risk of DM and severe depression. When jointly considered, cancer survivors who resided in the most disadvantaged neighborhoods were at the highest risk of developing these health outcomes compared to other subgroups. Our findings may inform screening strategy and addressing social determinants of health among AYA cancer survivors.

Survivorship after adolescent and young adult cancer: models of care, disparities, and opportunities.

Survivors of adolescent and young adult (AYA; age 15-39 years at diagnosis) cancer are a growing population with the potential to live for many decades after treatment completion. Survivors of AYA cancer are at risk for adverse long-term outcomes including chronic conditions, secondary cancers, impaired fertility, poor psychosocial health and health behaviors, and financial toxicity. Furthermore, survivors of AYA cancer from racially minoritized and low socioeconomic status populations experience disparities in these outcomes, including lower long-term survival. Despite these known risks, most survivors of AYA cancer do not receive routine survivorship follow-up care, and research on delivering high-quality, evidence-based survivorship care to these patients is lacking. The need for survivorship care was initially advanced in 2006 by the Institute of Medicine. In 2019, the Quality of Cancer Survivorship Care Framework (QCSCF) was developed to provide an evidence-based framework to define key components of optimal survivorship care. In this commentary focused on survivors of AYA cancer, we apply the QCSCF framework to describe models of care that can be adapted for their unique needs, multilevel factors limiting equitable access to care, and opportunities to address these factors to improve short- and long-term outcomes in this vulnerable population.

Tackling Non-Small Cell Lung Cancer in Young Adults: From Risk Factors and Genetic Susceptibility to Lung Cancer Profile and Outcomes.

Lung cancer has traditionally been associated with advanced age; however, its increasing incidence among young adults raises concerning questions regarding its etiology and unique considerations for this population. In contrast to the older population, the onset of lung cancer at younger age may be attributed to a complex interplay of incompletely understood individual susceptibility and prevalent environmental risk factors beyond tobacco smoke exposure, such as radon gas and air pollution, which are widespread globally. Consequently, this leads to distinct clinical and molecular profiles, requiring a tailored approach. Furthermore, a diagnosis of cancer represents a threatening event during the prime years of a young person's life, prompting concern about career development, social aspects, fertility aspirations, and physical independence. This poses significant additional challenges for health care professionals in a field that remains underexplored. This comprehensive review recognizes lung cancer in young adults as a distinct entity, exploring its clinical and molecular characteristics, diverse predisposing factors, and priorities in terms of quality of life, with the aim of providing practical support to oncologists and enhancing our understanding of this under-researched population.

Experiences of underrepresented adolescent and young adult (AYA) cancer survivors engaging in research-related activities.

10073 Background: Adolescent and young adult (AYA) cancer survivors are an age-defined cohort (15-39 years at diagnosis) confronting unique biopsychosocial needs throughout their cancer experience. Underrepresented (sexual and gender minority [SGM] and/or Black, Indigenous, and People of Color [BIPOC]) AYAs face additional challenges associated with discrimination, mistrust of providers, and culturally incongruent services. As a result, many underrepresented AYAs experience suboptimal oncological care and disparate outcomes when compared to cis-gendered heterosexual and/or white peers. This study explored the experiences of underrepresented AYA cancer survivors engaging in research-related activities. Methods: This study is part of a larger Patient Centered Outcomes Research Institute (PCORI)-funded project that is evaluating multilevel facilitators and barriers to oncological care and research for underrepresented AYA cancer survivors. With support from five academic cancer centers and five community-based organizations supporting AYAs across the US, we have assembled an intersectional community advisory panel (CAP) of 10 AYAs who identify as BIPOC and/or SGM. Together with the CAP, a semistructured interview guide was developed, and from January to February 2024, we conducted video interviews. Data were analyzed using thematic analysis of verbatim transcribed interview scripts. The CAP assisted the investigative team in the analyses and interpretation of data. Results: Of the 20 participants interviewed, roughly 70% identified as BIPOC, 40% as SGM, and 10% as both BIPOC and SGM. Participants included underrepresented AYA cancer survivors who, prior to this specific study, had or had not participated in cancer-related research. Three major themes affecting underrepresented AYAs and engagement in research-related activities were discovered, and included: 1) Layering of identities, culture, and stigma; 2) The role of trusted conduits in facilitating engagement; and 3) Beyond compensation: reasons of pursuance. Conclusions: The resultant themes illuminate multilevel facilitators and barriers to research engagement among underrepresented AYA cancer survivors. Findings will assist in guiding researchers, oncology care providers and program administrators both in academic and community settings in the design of inclusive and equitable cancer care delivery programs for underrepresented AYA cancer survivors.

Barriers, facilitators, and other factors associated with health behaviors in childhood, adolescent, and young adult cancer survivors: A systematic review.

Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population. MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general). Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking. This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.

Mapping models of care for children, adolescent and young adult cancer survivors: A scoping review.

e13793 Background: Young cancer survivors, with decades of life ahead, encounter substantial risks for treatment-related late effects. Achieving optimal outcomes requires a comprehensive multi-dimensional approach. This scoping review aimed to systematically map the evidence on models of survivorship care for Child (0-14) and Adolescent and Young Adult (AYA, 15-39) cancer survivors aligning with the Framework for Quality Cancer Survivorship. Methods: Conducted according to PRISMA extension for scoping reviews, this study systematically searched MEDLINE, CINAHL and Embase for English articles from Jan 2006 to Jan 2024. Inclusion criteria were studies describing patient and health service domain for Child and AYA cancer survivorship models of care. Dual processes were used for article screening, selection, and data extraction. A deductive analysis, using Content Analysis informed results, presented in a narrative synthesis. Results: Of the 5,298 records screened 38 described Child and 10 described AYA models of care. The majority were cohort and cross-sectional studies from the USA, Canada, and the UK representing 6,101 Child and 5,283 AYA cancer survivors. Across these diverse studies, a broad range of outcomes were identified with most domains of the Framework represented. No model of care described more domains than another. Across the 13 possible elements of care and outcomes, most (68%) reported on less than five of these. The domains most represented included elements of care rather than outcomes at the service level such as the clinic structure (52%), communication and decision making (52%) and patient/carer satisfaction (50%). At the patient level, quality of life outcomes and assessment and management of physical symptoms were represented in 40% of studies. There were few studies reporting on health promotion (23%), chronic conditions (13%), mortality and healthcare utilization (5% each) and none reported on costs. In terms of outcomes, oncologist long-term follow up care showed higher adherence to risk-based recommendations compared to primary care models in some studies. Other studies suggest a shared care model increases adherence and decrease lost to follow-up. At the service level, high satisfaction with care was common in all models. Overall, there was not enough to evidence to support one model over another in either Child or AYA survivorship care. Conclusions: Despite decades of research in survivorship care, there is not enough evidence about the effectiveness and efficiency of different models of care. No single model stands out as superior, and there are notable gaps in understanding the economic and value proposition of different models. Addressing these gaps is crucial for the future development, and provision of quality survivorship care tailored for this patient population.

Clinical practice guidelines for adolescent and young adult cancer: A literature review.

e13727 Background: Cancers among adolescents and young adults (AYA, aged 15-39) are rising in incidence, yet formal guidelines for diagnosis, treatment, and management of AYA-specific cancers are not widely known or disseminated. Practice patterns vary widely, contributing to a lack of improvement in outcomes for this underserved population. Clinicians and health systems have reported a need for additional guidance in care delivery for AYAs. Methods: We conducted a comprehensive literature review to identify clinical practice guidelines for cancer care delivery specific to AYAs published in PubMed or MEDLINE since 2010. MeSH and other key words were applied, using a search strategy guided by a health science librarian (EM). 795 papers were identified, with 690 excluded based on title and abstract review. 105 papers underwent full text review, and 64 papers underwent complete data extraction. Using Covidence software, two team members independently reviewed articles at the data extraction phase, with disagreements resolved through discussion. Results: We identified 22 papers that met our inclusion criteria as clinical practice guidelines specific to AYA cancer care. Clinical focus included breast cancer (4), sarcoma (4), brain tumors (2), gynecologic malignancies (2), acute lymphoblastic leukemia (1), colorectal cancer (1), NUT carcinoma (1), and proton therapy (1). Six papers covered general principles of caring for AYAs, regardless of cancer diagnosis. Key themes across guidelines included the importance of fertility preservation and psychosocial support, multidisciplinary care provided at specialized centers, and consideration of long-term toxicities of treatment. Conclusions: Clinical practice guidelines exist to inform clinicians and health systems on best practices for caring for AYAs with cancer, a growing and underserved population. Further dissemination of these guidelines may assist with improving outcomes. Comprehensive summary of these and other AYA specific guidelines is forthcoming and may serve as a useful clinical reference. [Table: see text]

Analyzing the gut microbiome in adolescent and young adult patients with melanoma receiving immune checkpoint blockade.

9563 Background: Melanoma is the third most common cancer in adolescent and young adults (AYA), a unique cohort defined as patients between 15-39 years of age per the National Cancer Institute. Immune checkpoint inhibitors (ICI) have changed the landscape for advanced melanoma treatment, and the gut microbiota has been shown to remodel the tumor microenvironment to improve ICI efficacy. There is a paucity of research in this cohort, however studies show that AYA patients, in general, have historically not seen the same survival gains as other age groups. Furthermore, literature shows that survival was much worse for AYA's with stage IV melanoma than observed among older adults. Methods: The AYA cohort in this retrospective review is from the 2021 Science publication entitled "Dietary fiber and probiotics influence the gut microbiome and melanoma immunotherapy response". This cohort was matched on a 2:1 basis with older non-AYA patients 50-70 years of age. We controlled for sex, BMI, race, treatment naivety, stage of disease, as well as smoking, drug, and alcohol status. Results: Our AYA cohort of 23 patients is comprised of 15 females, 22 Caucasians, 20 with primary cutaneous melanoma, 12 with stage III at the start of treatment and 11 with stage IV, 17 were BRAF positive, 8 received combined immunotherapy, 20 were treatment naïve, and 11 were responders. We found no difference in alpha or beta diversity in AYA and older non-AYA patients, however alpha diversity increased with age. This is consistent with literature regarding aging gut microbiomes. Furthermore, we noted the most common microbes found between these groups varied considerably. Using differential analyses, we found, for example, a higher abundance of Ruminococcaceae, at the family level, in older non-AYA patients and a higher abundance of Bacteroides stercoris in AYA patients. Literature shows the relative abundance of Ruminococcaceae increased with age and was significantly higher in older patients. Furthermore, Bacteroides stercoris correlates positively with fiber, grain, and vegetable intake. Additionally, Blautia massiliensia, Blautia obeum, and Dorea longicatena were found to be significantly more prevalent (p=0.010, p=0.34, and p=0.035, respectively)) in older non-AYA patients. These species are all known to be obesity biomarkers. Conclusions: We found that the gut microbiota of AYA and older non-AYA melanoma patients differ. Older non-AYA patients have bacterial species associated with negative biomarkers which may be due to an aging gut microbiome. Establishing microbial features in the AYA population can help with microbiome modulation as a therapeutic strategy. Enriching modalities include fecal microbiota transplantation, probiotics, and improving diet as well as fiber intake. Further research should explore if the gut microbiome influences worse outcomes in AYA's with late stage melanoma.