Female Adolescents And Young Adults Research Articles

MTOR inhibitors potentially preserve fertility in female patients with haematopoietic malignancies: a narrative review.

Haematologic malignancies are considered among the more common adolescent and young adult (AYA) cancers. Many female AYA patients with haematopoietic malignancies face impaired fertility. Haematologic malignancies patients tend to be treated with more aggressive systemic chemotherapy than that of solid tumours. In adult women, treatment-related contraception causes age-related fertility loss. Graft-versus-host disease (GVHD) after allogeneic haematopoietic stem cell transplantation is associated with decreased fertility. Ovarian cryopreservation is often indicated for haematopoietic malignancies; however, follicle loss associated with ovarian cryopreservation and ovarian minimal residual disease, which result in the withdrawal of the transplantation, are important issues. These problems may not be fully addressed by conventional methods of fertility preservation, such as oocyte, embryo, and ovarian cryopreservation, leaving room for research into new treatment approaches, such as fertility preservation drugs. In recent years, preclinical studies have shown that mTOR inhibitors may preserve chemotherapy-induced follicular loss, may have follicle-preserving effects on follicle loss associated with cryopreservation and transplantation of ovarian tissue, may have fertility-preserving effects on aging-related infertility. Clinical studies have shown that mTOR inhibitors may have the potential for indirect fertility preservation by controlling GVHD, have a limited anti-tumor effect against haematopoietic malignancies. The purpose of this article is to outline the various issues faced by female survivors of haematopoietic malignancies and discuss the potential of mTOR inhibitors as a safe treatment option. Based on current research, mTOR inhibitors seem promising and innovative fertility preservation agents regarding preclinical conditions, and further study, including clinical trials, should be expected.

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.

1825-LB: Reproductive Health (RH) and Gestational Diabetes (GDM) Knowledge Mediates the Intervention Effect on the Intention to Communicate in Dyads of American Indian and Alaska Native (AIAN) Female Adolescents and Young Adults (FAYA) at Risk for GDM and their Adult Female Caregivers

AIAN women are unduly impacted by GDM. This secondary analysis of Stopping GDM trial data explored possible mechanisms of action of a psycho-behavioral educational intervention targeting healthy behaviors to reduce GDM risk from pre- to post-test among AIAN FAYA. Dyads of FAYA and their adult female caregivers were recruited from 5 sites. Each dyad member independently completed questionnaires regarding RH and GDM knowledge, health beliefs, and intention to initiate discussion with healthcare providers (HCPs) and their corresponding dyad member. Between assessments intervention participants viewed a 45-minute video, the initial component of the intervention. Dyadic mediation analysis was conducted using the Actor-Partner Interdependence Model extended to Mediation (APIMeM) assuming distinguishable dyad members. The sample (N=149 dyads; intervention; n=79; control: n=70) included FAYA (mean age 16.7±3.0 years) and adult female caregivers (mean age 44.1±9.3 years; 81.0% being mothers of FAYA). APIMeM revealed a positive actor indirect effect of the intervention for improvement in the FAYA’s intention to initiate discussion through increases in FAYA’s RH and GDM knowledge (1.53, 95%CI=[0.27, 2.98]). A positive partner indirect effect was also observed for the intervention on the improvement in the FAYA’s intention to initiate discussion through increases in the adult caregiver’s RH and GDM knowledge (0.61, 95%CI=[0.042, 1.42]). No effects were found for changes in health beliefs of FAYA or adult caregivers as mediators of intervention effects on FAYA’s and adult caregiver’s intention to initiate discussion. These results suggest that enhancing RH and GDM knowledge may improve key downstream outcomes such as communication between FAYA, adult caregivers and HCPs for AIAN FAYA at risk for GDM. Disclosure S.M. Sereika: None. K.R. Moore: None. S.A. Stotz: None. X. Pei: None. Y. Wang: None. D. Charron-Prochownik: None. Funding National Institutes of Health (R01-NR014831)

Abstract PO4-17-10: Epidemiological Analysis and Overall Survival of Female Adolescent and Young Adults Breast Cancer in a Developing Middle Eastern Country Over 18 Years

Abstract Background: Breast cancer is the most common type of cancer among female adolescents and young adults (AYAs) aged 15-39 years at diagnosis. AYAs with breast cancer have worse prognosis and are more likely to present with unfavorable tumor biology. However, breast cancer in AYAs is still poorly reported in middle eastern populations. Methodology: This is a retrospective cohort study which examined female AYAs patients aged 15 to 39 years at the time of diagnosis who were diagnosed with breast cancer between 2000 and 2018, using data from the Jordan Cancer Registry. Kaplan-Meier analysis was performed to assess the 5-year overall survival of the patients over time. Results: A total of 3831 Female AYAs were diagnosed with breast cancer in Jordan between 2000 and 2018 with a median age of 34.2 (IQR 30.9-38.3) years. 43.2% of female AYAs breast cancer cases were right breast cancer, whereas left breast cancer occurred in 47.4% of cases, and only 2.15% of cases were bilateral breast cancer. Meanwhile, 7.31% of cases did not have a reported laterality in the registry records. Most female AYAs patients had high grade breast cancer with grade III breast cancer being the most common (N=1349, 35.2%) followed by grade II breast cancer (N=1093, 28.5%). Among this female AYA cohort, 2208 (59.3%) were treated with surgical intervention, 1621 (43.5%) patients were given chemotherapy, 1220 (32.7%) patients had radiotherapy, 265 (7.15%) patients had hormonal therapy and only 47 (1.27%) were treated with immunotherapy. Among the entire studied cohort, 229 (5.98%) patients died during follow up period. The 5-year overall survival was 94% (95% CI 93.3% to 94.8%) Conclusion: Female AYAs breast cancer tends to have a predilection towards the left breast, but presents at a more advanced grade compared with other age groups in females. Citation Format: Ahmed Abdulelah, Zaid Abdulelah, Abdulrahman Alhajahjeh, Ahmad Ghazzawi, Layla El-Amayreh, Hikmat Abdel-Razeq. Epidemiological Analysis and Overall Survival of Female Adolescent and Young Adults Breast Cancer in a Developing Middle Eastern Country Over 18 Years [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-10.

The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis.

Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P <.001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P <.05). As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.

Global burden of rheumatoid arthritis among adolescents and young adults aged 10-24 years: A trend analysis study from 1990 to 2019.

In recent decades, there has been a global increase in the burden of rheumatoid arthritis (RA) among adolescents and young adults (AYAs), making it a significant public health issue. However, our understanding of the disease burden, harm, and influencing factors of RA in this population remains insufficient. This study aimed to assess the trends in RA burden among AYAs aged 10-24 years from 1990 to 2019 at the global, regional, and national levels. Incidence, prevalence, and disability-adjusted life years (DALYs) rate per 100,000 population, as well as average annual percentage changes (AAPCs), of RA among individuals aged 10-24 years were reported globally, regionally, and nationally based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). These global trends were further analyzed by age, sex, and Sociodemographic index (SDI). Joinpoint regression analysis was used to determine the year in which the most significant changes in global trends occurred. Globally, the incidence of RA among AYAs increased from 4.98 per 100,000 population in 1990 to 5.41 per 100,000 population in 2019, with an AAPCs of 0.29 (95%CI: 0.26, 0.32, p < 0.001). The most significant increase occurred in 2000, while the most significant decrease occurred in 2014. The prevalence increased from 34.11 per 100,000 population in 1990 to 36.34 per 100,000 population in 2019, with an AAPCs of 0.22 (95%CI: 0.19, 0.24, p<0.001); The most significant increase was observed in 2000, and the most significant decrease occurred in 2014. DALYs rate with RA were 5.96 per 100,000 population in 1990 and 5.79 per 100,000 population in 2019 for AYAs, with an average decrease of 0.1 years per year (AAPCs = -0.1, 95%CI: -0.2, -0.01, p = 0.04). In terms of gender, the incidence, prevalence, and DALYs rate were higher for females compared to males during the same period. Regarding age, the incidence, prevalence, and DALYs rate increased with increasing age. Based on the SDI quintile, the incidence, prevalence, and DALYs rate of RA were highest in countries with high SDI and lowest in countries with low SDI from 1990 to 2019. However, the relationship between incidence and SDI is non-linear. In terms of regions, Tropical Latin America exhibited the highest incidence, prevalence, and DALYs rate, while Andean Latin America experienced the most rapid increase in incidence and prevalence. Southern Latin America saw the fastest growth in DALYs rate, whereas Southern Sub-Saharan Africa witnessed the most significant decline. In conclusion, the study revealed an overall increase in the incidence and prevalence of RA among adolescents and young adults (AYAs) over the past three decades, while DALYs rate remained relatively stable. Furthermore, the incidence, prevalence, and DALYs rate of RA were found to increase with age. Fortunately, recent proactive preventive measures and treatment methods have shown promising results. Moving forward, it is crucial to prioritize the female population and AYAs patients in order to further alleviate the global burden of RA.

‘I am enough!’ study of social self-efficacy in female AYA college students

The Association of Adolescents and Child Care in India (AACCI; www.aacci.in) conducts multicentric studies on youth behavior in India using openly accessible psychometric tools. This study is part of a multi-centric youth project “Building Resilience in Youth;” we used Connolly’s (1989) Social Self-Efficacy Scale (SSES) to explore the relationship between social self-efficacy (SSE), an important soft skill for adolescents and young adults (AYAs), and several sociodemographic variables, including age, sibling status, academic course, engagement in extracurricular activities, perceived Internet/social media usage and dependence, substance use, and perception of control over one’s life. The study design was a cross-sectional study conducted in 2018 with 354 female AYAs aged 17 to 21 years from an all-women, multi-stream college in Delhi. The results showed that participants in the 17-19 age group had higher total SSES scores along with the Friendship/Intimacy, group, and Giving/Receiving Help subscales. Participants engaging in extracurricular competitions had a higher total SSES score including Assertiveness, Group, Public Performance, and Giving/Receiving Help subscales. Participants who had no siblings scored higher on the Friendship/Intimacy subscale. Participants competing in sports competitions score higher on the public performance subscale. All other demographic variables did not have a statistically significant relationship with the total and subscale SSES scores. The results allowed the management to conduct parent and student workshops. In addition, more studies are needed to qualitatively understand the role of age, extracurricular competitions, and sibling status on SSE with a more diverse sample

Adaptation of the sexual and reproductive empowerment scale for adolescents and young adults in Kenya.

Measuring empowerment is critical to understanding the level of control adolescents and young adults (AYA) have over their sexual and reproductive health (SRH) behaviors, and could provide a key window into addressing their unique SRH needs. We adapted the Sexual and Reproductive Empowerment (SRE) scale for AYA for use in an East African context. This multi-method qualitative study sampled 15-23 year-old female adolescents and young adults in Kisumu, Kenya. We conducted in-depth interviews (n = 30) and analyzed transcripts with an inductive, constant comparison approach. Empowerment domains were integrated with Kabeer's (1999) framework in a conceptual model, which we referenced to revise the original and develop new scale items. Items underwent expert review, and were condensed and translated through team-based consensus-building. We evaluated content validity in cognitive interviews (n = 25), during which item phrasing and word choice were revised to generate an adapted SRE scale. Participants (n = 55) had a median age of 18 (range 16-23), and 75% were under 19 years. We categorize three types of adaptations to the SRE scale: new item generation, item revision, and translation/linguistic considerations. We developed nine new items reflecting AYA's experiences and new domains of empowerment that emerged from the data; new domains relate to self-efficacy in accessing sexual and reproductive health care, and how material needs are met. All items were revised and translated to echo concepts and language relevant to participants, navigating the multilingualism common in many African countries. Centering the voices of female Kenyan AYA, this study provides insight into measuring the latent construct of adolescent sexual and reproductive empowerment in an East African setting, and supports the adapted SRE scale's content validity for Kenya. We detail our multi-method, theory-driven approach, contributing to limited methods guidance for measure adaptation across contexts and among diverse adolescent populations.

Adolescent and young adult Hodgkin lymphoma patients at risk for subcutaneous fat gain during early cancer treatment: a brief report

Computed tomography scans were assessed for subcutaneous fat area and density at thoracic vertebra 4 in 65 adolescent and young adult (AYA) patients with Hodgkin lymphoma. Subcutaneous fat was quantified over 3 timepoints; (1) baseline, (2) end of initial anthracycline treatment (EOT) and (3) 1 year. Fat area increased at EOT (62.3 ± 5.4 cm/m2 vs 53.5 ± 5.0 cm/m2, p < 0.01) and 1 year (65.8 ± 5.6 cm/m2 vs 53.5 ± 5.0 cm/m2, p < 0.01) compared to baseline. Fat density significantly decreased at EOT (-91.2 ± 1.4 HU vs −86.5 ± 1.4 HU, p < 0.01) and at 1 year (-90.3 ± 1.6 HU vs −86.5 ± 1.4 HU, p = 0.01) compared to baseline. Female, radiation receiving, and anthracycline dosage >250mg/m2subgroups experienced significant fat gain (p < 0.05 for all). Female AYA Hodgkin lymphoma patients receiving radiation, and/or high-dose anthracyclines may be at higher risk of subcutaneous fat gain during therapy.

Sexuality among young Danes treated for mental health problems: Baseline findings in a nationwide cohort study

Mental health problems are common among adolescents and young adults (AYA), but although sexuality plays a central role in the transition from adolescence to adulthood, associations between such problems and sexuality have only been sparsely researched in AYA. The aim of this study was to investigate the association between mental health problems and various outcomes related to body and sexuality, romantic relationships, sexual functioning, and sexual risk behaviors among AYA. We used questionnaire data from 8696 Danish AYA aged 15–24 years who participated in the nationwide cohort study Project SEXUS at baseline in 2017–2018. Logistic regression analyses yielded demographically weighted, age-adjusted odds ratios for associations between mental health problems and sexual outcomes. Female AYA treated for mental health problems reported more active sex lives than other women. Treatment for mental health problems was associated with statistically significantly increased odds ratios for several sexual dysfunctions, and treated AYA significantly more often reported sexual debut before age 15 years, high sex partner numbers, sexual victimization, unsafe sex, sexually transmitted infections, induced abortions, discontentment with the appearance of body and genitalia, gender non-conformity, same-sex sexual experience, and non-heterosexual identity. Compared to healthy peers, AYA treated for mental health problems constitute a vulnerable group at increased risk of sexual adversities. Healthcare professionals should acknowledge these possible sexual challenges and offer relevant counselling to reduce the risk of adverse sexual outcomes in this group.

Transition Readiness Assessment Questionnaire: Skill gaps and psychosocial predictors of transition readiness among adolescents and young adults with chronic medical conditions.

Transferring from paediatric to adult care can be challenging. Adolescents and young adults (AYAs) with chronic health conditions need to develop a specific set of skills to ensure lifelong medical follow-up due to the chronicity of their condition. The Transition Readiness Assessment Questionnaire-French version (TRAQ-FR) is a 19-item questionnaire measuring such skills. The aims of the study were to (1) describe participant characteristics and (2) identify constructs related to, and predictors of, having learned domain-specific transition readiness skills. Participants included 216 AYAs aged 14-20 years (M = 15.93; SD = 1.35; 54.1% male) recruited from five outpatient clinics in a Canadian tertiary hospital. AYAs completed the TRAQ-FR, the Pediatric Quality of Life Inventory 4.0 (PedsQL) and a sociodemographic questionnaire. Descriptive, bivariate and binary logistic regression analyses were conducted. Overall, participants reported significantly higher scores on the Talking with Providers, Managing Daily Activities and Managing Medications subscales than on the Appointment Keeping and Tracking Health Issues subscales (F[41075] = 168.970, p < .001). At the item level, median scores (on a 5-point Likert scale) suggest that AYAs had begun practising five of the 19 skills (median scores ≥4; 'Yes, I have started doing this'), while a median score of 1 ('No, I don't know how') was found for one item ('Do you get financial help with school or work?'). At the subscale level, TRAQ-FR skills and skill gaps were related to AYAs' age, sex and PedsQL scores (ps < .05). Older and female AYAs were more likely to have begun practising specific TRAQ-FR subscale skills. Better psychosocial functioning was also related to having learned specific transition readiness skills. AYAs show several gaps in transition readiness. Targeted intervention in transition readiness skill development could take into account AYAs' age, sex and psychosocial functioning for a successful transfer to adult care.

Fertility assessment and treatment in adolescent and young adult cancer survivors.

In the survivorship setting, adolescent and young adult (AYA) cancer survivors frequently demonstrate little knowledge of infertility risk, are unclear regarding their fertility status, and may under- or overestimate their treatment-related risk for infertility. In female AYA survivors, ovarian function usually parallels fertility, and can be assessed with serum hormone levels and ultrasonography. Posttreatment fertility preservation may be appropriate for survivors at risk for primary ovarian insufficiency. In male AYA survivors, fertility and gonadal function are not always equally affected, and can be assessed with a semen analysis and serum hormones, respectively. As reproductive health issues are commonly cited as an important concern by survivors of AYA cancer, multidisciplinary care teams including oncology, endocrinology, psychology, and reproductive medicine are advocated, with the aim of optimal provision of fertility advice and care for AYA cancer survivors.

Thoughts about fertility among female adolescents and young adults with cancer: a qualitative study

PurposeNine hundred female adolescents and young adults (AYAs) aged 15–39 are diagnosed with cancer in Denmark annually. Advances in cancer therapy have led to increased long-term survival; however, a serious side effect of cancer therapy is reduced fertility. The aim of our study was to explore the thoughts about fertility among female AYAs with cancer.MethodsOur study was conducted from September 2020 to March 2021 at the Copenhagen University Hospital, Rigshospitalet. Inclusion criteria were female AYAs with cancer aged 18–39. Twelve individual, semi-structured, qualitative interviews were performed with female AYAs with cancer (20–35 years). Data were analysed using thematic analysis.ResultsFour main themes were found: (1) the female AYAs held on to a hope of having children in the future; (2) the female AYAs experienced time pressure and waiting time as a sprint as well as a marathon; (3) the female AYAs faced existential and ethical choices about survival and family formation; and (4) the female AYAs felt a loss of control of their bodies.ConclusionOur study contributes with knowledge on how important holding on to the hope of children in the future is among female AYAs with cancer. Meanwhile, they are frustrated by the rushed decision on fertility preservation at diagnosis. The female AYAs also have existential and ethical concerns related to the choice of cancer therapy and fertility preservation. Finally, they suffer from altered body image, loss of femininity, and body control due to hormone therapy.

550-P: Food Insecurity and the Efficacy of a Gestational Diabetes (GDM) Risk Reduction Intervention—Healthy Eating Outcomes among American Indian and Alaska Native (AI/AN) Female Adolescents and Young Adults (FAYAs)

AI/ANs are unduly impacted by GDM and food insecurity. Employing a clinical trials design, this secondary analysis used Stopping GDM trial data to describe and explore food insecurity as a moderator of the efficacy of a GDM risk reduction intervention on healthy eating behaviors and self-efficacy at 3 months among AI/AN FAYAs. Participants were AI/AN FAYAs and their mothers. Assessments included mother’s food insecurity using USDA Household Food Security Survey Module and FAYA’s healthy eating self-efficacy using Self-Efficacy for Healthy Eating and healthy eating behaviors from CDC Youth Risk Behavior Surveillance System. The sample (N=149 dyads) was FAYAs (mean age 16.7±3.0 years) and their mothers, with 64% (n=95) living together. More than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p=.045) and cohabitating dyads (p=.002). By 3 months healthy eating self-efficacy (p=.048) and limiting snacking between meals (p=.031) improved more in the control group than the intervention group but only for cohabitating dyads. For the full sample the intervention group had increases in times eating vegetables (p=.022) and fruit (p=.015), while the control group had declines. In the full sample food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p≥.05) but did moderate the group by time interaction for times drinking soda (p=.004) and days eating breakfast (p=.013). For cohabitating dyads food insecurity did moderate self-efficacy for eating 3 meals a day (p=.024) and days eating breakfast (p=.012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on ‘upstream causes’ of GDM health disparities among AI/AN communities. Disclosure S.M.Sereika: None. S.A.Stotz: None. L.E.Hebert: None. L.Scarton: None. K.R.Moore: Consultant; Novo Nordisk. D.Charron-prochownik: None. The stopping gdm study group: n/a. Funding National Institutes of Health (R01NR014831)

The Impact of Systemic Oncological Treatments on the Fertility of Adolescents and Young Adults-A Systematic Review.

Over the past decades, advancements in oncological treatments have led to major improvements in survival. Particularly for adolescents and young adults (AYAs), fertility is an important concern in cancer survivorship. The purpose of the review is to provide physicians with a practical overview of the current knowledge about the impact of systemic oncological treatments on the fertility of female and male AYAs. A systematic review was performed based on relevant articles obtained from 4 databases up until 31 December 2022. The mechanisms of gonadotoxicity and the concurrent risk is described for the following categories: chemotherapy, targeted therapy and immunotherapy. For the category "chemotherapy", the specific effects and risks are listed for the different classes and individual chemotherapeutics. In the category "targeted therapy", a distinction was made between tyrosine kinase inhibitors (TKIs) and monoclonal antibodies. Information concerning immunotherapy is scarce. The effects of chemotherapy on fertility are well investigated, but even in this category, results can be conflicting. Insufficient data are available on the fertility effects of targeted therapy and immunotherapy to draw definitive conclusions. More research is needed for these therapies and their evolving role in treating cancers in AYAs. It would be useful to include fertility endpoints in clinical trials that evaluate new and existing oncological treatments.

Oncofertility Referral Patterns for Female Adolescent and Young Adult Cancer Survivors [ID: 1380296

INTRODUCTION: Oncofertility counseling for adolescent and young adult (AYA) cancer survivors is standard of care, but referral rates to reproductive endocrinology and infertility (REI) are low. We examined factors associated with oncofertility referrals in a diverse urban cancer center. METHODS: This is a retrospective cohort study of female AYA survivors aged 15–39 years between 2015 and 2021. RESULTS: Female AYA survivors (n=303) had a mean age of 30.9 (±5.75), ranging 16–39 years. Only 21 (6.9%) patients had oncofertility counseling prior to starting cancer treatment. The population was 40.8% White (n=122) and 37.8% Black (n=113). Seventy-two (25.6%) were referred to REI, and 62.0% of those (n=44) underwent counseling. Black AYA survivors had three times higher odds of referral than White survivors (odds ratio [OR] 2.99, 95% CI 1.49–5.96), and parity was associated with lower odds of referral (OR 0.35, 95% CI 0.19–0.68). Eighteen of the Black survivors referred (52.9%) underwent counseling. Of the 22 White survivors referred, 81.8% (n=18) underwent counseling, more than expected compared with other races (X2=7.46, P=.05). Age (OR 0.82, 95% CI 0.71–0.94) and parity (OR 0.22, 95% CI 0.06–0.85) reduced odds of accepting referral. In a multivariable model including age, parity, race, insurance, cancer type, and treatment received, race was no longer predictive, but childbearing status remained associated with lower odds of oncofertility referral (OR 0.19, 95% CI 0.08–0.46). CONCLUSION: Most female AYA survivors did not receive timely oncofertility counseling. Black survivors were offered referral more than White individuals, which did not improve access to REI services. Future efforts will focus on integrating REI services into cancer center operations.

Premature ovarian insufficiency in female adolescent and young adult survivors of non-gynecological cancers: a population-based cohort study

BackgroundThe risk of premature ovarian insufficiency (POI) is increased in adolescent and young adult (AYA) cancer survivors, with the prevalence depending on cancer diagnosis, treatment, and patient factors. Prior studies are limited by sample size and type of cancer included. The objective of this study was to assess the risk of POI in female AYA survivors of non-gynecologic cancers, using a population-based approach.MethodsThis population-based retrospective cohort study comprises 21,666 females, 15–39 years old, diagnosed with a single non-gynecologic cancer in Ontario, Canada from 1995 to 2015.Through health administrative data linkage, participants were followed until their 40th birthday, December 31, 2018, bilateral oophorectomy, loss of health insurance eligibility or death. Each cancer survivor was matched to 5 females who were not diagnosed with cancer (unexposed, n = 108,330). Women with bilateral oophorectomy or a prior menopause diagnosis were excluded. POI was identified through use of the ICD-9 code for menopause (ICD9-627). Modified Poisson regression models were used to calculate the adjusted relative risk (aRR) of POI for AYA cancer survivors compared to unexposed individuals, adjusted for income, parity, age, and immigration status.ResultsThe occurrence of POI was higher in survivors of AYA cancer versus unexposed patients (5.4% vs. 2.2%). Survivors of AYA cancer had an increased risk of POI relative to unexposed patients (aRR 2.49; 95% CI 2.32–2.67). Risk varied by type of cancer: breast (4.32; 3.84–4.86), non-Hodgkin’s lymphoma (3.77; 2.88–4.94), Hodgkin’s lymphoma (2.37; 1.91–2.96), leukemia (14.64; 10.50–20.42), thyroid (1.26; 1.09–1.46) and melanoma (1.04; 0.82–1.32). Risk varied by age at time of cancer diagnosis, with a higher risk among females diagnosed at age 30–39 years (3.07; 2.80–3.35) than aged 15–29 years (1.75; 1.55–1.98).ConclusionsAYA survivors of non-gynecologic cancers are at an increased risk of POI, particularly survivors of lymphomas, leukemia, breast, and thyroid cancer. The risk of POI is increased for those diagnosed with cancer at an older age. These results should inform reproductive counseling of female AYAs diagnosed with cancer.

Prevalence, Severity, Trajectory, and Predictors of Symptom Burdens Among Adolescents and Young Adults with Hodgkin Lymphoma: A Population-Based Cohort Study

Background: Though adolescents and young adults (AYA) with Hodgkin lymphoma (HL) experience high cure rates, previous studies suggest that this population experiences significant symptom burdens which contribute to poor quality of life. We thus aimed to characterize the prevalence, trajectory, and predictors of symptom burdens among a population-based cohort of AYA with HL. Methods: All Ontario, Canada AYA aged 15-29 years with a HL diagnosis between 2010-2018 were identified and linked to population-based healthcare databases. Symptom burdens were determined through linkage to Edmonton Symptom Assessment System-Revised (ESAS-r) scores, routinely obtained from Ontario cancer patients at the time of outpatient visits and collected provincially. For each symptom, multistate transition models estimated mean single-stay duration of specific severity states [none (0) vs. mild (1 vs. 2 vs. 3) vs. moderate (4-6) vs. severe (7-9)], trajectories, and associations with death. Logistic regression models determined patient, disease, and treatment-related variables associated with experiencing severe symptoms within the first year of diagnosis. Results: 672 AYA with HL and at least one ESAS-r score were included in the cohort, with a median age of 23 years [interquartile range (IQR) 21-26 years] and of whom 339 (50.4%) were male. The median number of ESAS scores in the first year of diagnosis was 9 (IQR 4-13). The most prevalent moderate or severe symptom was fatigue, impacting 66.1% of AYA during the first year after diagnosis. Moderate or severe fatigue remained prevalent throughout the year, and was reported by 48/214 (22.4%) ESAS-r screens in the last six weeks of the year. Severe fatigue was experienced by 29.8% of AYA, and was reported by 19/214 (8.9%) ESAS-r screens in the last six weeks of the year. Other prevalent moderate or severe symptoms included drowsiness (48.8% of AYA), anxiety (46.1%) and poor appetite (44.3%). Anxiety and fatigue were associated with the longest mean sojourn time in the severe state (0.8 months and 0.7 months respectively). Overall, AYA experiencing moderate symptoms were more likely to subsequently experience improvement vs. worsening symptoms. Female AYA were more likely to experience moderate or severe levels of most symptoms compared to males. For example, females were approximately twice as likely to report severe anxiety [adjusted odds ratio (aOR) 1.99, 95th confidence interval (95CI) 1.22-3.23], nausea (aOR 2.19, 95CI 1.13-4.25), and fatigue (aOR 1.69, 95CI 1.20-2.37). Presenting disease stage was not associated with severity of symptom burden for any symptom. Encouragingly, no consistent disparities in symptom burden were seen among AYA living in rural or poor urban neighborhoods, compared to AYA living in the richest urban neighbourhoods. Similarly, no consistent disparities were observed among AYA living in Northern Ontario. However, one exception to this broadly positive trend was that AYA in the poorest urban areas were more likely to report severe pain (aOR 2.93, 95CI 1.32-6.49). Conclusions: AYA with HL experience substantial symptom burdens. Cancer-related fatigue and anxiety are particularly prevalent both during and after treatment. Interventions targeting these symptoms are likely to have the most impact in improving quality of life in this population, particularly those that account for sex-based differences in reporting and prevalence.

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study

PurposePregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors.MethodsA cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18–39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations.ResultsSurvivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior.ConclusionsIncreasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA.Implications for cancer survivorsScreening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

Sex differences in cancer incidence and mortality among patients managed at King Hussein Cancer Center.

We investigated if female survival advantage trends in cancer are consistent within Jordanian patients with cancer across different age groups and nonsex specific cancer types. We explored the King Hussein Cancer Center registry for primary malignant tumors from 2006 to 2019. The registry (n=16 454) was stratified into three groups based on age: children (&lt;15 years), adolescents and young adults (AYA) (modified; 15-49 years), and older adults (≥50 years). Kaplan-Meier analysis was used to estimate the 5-year all-site cancer-specific survival probabilities, which were compared using the log-rank test by sex and age group. Out of 16 454 eligible records, 2286 (13.9%) were children, 5975 (36.3%) were AYAs, and 8193 (49.8%) were older adults. Males outnumbered females 10 339 (62.8%) to 6115 (37.2%). The 5-year OS rates were 74.0% (71.6%-76.4%) and 72.7% (69.9%-75.5%) for pediatric males and females, respectively, 57.3% (55.6%-59.0%) and 64.5% (62.6%-66.4%) for male and female AYAs, respectively, and 37.5% (36.2%-38.9%) and 44.2% (42.3%-46.2%) for older adult males and females, respectively. Females demonstrated significantly better overall survival in the AYA and older adults' groups. In conclusion, females exhibit a survival advantage in terms of nonsex specific cancers. This advantage peaks at the AYA age stratum and mitigates thereafter. Further studies are warranted to examine the etiological factors behind such discrepancy on a site-by-site basis so that sex-specific interventions can be designed and validated.