Young Adult Cancer Research Articles

P-163 Epidemiology and outcome of gastrointestinal cancers in adolescents and young adults: Experience from South India

P-163 Epidemiology and outcome of gastrointestinal cancers in adolescents and young adults: Experience from South India

Evaluation of potential socioeconomic and racial/ethnic disparities in all-cause mortality in adolescent and young adult patients with cancer.

6501 Background: Adolescent Young Adult (AYA) cancer patients, aged 15-39, have historically been understudied. For older adults, socioeconomic (SES) and racial/ethnic disparities in mortality have been demonstrated, but less is known about survival disparities for AYA patients. Most existing studies do not account for the influence of insurance status and access to care. To address this gap, we evaluated the association of SES and race/ethnicity with overall mortality for AYA cancer patients who were members of an integrated health delivery system with relatively equal access to care. Methods: Patients diagnosed with cancer at age 15-39 years old in Kaiser Permanente Southern California between 2010-2018 were included. The fourteen most common AYA cancer types within our cohort were included (excluding thyroid cancer due to low mortality rate). The Neighborhood Deprivation Index (NDI) was used as a marker of SES. Patients were placed into NDI quartiles (Q1: least deprived-Q4: most deprived). Mortality rate per 1,000 patient years was calculated for each racial/ethnic group and NDI quartile. Multivariable cox model was used to estimate hazard ratios (HRs) for all-cause mortality. Models included race/ethnicity and NDI subgroup simultaneously, adjusting for sex, age and stage at diagnosis, and cancer type. Results: A total of 6,380 patients (59% female, median age: 33) were followed for a maximum of ten years. Racial/ethnic distribution was 45% Hispanic, 36% non-Hispanic White, 10% non-Hispanic Asian/Pacific Islander, 7% non-Hispanic Black, 2% Other/Unknown. Overall mortality was 21.8 deaths per 1,000 person years. Crude mortality rates were higher among Non-White racial/ethnic groups (Asian/Pacific Islander: 26.7, Black: 26.2, Hispanic: 25.6, Other/Unknown: 30.3) compared to White patients (16.4). In the adjusted model, Hispanic (HR=1.32, 95% confidence interval [CI] 1.03-1.50, p=0.004) and Black (HR=1.35, 95% CI 1.00-1.83, p=0.05) patients experienced significantly higher risk of all-cause mortality compared to White patients. No mortality differences were observed between Asian/Pacific Islander and White patients. Patients from more deprived neighborhoods had higher mortality risk (Q1: 19.9, Q2: 19.8, Q3: 24.1, Q4: 27.4). In the adjusted model, there was no significant difference in all-cause mortality between Q1 and Q2-Q4 [Q2 (HR=0.88, 95% CI 0.71-1.10), Q3 (HR=0.94, 95% CI 0.75-1.17), Q4 (HR=0.96, 95% CI 0.76-1.22)]. Conclusions: Our study suggests that for insured AYA cancer patients with similar access to care, Hispanic and Black patients have increased risk of all-cause mortality as compared to White patients, while no significant SES survival disparities were observed. These findings warrant further investigation, awareness, and intervention to address inequities in cancer care among vulnerable populations.

Changes, challenges and support in work, education and finances of adolescent and young adult (AYA) cancer survivors: A qualitative study.

An increasing number of adolescents and young adults (AYA) are becoming cancer survivors and are dealing with long-term effects of the disease and its treatment. We aimed to collect detailed self-reported information about the areas of work, education, and the financial situation of AYA survivors after acute treatment. We further examined sources of support that were perceived as particular helpful. We conducted semi-structured interviews with a sample of 11 AYA cancer survivors (on average 5 years from diagnosis; mean age at diagnosis=25.7 years) that had been recruited for the AYA-Leipzig longitudinal study. Interviews were transcribed and data were analysed using qualitative content analysis. The following themes emerged as relevant: (1) career modifications and job loss, (2) career interruptions and delays, (3) uncertainty in the return-to-work process, (4) reduced work ability, (5) discrimination at the workplace, (6) changes in the personal importance of work and (7) financial burdens. Sources of considerable support included relatives as well as German social security institutions. Health care providers should address the specific risk of a financial burden and the somewhat complex social legal situation of young adult survivors after cancer diagnosis. AYA cancer survivors need age-specific comprehensive cancer survivorship support programs. These should accompany them in the long term and be targeted to the individual need for career modification or reorientation - even after the completion of cancer treatment and rehabilitation.

Growing wiser with age: Results from the ACCELERATE Fostering Age Inclusive Research Group clinical trial survey.

e13596 Background: Adolescent and Young Adult (AYA) cancer patients are disproportionately excluded from clinical trials because of trial age limits that prevent access across the paediatric and adult oncology divide. Working under ACCELERATE, the international collaborative working to improve paediatric cancer drug design and regulation, the Fostering Age Inclusive Research (FAIR) group's aim is to reduce this inequality in access. Here, we report an international survey of AYA oncology professionals, and identify key barriers to age-inclusive participation in clinical trials. Methods: An online survey was created by ACCELERATE-FAIR trials working group members, and subsequently distributed to academic and industry professionals involved in AYA oncology through international networks including the ACCELERATE multi-stakeholder platform, ITCC, and cancer-specific research groups. Demographic factors were recorded, and participants were asked to consider whether listed potential barriers to AYA inclusion are ‘thought’ (presumed/expected) or ‘real’ in practice. Responses were recorded using in-built survey software. Results: The 124 respondents were from Europe (75%), America (22%; North America, Brazil), Algeria, India and Australia. 66 respondents (53%) had participated in opening an ‘adult’ phase I/II which permitted inclusion of adolescents ( < 18 years old), and 63 (51%) had opened a ‘paediatric’ phase I/II trial that included adult cancer patients. Key ‘thought’ barriers to AYA inclusion in early phase (I/II) adult oncology trials largely mirrored ‘real’ barriers, such as “Limited incidence of the disease in adolescents (ages 12 to 17)” and “Trials approved in certain institutions or countries only for 18 years old and above”. A key ‘real’ barrier to the inclusion of AYA patients was “Reluctance from medical oncologists”, identified by 21 responders. Important disparities in the ‘thought’ and ‘real’ barriers to AYA enrolment were also highlighted; “No appropriate adult oncology network” was identified by 2 respondents as a ‘thought’ barrier, and by 13 as a ‘real’ barrier. Importantly, only 35% of respondents were aware of the FDA’s guidance on the inclusion of 12-17 year old patients in adult early-phase trials. Conclusions: This international drug development multi-stakeholder survey highlighted key barriers to clinical trial access in AYA oncology. Whilst more than half of respondents reported being involved in trials which were AYA inclusive, there were clear disparities in understanding the ‘thought’ and ‘real’ barriers to trial entry. Key issues included a lack of medical oncologists responding to this survey. Whilst the issues surrounding AYA inclusion in clinical trials remain, we illustrate key goals for future improvement such as improving understanding around FDA guidance in this area and collaborating further with medical oncologists.

Healthy lifestyle behaviors among a diverse population of early posttreatment adolescent and young adult (AYA) survivors participating in a virtual stress management program.

e24048 Background: Adolescent and young adults (AYA) cancer survivors have worse long-term physical health than survivors of adult cancers. Healthy lifestyle behaviors can maximize physical health and enhance quality of life. The National Comprehensive Cancer Network (NCCN) publishes survivorship guidelines for healthy behaviors; however, it is unclear if AYA survivors follow these recommendations. Methods: This is a secondary analysis of a waitlist-controlled trial of an adapted mind body stress management group program for AYA survivors recruited between 03/2019-09/2020. Participants completed self-report questionnaires assessing tobacco use, e-cigarette use, alcohol use, physical activity, and sleep quality both before and after completing the 8-week group program. Descriptive statistics were used to characterize the proportions of survivors meeting NCCN guidelines at time of enrollment. Results: Seventy-two AYA survivors participated in this study (mean age 24, 74% female, 60% Non-Hispanic White, 21% Hispanic, 4% Black, 53% hematologic malignancy, mean 1.6 years post-treatment).Table 1 summarizes NCCN guidelines and concordant behavior at enrollment. Most participants met guidelines for tobacco and e-cigarette use at study entry, with the majority reporting they abstained from using tobacco (85%) and e-cigarettes (90%). Only 28% reported abstaining from any alcohol use. Of those who consumed alcohol, most reported consuming < 3 drinks per day (83%), but 65% endorsed at least occasional binge drinking behavior ( > 5 drinks). Only 52% met guidelines for vigorous- or moderate- intensity activity (i.e. 75 and 150 minutes weekly, respectively). Specifically, participants reported a median of 47.5 minutes/week (IQR 0-120 min/week) of vigorous-intensity activity and 60 minutes/week (IQR 30-140) of moderate-intensity activity. Many experienced sleep concerns, with only 30% reporting good or very good sleep (i.e. > 4 on a 1 (very poor)-5 (very good) Likert scale). Conclusions: In a racially/ethnically diverse sample of AYA survivors, NCCN survivorship guideline concordance for healthy lifestyle was mixed. Of concern was that AYA survivors’ use of tobacco and e-cigs was similar to the general population. Furthermore, alcohol and physical activity recommendations were mostly not followed, and reported sleep quality was poor. These results highlight the need to better understand barriers and promote healthy lifestyles to optimize post-treatment outcomes. [Table: see text]

Caring for Children in Relation to Financial Hardship, Advance Care Planning, and Genetic Testing Among Adolescent and Young Adults with Cancer.

Purpose: When a cancer diagnosis coincides with caring for children, it may influence the financial impacts of cancer and decisions to pursue advance care planning (ACP) or genetic testing. We examined associations between caring for children and financial hardship, ACP, and genetic testing among female adolescent and young adult (AYA) cancer survivors in North Carolina and California. Methods: Participants were diagnosed at ages 15-39 years with breast, melanoma, gynecologic, lymphoma, or thyroid cancer during 2004-2016. We estimated adjusted prevalence differences (aPDs) and ratios (aPRs) for each outcome by child caring status using marginal structural binomial regression models. Results: Among 1595 women ages 19-54 years at survey (median = 7 years since diagnosis), 819 (51.3%) reported that they were caring for children at diagnosis. Women caring for children had a higher prevalence of material financial hardship (e.g., medical debt; 30% vs. 21.9%; aPD = 9%, 95% confidence interval [CI]: 3 to 14; aPR = 1.39, 95% CI: 1.12 to 1.72) but similar levels of psychological financial hardship compared to noncaregivers. Women caring for children were more likely to complete ACPs (42.2% vs. 30.7%; aPD = 9%, 95% CI: 3 to 16; aPR = 1.30, 95% CI: 1.08 to 1.57). Among the 723 survivors of breast, endometrial, and ovarian cancer, the prevalence of genetic testing was higher among women caring for children (89%) than noncaregivers (81%); this difference was not statistically significant. Conclusion: Women caring for children at diagnosis may be at elevated risk for adverse financial outcomes and may benefit from additional financial navigation support. Childcare responsibilities may further complicate health decision-making for AYAs diagnosed with cancer.

The genomic landscape of adolescent and young adult (AYA) malignancies using DNA and RNA-based next generation sequencing.

e15091 Background: Survival for adolescents and young adult (AYA) cancer patients (defined as age 15-39 years by the NCI) has not improved compared to survival outcomes in pediatric and older adult patients. Several factors contribute to the outcomes disparity, including lack of access to novel treatments. Currently, only a fraction of AYA cancer patients receive advanced genomic testing. Herein, we aim to characterize the molecular landscape of AYA cancers. Methods: De-identified records of 2,706 AYA patients diagnosed with solid tumors and hematologic malignancies who received Tempus xT next-generation sequencing (NGS) were identified. The prevalence of pathogenic/likely pathogenic (P/LP) single-nucleotide variants (SNVs), insertions/deletions (indels), fusions, and copy number alterations were assessed to describe the somatic landscape. Tumor biomarkers, such as microsatellite instability (MSI) and tumor-mutational burden (TMB) were also analyzed. Results: The cohort consisted of 2,706 AYA patients diagnosed with: central nervous system (N = 779), breast cancer (N = 700), bone and soft tissue sarcomas (N = 226), hematologic (N = 198), and gastrointestinal (GI) (N = 803) malignancies. Among 407 high-grade gliomas (HGG WHO Grade 3 & 4), variants in TP53 167 (41%), 136 (33%) IDH1, 125 (31%) ATRX, and 48 (12%) TERT were seen. Among the 82 patients with low-grade glioma (LGG, WHO Grade 1 & 2), 42 (51%) had a variant in IDH1, 40 (49%) TP53, and 35 (43%) ATRX. Among 269 patients with HR+ HER2- breast cancer, 82 (30%) had variants in TP53, 66 (25%) PIK3CA, 46 (17%) GATA3, 43 (16%) FGFR1 and 34 (13%) in ESR1. In triple-negative breast cancers (TNBC), 95 (77%) had a variant in TP53, and 9 (7.3%) in BRCA1. In ewing sarcomas (N = 36), 28 (78%) patients had a fusion with EWSR1, with TP53, STAG2, FGFR2, and RET altered in 2 (5.6%) patients. Within osteosarcomas (N = 46), 12 (26%) patients had a variant in TP53 and 9 (20%) in RB1 . In the AML subgroup (N = 34), WT1 was altered in 5 (15%) and FLT3 in 4 (12%) cases. Finally, in the GI cohort (806), 22 (5%) cases were MSI-H. Within colorectal cancer patients (N = 446), 247 (55%) patients had a variant in TP53, 150 (34%) in KRAS, 64 (14%) in PIK3CA, and several with NRG1 (8, 1.8%) and NTRK (3, 0.7%) fusions. Conclusions: We describe the somatic landscape of common malignancies in one of the largest AYA datasets. Additional analyses will focus on how this landscape differs from non-AYA age groups.

Results of a tailored multimodal lifestyle follow-up care program focusing on physical activity, nutritional behavior and psychological processes in adolescent and young adult cancer survivors: The CARE for CAYA multicenter, randomized clinical trial.

12002 Background: The aim of the CARE for CAYA-program (CFC-P) was to implement a multimodal lifestyle program in addition to medical follow-up care for child, adolescents and young adult cancer survivors (CAYAs). Methods: The CFC-P was a multicenter program with an initial randomized clinical trial (RCT) comparing need-based modular interventions to usual care for CAYAs aged between 15 and 39. A comprehensive assessment (questionnaires and medical examination) was conducted to determine individual needs regarding nutrition, physical activity and psycho-oncology. If “high need” was identified, CAYAs could take part in up to three modules over 12 months. In the intervention group (IG), each module included five consultations plus newsletters. The control group (CG) included one baseline counseling in each module. The primary outcome was defined as the rate of CAYAs with “high need(s)” after 12 months of intervention. Secondary outcomes included feasibility, cost-effectiveness, modular-specific endpoints, quality of life (QoL) and fatigue. Results: 791 CAYAs were included at 14 German CAYA survivorship clinics from December 2017 to March 2021. Most common tumor types were lymphoma 26.8% (n = 211), sarcoma 13.2% (n = 104) and leukemia 10.0% (n = 79). 58.0% (n = 457) were female, median age was 23.9 years, time since end of tumor specific therapy was < 5 years in 54.4%, > 5 years in 21.2%, > 10 years in 11.5% and > 15 years in 12.9% of patients (median: 57.0 months). 86.2% (n = 679) reported an initial “high need” in at least one module. After 52 weeks, 83.9% (n = 396 of 472 evaluable participants) continued to report or developed a “high need”: 59.3% (n = 235) in IG and non-randomized cohort, 28.8% (n = 114) in CG and 12.7% (n = 47) with no initial “high need”. 357 participants were evaluable in the RCT (63% (n = 226) female, median age 25.0 years). 26.2% (n = 94) reported a “high need” in one, 35.7% (n = 128) in two and 37.6% (n = 135) in three modules. 271 patients could be analyzed at 52 weeks, 87.0% of IG (n = 120 of 138) and 86.5% of CG (n = 115 of 133) continued to have at least one “high need”. The primary outcome did not differ significantly between groups (p = .905). However, both showed an increase of QoL and a reduction of fatigue. Conclusions: In the CFC-P, the feasibility of a large trial to regularly assess lifestyle habits and the psychosocial situation and determine the efficacy of a need based multimodal interventions in CAYAs was demonstrated. Although a high need for support was revealed in this population, no significant changes with the applied interventions were noted after 12 months. The obtained data will guide the development and implementation of multimodal interventions in long term follow up of CAYAs. Clinical trial information: DRKS00012504 .

Differences in oncofertility beliefs, knowledge, and practice between medical oncologists and advanced practice providers: Identifying quality improvement targets.

e18747 Background: Despite the deleterious effects of systemic cancer treatment on fertility, many young adult cancer patients do not receive fertility preservation. Historically, oncofertility was discussed by the medical oncologist (MO), but an increasing advanced practice provider (APP) oncology workforce provides opportunities for quality improvement (QI) in oncofertility care. To identify levers for QI interventions, we explored how fertility beliefs, knowledge, and practice of MOs differ from APPs. Methods: MOs and APPs working in inpatient, outpatient, academic and community clinical settings were identified from providers at The Jonsson Comprehensive Cancer Center (JCCC). Participants completed an online survey prior to a fertility preservation seminar. Survey questions queried beliefs about fertility preservation, knowledge about guideline recommendations, and individual fertility practices in the 3 months prior to survey completion. Responses were collected anonymously through a HIPAA-compliant web platform. Pearson chi-squared and two-sample T tests were used for statistical comparisons between MOs and APPs using STATA v15.1. This study received exempt status from the University of California Los Angeles (UCLA) Institutional Review Board. Results: 32 (52.5%) APPs and 29 (47.5%) MOs completed the survey. APPs were younger than MOs (28% vs. 14% were 30-39 years, p = 0.072) and more frequently female (91% vs. 38%, p < 0.001). Practice specialties varied equally between both groups and they had similar distribution of post-training oncology experience. Participants saw an average of 6.0 (APP) and 5.7 (MO) new cancer patients of reproductive age per month. While APPs and MOs reported concern about the effects of cancer treatment on fertility, APPs were more likely to agree with the statement “Offering fertility preservation to patients before cancer therapy compromises their oncological treatment” than MOs (44% vs. 31%, p = 0.047). APPs reported less familiarity with fertility preservation guidelines (scale 0-10, mean 4.3 vs. 5.8, p = 0.013) and MOs were more comfortable discussing specific fertility preservation techniques. There were no significant differences in referral practices. In the 3 months prior to survey, MOs reported having fertility discussions more frequently than APPs (52% vs 28%, p = 0.047) and more regularly had discussions before treatment initiation (97% vs. 78%, p = 0.033). Conclusions: Improving oncofertility care for young cancer patients is an important quality metric. This exploratory study demonstrated significant differences in beliefs, knowledge, and practice between MOs and APPs regarding fertility preservation for cancer patients. These results will shape our future QI initiatives, which will target system, practice, and education with a specific focus on non-MO providers.

Outcomes of childhood, adolescent, and young adult cancer survivors (CAYACS) with solid organ transplants: A population-based study.

10056 Background: Organ toxicity requiring solid organ transplant (SOT) is a rare but serious effect of cancer treatment. Given restricted donor organ supply, teams must assess CAYACS requiring SOT in relation to potential recipients with non-malignant indications; decisions are limited by scant long-term outcome data. We compared long-term outcomes for CAYACS requiring SOT with other SOT recipients. Methods: All Ontario, Canada children < 18 years at cancer diagnosed 1986-2021 at pediatric centres, and AYA aged 15-21 diagnosed at adult centres for acute leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012 were identified using population-based clinical databases. Patients with SOT prior to their primary cancer diagnosis were excluded. SOT was identified through linkage to healthcare databases; patients were matched 1:2 to non-malignant SOT recipients by sex, SOT year and type, and birth year. Post-SOT outcomes including overall survival (OS) and post SOT cancers were compared between CAYACS and SOT controls. Results: Among 16,533 CAYA with cancer, 85 received SOT: 46 liver, 18 kidney, 11 lung, and 10 heart. Among liver recipients, 33 (71.7%) were for primary cancer treatment (e.g. hepatoblastoma) vs. 13 (28.3%) for organ toxicity. Median age at original cancer diagnosis was 4 years [interquartile range (IQR) 1-13] and at SOT was 13 (IQR 3-20). CAYACS with SOT as treatment for long-term toxicity (liver subset plus all renal, lung, heart, N = 52) had a median time from cancer diagnosis to SOT of 9 years (IQR 4-16) and experienced lower 10-year OS from time of SOT [67.7%, 95th confidence interval (95CI) 50.8-79.9] vs. SOT matched controls [86.0% (74.8-92.5); hazard ratio (HR) 3.9; 95CI 1.6-9.7; p = 0.003]. When stratified by SOT type, similar trends were seen but were only statistically significant among lung SOT recipients (Table). The 5-year cumulative incidence of primary cancer relapse from time of SOT among those who received liver SOT for primary cancer therapy was 15.9% (95CI 5.6-30.8). Among CAYACS who require SOT following organ toxicity, 10-year cumulative incidence of second cancers was 8.6%±4.2%; this was similar to the incidence of first cancer among SOT controls (6.4%±2.6%; HR 1.6, 95CI 0.6-4.0; p = 0.34). Conclusions: Though CAYACS requiring SOT have inferior survival compared to other SOT patients, the majority achieve long-term cancer-free survival. These data can inform discussions on the suitability of CAYACS for SOT. [Table: see text]

Social determinants of health burden among adolescent and young adult cancer patients and impact on overall survival.

12017 Background: The 5-year survival rates for adolescents and young adults (AYA) with cancer have steadily improved, yet disparities by race/ethnicity persist. The drivers of these disparities remain unclear. Neighborhood socioeconomic deprivation has been linked to adverse health outcomes independent of the effects of individual-level measures of social determinants of health (SDOH). We evaluated the impact of neighborhood SDOH on overall survival (OS) in a diverse AYA cancer patient population treated in a single academic setting. Methods: This study utilized a multi-ethnic cohort of AYA cancer survivors (N=10,261) diagnosed between ages 15-39 seen at MD Anderson Cancer Center between 2000 and 2016. Patient demographics, zip code at presentation, cancer characteristics, and follow-up were obtained from our institutional tumor registry. Zip codes were linked to Area Deprivation Index (ADI) values, a validated neighborhood-level SDOH measure, with higher ADI representing worse SDOH. Results: The cohort included 6,361 (62%) non-Hispanic White, 1,112 (10.8%) non-Hispanic Black, and 2,133 (20.8%) Hispanic AYA cancer patients, with 655 (6.4%) of other ethnicities or missing information. The mean ADI value was significantly higher (p<0.05) for Black (61.7) and Hispanic (65.3) patients, compared to White (51.2) patients. Analysis of ADI by cancer type showed significant differences, mainly driven by the significantly higher ADI in patients with cervical cancer (62.3) than other cancer types. In contrast, AYA patients diagnosed with breast cancer (53.0) and CNS tumors (52.9) resided in neighborhoods with the lowest ADI values. ADI was a significant predictor of OS overall. In multivariable models that included gender, age at diagnosis, cancer diagnosis, and race/ethnicity, risk of death for AYA cancer patients residing in neighborhoods with ADI in the highest quartile was greater than that for patients in the lowest quartile (HR: 1.09, 95% CI: 1.00-1.19, p=0.043). Conclusions: Our results in this large multi-ethnic cohort indicate that non-White AYA patients with cancer more commonly live in neighborhoods associated with higher ADI compared to their White counterparts. Even when treated in the same academic setting, AYA cancer patients with higher ADI experienced worse OS across cancers. Although the magnitude of the effect was moderate, the presence of this effect within a tertiary cancer center with existing barriers to care suggests that ADI is a meaningful risk factor impacting survival. Further analysis is warranted to determine the generalizability of these findings to the patient population more broadly. However, the results provide intriguing evidence for potential interventions aimed at supporting AYA cancer patients from disadvantaged backgrounds.

Subjective and objective hearing loss among US adult cancer survivors: A national cross-sectional study.

e24059 Background: Approximately 13% of adults had some degree of hearing loss (HL), and the prevalence is higher among adults aged 65 and over (30.9%). Approximately 50-80% of the childhood, adolescent and young adult cancer survivor population report HL following treatment with high-dose platinum-based chemotherapy, head or brain radiotherapy. We aimed to 1) estimate the prevalence of subjective and objective hearing loss (HL) among cancer survivors and compare to the general population; 2) assess the performance of subjective HL questions in detecting HL by audiometry among cancer survivors. Methods: Adults aged 20-80 years old were selected from the National Health and Nutrition Examination Survey. The weighted prevalence of subjective HL (having troublesome hearing and tinnitus) and objective HL (speech-frequency HL and high-frequency HL) by audiometry test was calculated. Chi-square test and multi-adjusted logistic regression models were used to compare HL between cancer survivors and the general population. To evaluate the performance of subjective HL questions as a tool to screen for objective HL by audiometry, area under the curve (AUC) were estimated using age-and gender- adjusted logistic regression. Results: Compared to the general population, cancer survivors had a statistically significantly higher prevalence of troublesome hearing (aOR = 1.43; 95%CI:1.22-1.68), tinnitus (aOR = 1.28; 95%CI:1.08-1.53), speech-frequency HL (SFHL) (aOR = 1.44; 95%CI:1.20-1.73) and high-frequency HL (HFHL) (aOR = 1.74; 95%CI:1.45-2.09). The sensitivity and specificity of the combined subjective questions “whether having troublesome hearing and/or tinnitus” in detecting HL was shown in Table. The age- and gender- adjusted AUC for detecting SFHL and HFHL using combined questions was 0.88 and 0.90. Conclusions: Cancer survivors have a significantly higher prevalence of both subjective and objective HL, but a lack of hearing examination. Two subjective HL questions could accurately identify those have true HL and provide a simple and efficient screening tool for providers. Cancer survivors and their families should be educated and encouraged to discuss hearing concerns, and providers should facilitate raising awareness and provide early screening and timely referral when HL is identified.[Table: see text]

Association of Medicaid expansion with treatment receipt, delays in treatment initiation, and survival among young adult women with breast cancer.

1509 Background: Medicaid expansion under the Affordable Care Act has been shown to increase insurance coverage and early-stage cancer diagnoses for young adults (YAs), the age group with the highest uninsured rate. We examined whether Medicaid expansion was associated with increased receipt of timely, guideline-concordant treatment and survival among YA women newly diagnosed with breast cancer, the most common YA cancer diagnosis. Methods: Using the National Cancer Database, we identified 51,675 women aged 18-39 years who were diagnosed with breast cancer in 2011-2018. We applied the difference-in-differences (DD) method to estimate outcome changes pre vs. post Medicaid expansion, in expansion- vs. non-expansion states. Linear probability models estimated associations of Medicaid expansion with receipt of guideline-concordant treatment – including any endocrine therapy among women with ER-positive or PR-positive breast cancer, and any chemotherapy or targeted therapy among women with ER-negative and PR-negative breast cancer – and initiation of guideline-concordant treatment (surgery, chemotherapy, or targeted therapy for stage I-III diagnoses, and systemic therapy for stage IV diagnoses) <60 days after diagnosis. Flexible parametric survival models were used to estimate 2-year overall survival. DD models also adjusted for age, race/ethnicity, rurality, zip code-level income, comorbidity, and diagnosis year, with standard errors clustered at the state level. Analyses were stratified by stage at diagnosis (stage I-III vs. IV). Results: Of the subset of women with stage I-III ER-positive or PR-positive breast cancer, the percentage receiving endocrine therapy increased in expansion states (85.20% pre-expansion to 86.46% post-expansion), but decreased in non-expansion states (84.32% to 82.79%), resulting in a net increase of 2.42 percentage points (ppt; 95% CI = 0.56 to 4.28) associated with Medicaid expansion in the adjusted DD model. Among all women with stage I-III breast cancer, the percentage with treatment initiation <60 days after diagnosis decreased less in expansion states (84.10% pre-expansion to 82.36% post-expansion) than in non-expansion states (86.95% to 83.98%), resulting in a net reduction of 1.61 ppt (95% CI = 0.05 to 3.18) in treatment delays associated with Medicaid expansion. Notably, the 2-year overall survival increased in expansion states (96.84% pre-expansion to 96.99% post-expansion), but decreased in non-expansion states (97.24% to 96.30%), resulting in a net survival increase of 1.00 ppt (95% CI = 0.21 to 1.79) associated with Medicaid expansion. Conclusions: Among YA women with stage I-III breast cancer, Medicaid expansion was associated with increased receipt of guideline-concordant treatment, reduced delays in treatment initiation, and improved 2-year survival.

Exploring the reproductive and sexual health concerns of young adults with cancer.

e24176 Background: Young adults (YA) with cancer face unique challenges due to their developmental stage at the time of diagnosis/treatment. In the limited number of studies that have looked at reproductive and sexual health among YA being treated for cancer, YA expressed a need for increased communication and guidance in these areas. There is inadequate insight into the extent of sexual and reproductive concerns YA have and the substance of related counseling patients have received in the past, if any. As survivorship rates improve in this age group the need to address reproductive and sexual health as a part of comprehensive cancer care increases. Methods: This was a cross sectional study via a one time survey created on REDCap. Eligibility included diagnosis of malignancy (lymphoma, leukemia, breast cancer, or testicular cancer) between ages 18-39, less than 5 years from therapy completion. Eligible participants were identified via an i2b2 filter on Epic. Enrolled participants completed an online survey that focused on their concerns surrounding sexual health, fertility, contraception, the HPV vaccine, and any counseling they received in those areas. Questions regarding patient demographics, diagnostic, and treatment information were included. Results: The survey was completed by 23 patients (126 eligible, 52 contacted after permission given by the primary oncologist). Patients were 52% female, 73% non-Hispanic/Latino. 57% were between ages 18-24 at diagnosis and the most common cancer for females and males were lymphoma and testicular cancer respectively. 57% of patients stated they had questions about sexual activity during their cancer diagnosis and treatment, 35% recalled having a discussion with a provider. 60% of patients said cancer affected their sex life, with over 80% of those stating it was a net negative effect. 82% of patients had questions about fertility, and 87% had a discussion with a provider. 24% had questions about contraception with 43% having a discussion. 43% of patients were unsure if there was any conversation about the HPV vaccine. Conclusions: YA cancer patients seem to have many questions surrounding sexual and reproductive health. The biggest discrepancy between questions had and conversations had was specifically in the area of sexual health. Future research should delve into the content of the questions and how providers can better address sexual health in a standard manner. Most patients who had questions concerning fertility report they did have some discussion, although satisfaction varies. The majority of patients said cancer negatively affected their sex life, but it is yet to be determined if this affects overall quality of life and if providers can help. The lack of HPV vaccine counseling should be further explored.[Table: see text]

Disparities in cancer care among sexual and gender minority adolescent and young adult patients: A scoping review.

Adolescent and young adult cancer patients (AYAs) who are sexual and gender minorities (SGM) are a rapidly increasing population that experiences unmet cancer-related needs. Despite emerging awareness, little is known about cancer care and outcomes for this vulnerable population. The purpose of this scoping review was to explore current knowledge and gaps in the literature on cancer care and outcomes for AYAs who identify as SGM. We reviewed empirical knowledge on SGM AYAs by identifying, describing, and critically appraising the literature to date. We conducted a comprehensive search on OVID MEDLINE, PsycINFO, and CINAHL in February 2022. Additionally, we developed and piloted a conceptual framework for appraising SGM AYA research. A total of 37 articles were included in the final review. Most studies focused exclusively on SGM-related outcomes as the primary aim of the study (81.1%, n = 30), whereas others included some focus on SGM-related outcomes (18.9%, n = 7). The majority of studies included AYAs as part of a broader age range (86.0%, n = 32), and only a few studies examined exclusively AYA samples (14.0%, n = 5). Gaps in scientific evidence on SGM AYAs were seen across the cancer care continuum. Numerous gaps in knowledge of cancer care and outcomes exist for SGM AYAs diagnosed with cancer. Future efforts should fill this void with high-quality empirical studies that reveal unknown disparities in care and outcomes and are inclusive of the intersectionality of SGM AYAs with other minoritized experiences, thereby advancing health equity in meaningful ways.

Feasibility of an Electronic Patient-Reported Outcome Tool for Screening Distress and Supportive Care Needs of Adolescents and Young Adults with Cancer.

Purpose: Although adolescent and young adult (AYA) cancer patients are digital natives and have high digital communication needs, previous studies of screening tools for AYAs have primarily used paper when measuring patient-reported outcomes (PROs). There are no reports on using an electronic PRO (ePRO) screening tool with AYAs. This study evaluated the feasibility of such a tool in clinical settings, and assessed the prevalence of AYAs' distress and supportive care needs. Methods: An ePRO tool based on the Distress Thermometer and Problem List (DTPL)-Japanese (DTPL-J) version for AYAs was implemented in a clinical setting for 3 months. To determine the prevalence of distress and need for supportive care, descriptive statistics were calculated for participant characteristics, selected items, and Distress Thermometer (DT) scores. Response rates, referral rates to an attending physician and other experts, and time required to complete PRO tools were assessed to evaluate feasibility. Results: From February to April 2022, 244 (93.8%) of 260 AYAs completed the ePRO tool based on the DTPL-J for AYAs. Based on a DT cutoff of ≥5, 65 of 244 patients (26.6%) had high distress. Worry (n = 81, 33.2%) was the most frequently selected item. Primary nurses referred 85 (32.7%) patients to an attending physician or other experts. The referral rate resulting from ePRO screening was significantly higher than that after PRO screening (χ2(1) = 17.99, p < 0.001). The average response time did not differ significantly between ePRO and PRO screening (p = 0.252). Conclusion: This study suggests the feasibility of an ePRO tool based on the DTPL-J for AYAs.

Colorectal cancer in young adults.

The incidence of colorectal cancer in young adults (CRCYAs) is increasing globally, and it is now the third leading cause of cancer death among young adults under 50 years old. The rising incidence is attributed to various emerging risk factors such as genetics, lifestyle factors, and microbiome profiles. Delayed diagnosis and more advanced disease presentation contribute to worse outcomes. A multidisciplinary approach to care is crucial to ensure comprehensive and personalized treatment plans for CRCYA.

(010) Correlates of Sexual Dysfunction in Young Adult Cancer Survivors: A Project REACH Study

Abstract Introduction Cancer treatment early in life contributes to a wide range of late effects such as sexual dysfunction, fatigue, sleep disturbances, and widespread pain. Although these concerns have been found to be related in older survivors, research is limited in young adult cancer survivors (YACS), particularly using validated measures of sexual dysfunction. Objective The current study aims to address this gap in research by describing relationships between sexual dysfunction and fatigue, sleep, and pain in YACS. Methods 164 young women (aged 18-39) previously treated for pediatric cancer completed self-report measures on sexual function, fatigue, sleep, and pain through Project REACH, a prospective cohort study. Sexual function was assessed using the Female Sexual Function Index (FSFI-6); participants were classified as experiencing significant sexual dysfunction if they scored ≤ 19 on this measure. Participants also completed the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and items adapted from the Brief Pain Inventory. Of note, lower FACIT-F, higher PSQI, and higher pain scores represent more impaired functioning. T-tests were used to compare participants with and without sexual dysfunction on fatigue (FACIT-F total score), sleep (PSQI total score), and pain (days of severe pain in the last week). A logistic regression was also performed to understand the effects of fatigue, sleep, and pain on the likelihood that participants would have sexual dysfunction. Results Over half (56%) of participants were classified as experiencing significant sexual dysfunction. Participants with sexual dysfunction had significantly more severe fatigue (p&amp;lt;.001), significantly worse sleep (p=.02), and significantly more days of severe pain (p=.006) than those without sexual dysfunction. The logistic regression model with fatigue, sleep, and pain was significant (p&amp;lt;.001) and correctly classified 69% of participants. In this model, more severe fatigue was significantly associated with an increased likelihood of having sexual dysfunction (OR=0.93, 95% CI [0.88-0.98]). More frequent severe pain was associated with an increased likelihood of having sexual dysfunction (OR=2.49, 95% CI [0.99-6.28]), although this finding was only marginally significant (p=.053). Sleep was not significantly associated with sexual dysfunction in the model. Conclusions As hypothesized, female YACS with sexual dysfunction had higher levels of fatigue, worse sleep, and more frequent severe pain than those without sexual dysfunction. However, when included in a logistic model, fatigue but not sleep was significantly associated with an increased likelihood of sexual dysfunction. This suggests that consistent with previous research on cancer survivors, fatigue in this population is more than simply the result of poor sleep. Fatigue may need to be directly addressed to improve sexual function in YACS. Although only marginally significant, overall pain may also contribute to sexual dysfunction in this population; as severe pain was infrequent and the sample small, future research should examine this relationship in larger samples. Additionally, as the current study examined general pain, more research is necessary to determine whether sexual or non-sexual pain is driving the potential relationship between sexual dysfunction and frequency of severe pain. Disclosure No

Screening young adult cancer survivors for depression and anxiety with the Primary Care Evaluation of Mental Disorders (PRIME-MD): Comparisons with a structured clinical diagnostic interview.

Survivorship guidelines recommend screening for depression and anxiety in young adult cancer survivors (YACS), but research validating measures in this population is limited. The current study aimed to examine use of the Primary Care Evaluation of Mental Disorders (PRIME-MD) to screen for depression and anxiety in YACS. 249 YACS (aged 18-40, 50% male) completed PRIME-MD via Telephone Automated Computer Assisted Structured Interview and the Structured Clinical Interview for the DSM-IV (SCID) via in-person interview. SCID responses were scored to identify depressive and anxiety symptoms and diagnoses. PRIME-MD was scored to identify YACS reaching the symptom threshold (≥1 depressive or anxiety symptom) and diagnostic threshold for depressive or anxiety disorder. ROC analyses evaluated concordance of the PRIME-MD with the SCID. The PRIME-MD depressive symptom threshold had excellent discrimination compared to SCID depressive diagnosis (AUC=0.83) with high sensitivity (86%) and specificity (81%). Similarly, the PRIME-MD depressive diagnosis threshold had excellent discrimination compared to SCID depressive diagnosis (AUC=0.86) as well as high sensitivity (86%) and specificity (86%). No PRIME-MD threshold met sensitivity (≥0.85) and specificity (≥0.75) criteria for identifying SCID depressive symptoms, anxiety disorders, or anxiety symptoms. PRIME-MD has potential utility as a screening measure of depressive disorders in YACS. The PRIME-MD depressive symptom threshold may be particularly useful in survivorship clinics as it requires only two items be administered. However, PRIME-MD does not meet study criteria for a standalone screen for anxiety disorders, anxiety symptoms, or depressive symptoms in YACS.

(056) Dyadic Approaches in Oncosexology: Understanding the Relationship between Couples’ Coping and Sexual Satisfaction among Young Adult Breast Cancer Patients and Their Partners

Abstract Introduction Recent evidence supports bio-psycho-social and non-linear models of sexual functioning. These models expand current understanding of cancer-related sexual health problems to include interpersonal factors such as relationship discord, fear of intimacy, and lack of communication (Bober &amp; Varela, 2012). Sexual satisfaction, defined as “an affective response arising from one’s subjective evaluation of the positive and negative dimensions associated with one’s sexual relationship” (Lawrence &amp; Byers, 1995; p. 268), is regarded as an important metric of sexual health and wellbeing. However, most studies have included only one member of the couple, and little is known about how each partner’s coping may mutually contribute to sexual satisfaction. We examined the reciprocal influence of couples’ coping behaviors on the individual’s and the partner’s sexual satisfaction. Objective The present work describes the relationship between couples’ coping behaviors and satisfaction with sexual relationship among young adult breast cancer patients and partners. Methods A sample of 40 romantic couples receiving care at an NCI-designated comprehensive cancer center completed cross-sectional online surveys. Validated questionnaires of satisfaction with sexual relationship (GMSEX), sexual function (IIEF, FSFI), and couple coping [Dyadic Coping Inventory, (DCI)] were administered. Couple coping includes both partners’ strategies implemented to manage their own and their partners’ distress, as well as shared coping behaviors. Items are organized in multiple subscales: stress communication, supportive, delegate, negative, and common dyadic coping. Stress communication refers to the strategies implemented by the partners to communicate to each other that they are stressed. Supportive dyadic coping occurs when one partner implements problem- and/or emotion-focused coping strategies to support the other person. Delegated dyadic coping occurs when one partner takes over responsibilities to reduce their partner’s stress. Negative dyadic coping includes behaviors that are hostile, ambivalent, and superficial. Common dyadic coping indicates coordinated responses between partners. Descriptive statistics and paired sample t-tests were used to assess differences between partners’ measures. In addition, confirmatory factor analysis (CFA) was used to estimate measurement models using Mplus8, while the pooled regression approach was utilized to estimate the Actor-Partner Interdependence Model (APIM). Results In the present sample, supportive and delegated dyadic coping behaviors contributed to greater sexual satisfaction for both partners, whereas only an actor effect was detected for stress communication, negative, and common dyadic coping. Significant differences were identified between partners, with breast cancer patients reporting higher stress communication (p&amp;lt;.05), partner-reported supportive (p&amp;lt;.05) and delegated coping behaviors (p&amp;lt;.05). Male partners rated higher patients’ engagement in stress communication behaviors (p&amp;lt;.05). In addition, more than one-half of patients screened positive for clinically significant sexual dysfunction (60.6%), compared to 20% of their partners. Conclusions These results provide evidence about the importance of dyadic approaches to investigating sexual satisfaction and functioning post-cancer treatment. Stress communication exerted an individual, rather than mutual, influence on sexual satisfaction of patients and partners. Delegated and supportive dyadic coping styles resulted in reciprocal influence and were associated with the higher sexual satisfaction among dyad members. Additional research is needed to confirm these findings in larger samples of cancer patients and develop effective interventions. Disclosure No