Young Adult Cancer Research Articles

Efficacy of a web-based psychoeducational intervention, Fex-can sex, for young adult childhood cancer survivors with sexual dysfunction: A randomized controlled trial

BackgroundNo web-based interventions addressing sexual problems are available for young adult survivors of childhood cancer. AimThis study aimed to test the efficacy of a web-based psychoeducational intervention, Fex-Can Sex, to alleviate sexual problems in young adults treated for cancer during childhood. MethodThis randomized controlled trial tested the effects of a 12-week, self-help, web-based intervention. Young adults (aged 19–40) reporting sexual dysfunction were drawn from a population-based national cohort of childhood cancer survivors and randomized to either an intervention group (IG, n = 142) or a wait-list control group (CG, n = 136). The primary outcome was ‘Satisfaction with sex life’ assessed by the PROMIS® SexFS v 2.0. Secondary outcomes included other SexFS domains, body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), and sex-related self-efficacy. Surveys were completed at baseline (T0), directly after the intervention (T1), and three months later (T2). The effects of the intervention were tested using t-test and linear mixed models, including intention-to-treat (ITT) and subgroups analysis. Adherence was based on log data extracted from the website system. The intervention included an open-ended question about perceived sexual problems. ResultsNo effect of the intervention was found in the primary outcome. Regarding secondary outcomes, the IG reported less vaginal dryness (Lubrication subscale) than the CG at T1 (p = 0.048) and T2 (p = 0.023). Furthermore, at T1, the IG reported less emotional distress than the CG (p = 0.047). Subgroup analyses showed that those with greater sexual problems at T0 improved over time (T1 and T2), regardless of group allocation. Overall, adherence to the intervention was low and participants' activity levels did not change the results. Additionally, some members of the IG reported increased understanding and acceptance of their sexual problems. ConclusionThe Fex-Can Sex intervention shows potential to improve sexual function, especially among those with greater dysfunction. To increase adherence and effect, we recommend the intervention to be further developed including more tailored content. Clinical trial registrationISRCTN Registry, trial number: 33081791 (registered on November 27, 2019).

Oral cancer in young adults: should we approach these patients differently?

The influence of age on treatment outcomes in oral cancer is unclear. We aimed to determine the prevalence of oral cancer in adults under age 45 and to compare treatment outcomes by age. Retrospective study of 284 patients treated for oral cancer from 2010 to 2021. The primary analysis involved the full cohort stratified by age (< vs. ≥ 45y). The second analysis included all patients under age 45 (n=44) matched 1:1 by sex and stage to older patients (age 55-70). In the primary analysis, the only significant difference was more comorbidities in the older group (p<0.001). In the matched-pair analysis, older patients were more likely to be smokers (75% vs. 54%; p=0.045) and had more comorbidities (p=0.007). The mean PLR and NLR values were significantly higher in the younger group. No significant differences were observed between age groups in disease stage or outcomes, suggesting that other variables are more important.

EPR24-119: Development of Heart Failure Following Anthracycline Exposure in Survivors of Adolescent and Young Adult Cancer in an Integrated Healthcare System.

EPR24-119: Development of Heart Failure Following Anthracycline Exposure in Survivors of Adolescent and Young Adult Cancer in an Integrated Healthcare System.

Reproductive Concerns and Associated Factors Among Adolescent and Young Adult Cancer Survivors in Uganda: A Hospital-Based Cross-Sectional Study.

Purpose: Reproductive health (RH) is a critical issue among cancer survivors worldwide. However, in developing countries where RH services for patients with cancer are often lacking, reproductive concerns among adolescent and young adult (AYA) survivors remain uncertain. In this study, we assessed the reproductive concerns of AYA cancer survivors in a resource-limited context of Uganda. Methods: We collected data from AYA cancer survivors at two facilities in Uganda using an interviewer-administered questionnaire. Descriptive statistics were calculated, one-way analysis of variance was used for intergroup comparisons, and multiple regressions were used to test for predictors of reproductive concerns. Results: A total of 110 AYA cancer survivors, with a median age of 20 years (interquartile range [IQR], 18-22), were interviewed. More than half (53.6%) of the respondents were males. The median time since cancer diagnosis was 19 months (IQR, 13.0-35.0). Almost all (91.8%) respondents had a future desire to have children, but only 15.5% received reproductive counseling. The mean total score for the reproductive concern subscales was highest for the fertility concern, followed by the information-seeking and health-related concerns. Reproductive counseling, desire to have children, and respondents' age were the factors influencing reproductive concern. Conclusions: The study shows a strong desire for biological parenthood with very low reproductive counseling among AYA cancer survivors, who remain concerned about their fertility, information needs, and health. This outcome underscores the need to integrate RH services into resource-limited cancer care settings.

Detecting High-Dose Methotrexate-Induced Brain Changes in Pediatric and Young Adult Cancer Survivors Using [18F]FDG PET/MRI: A Pilot Study.

Significant improvements in treatments for children with cancer have resulted in a growing population of childhood cancer survivors who may face long-term adverse outcomes. Here, we aimed to diagnose high-dose methotrexate-induced brain injury on [18F]FDG PET/MRI and correlate the results with cognitive impairment identified by neurocognitive testing in pediatric cancer survivors. Methods: In this prospective, single-center pilot study, 10 children and young adults with sarcoma (n = 5), lymphoma (n = 4), or leukemia (n = 1) underwent dedicated brain [18F]FDG PET/MRI and a 2-h expert neuropsychologic evaluation on the same day, including the Wechsler Abbreviated Scale of Intelligence, second edition, for intellectual functioning; Delis-Kaplan Executive Function System (DKEFS) for executive functioning; and Wide Range Assessment of Memory and Learning, second edition (WRAML), for verbal and visual memory. Using PMOD software, we measured the SUVmean, cortical thickness, mean cerebral blood flow (CBFmean), and mean apparent diffusion coefficient of 3 different cortical regions (prefrontal cortex, cingulate gyrus, and hippocampus) that are routinely involved during the above-specified neurocognitive testing. Standardized scores of different measures were converted to z scores. Pairs of multivariable regression models (one for z scores < 0 and one for z scores > 0) were fitted for each brain region, imaging measure, and test score. Heteroscedasticity regression models were used to account for heterogeneity in variances between brain regions and to adjust for clustering within patients. Results: The regression analysis showed a significant correlation between the SUVmean of the prefrontal cortex and cingulum and DKEFS-sequential tracking (DKEFS-TM4) z scores (P = 0.003 and P = 0.012, respectively). The SUVmean of the hippocampus did not correlate with DKEFS-TM4 z scores (P = 0.111). The SUVmean for any evaluated brain regions did not correlate significantly with WRAML-visual memory (WRAML-VIS) z scores. CBFmean showed a positive correlation with SUVmean (r = 0.56, P = 0.01). The CBFmean of the cingulum, hippocampus, and prefrontal cortex correlated significantly with DKEFS-TM4 (all P < 0.001). In addition, the hippocampal CBFmean correlated significantly with negative WRAML-VIS z scores (P = 0.003). Conclusion: High-dose methotrexate-induced brain injury can manifest as a reduction in glucose metabolism and blood flow in specific brain areas, which can be detected with [18F]FDG PET/MRI. The SUVmean and CBFmean of the prefrontal cortex and cingulum can serve as quantitative measures for detecting executive functioning problems. Hippocampal CBFmean could also be useful for monitoring memory problems.

Development of a Patient-Reported Sexual Health Outcomes Battery for Use in Adolescent and Young Adult Cancer Clinical Trials.

Development of a Patient-Reported Sexual Health Outcomes Battery for Use in Adolescent and Young Adult Cancer Clinical Trials.

Preliminary testing of "roadmap to parenthood" decision aid and planning tool for family building after cancer: Results of a single-arm pilot study.

Many young adult female cancer survivors need to use reproductive medicine, surrogacy, or adoption to have a child. This study pilot tested Roadmap to Parenthood, a web-based, self-guided decision aid and planning tool for family building after cancer (disease agnostic). A single-arm pilot study tested feasibility, acceptability, and obtained effect size estimates of the Roadmap tool. Participants, recruited via hospital-based and social media strategies, completed a baseline survey (T1), accessed the Roadmap tool (website), then completed surveys at one- and 3-months (T2 and T3, respectively). Feasibility and acceptability were evaluated with rates of eligibility, enrollment, and survey completion, and feedback. Pairwise t-tests and repeated measures ANOVA evaluated usage effects. Effect size estimates were calculated. Participants (N=98) averaged 31years old (SD=5.61); 71% were nulliparous. Enrollment rate was 73%, T1-T2 completion rate was 80%, and 93% accessed the website. From T1-T2, participants reported improvements in decisional conflict (p<0.001; Cohen's d=0.85), unmet information needs (p<0.001; Cohen's d=0.70), self-efficacy (p=0.003; Cohen's d=0.40), and self-efficacy for managing negative emotions (p=0.03; Cohen's d=0.29); effects were sustained at T3. There was no change in reproductive distress (p=0.22). By T3, 94% reported increased consideration of preparatory actions and 20%-61% completed such actions. The Roadmap intervention was feasible to conduct, acceptable to users, and led to improvements in key psychosocial outcomes. Future directions will test intervention efficacy in a randomized controlled trial with a larger sample and over a longer period. A web-based tool may help women make decisions about family building after cancer and prepare for potential challenges.

The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers Version 6

The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers Version 6

A Needs Assessment Approach for Adolescent and Young Adult Sexual and Gender Diverse Cancer Survivors.

Sexual and gender diverse (SGD) adolescent and young adult (AYA) cancer survivors are an increasing and vulnerable group with unique needs that often remain unmet in the healthcare system. This paper describes the conceptualization and development of a community-based organization dedicated to serving SGD AYAs, in addition to reporting on the results of a community-led needs assessment. A total of 56 SGD AYA community members completed the online survey. Most participants were between the ages of 26 to 33, identified as white, cisgender, bisexual women, and had hematologic malignancies. Identified unmet needs of SGD AYAs included the following: sexual health and family planning; gender affirmation; financial stability; and emotional support. Areas within the community organization were identified as gaps, areas of expansion, and assets. Results highlight the role of community and academic partnerships in improving cancer care delivery for SGD AYA cancer survivors.

Reel reflections: the role of entertainment media narratives in coping among young adult cancer survivors

Introduction Young adult cancer survivors (YACS; ages 18–39) report a significant psychological burden. Entertainment media narratives (e.g., books, movies, shows that are produced for mass consumption) might be an effective tool for reducing this distress, although little is known about present use among YACS. Method YACS completed a survey about their use of entertainment media narratives to cope with cancer using an adapted version of the Brief COPE. Additionally, YACS reported their use of entertainment media narratives to start conversations about their experience with others, and they described features of entertainment media narratives that they found helpful in coping. Results We recruited 108 YACS from three recruitment sites. Most participants were White (n = 65), female (n = 54), and recruited from Prolific (n = 56), an Internet-based, crowdsourced data collection platform. Participants were, on average, 30 years old and 45 months from the completion of their primary cancer treatment. YACS who used entertainment media to cope with cancer (n = 32; 29.6%) were significantly younger and significantly closer to the end of their primary treatment. Compared to nonusers, users of entertainment media narratives to cope were also more likely to identify as Black; identifying as Black was associated with a 2.05-factor increase in using narrative entertainment media to cope with cancer even when controlling for other demographic differences. Additionally, compared to their peers, Black YACS reported greater use of narratives to start cancer-related conversations. Emotional and inspirational storylines were the most helpful story features. Discussion Some YACS, especially Black YACS, use stories to cope with their cancer experience. YACS patients could find stories useful in exploring their cancer-related emotions, although the exact benefits are still unknown.

Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers.

Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains:psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. NCT05876325.

Five-year survival prognosis of young, middle-aged, and elderly adult female invasive breast cancer patients by clinical and lifestyle characteristics

PurposeEarly-onset breast cancer incidence has been increasing globally and in Taiwan. However, previous studies have not comprehensively examined how clinical and lifestyle characteristics influence the 5-year survival of breast cancer diagnosed at different stages of adulthood.MethodsWe analyzed the Taiwan National Cancer Registry and Cause of Death datasets to understand how clinical factors (including tumor and treatment characteristics) and lifestyle factors (including body mass index, cigarette smoking, and alcohol consumption) were associated with the 5-year survival of 8471 young, 57,695 middle-aged, and 14,074 elderly female adult invasive breast cancer patients respectively diagnosed at age 20–39, 40–64, and ≥ 65 years between 2002 and 2015, with mortality follow-up to 2020. Poisson regression was used for obtaining the crude and adjusted 5-year survival risk ratios.ResultsClinical and lifestyle characteristics were distributed differently but had mostly similar direction of association with 5-year survival for the three age groups. Receiving any treatment was associated with better survival, especially for elderly patients. Being underweight at initial cancer treatment was associated with worse survival than having normal weight, especially for elderly patients. Current smokers had worse survival than never smokers for middle-aged and elderly patients. The 5-year breast cancer-specific survival was not significantly higher for those of age 45–49 years than 40–44 years, despite the recommended starting screening age is 45 years in Taiwan.ConclusionOur findings contribute to the understanding of early-onset and later-onset female breast cancer characteristics and prognosis, which may inform surveillance and treatment strategies to achieve better breast cancer prognosis.

Abstract 7017: Increased epigenetic age acceleration in young adult and early onset colorectal cancer patients post-treatment: A ColoCare Pilot Study

Abstract Introduction: Advanced biological age relative to chronological age has been observed in individuals with colorectal cancer (CRC), and there is growing evidence that cancer treatments can further accelerate biological aging. However, the influence of age at diagnosis on these relationships has yet to be examined in detail. This pilot study used data from the ColoCare Study to explore pre- and post-treatment differences in age acceleration by chronological age at CRC diagnosis. Methods: The ColoCare Study is a prospective cohort study of newly-diagnosed CRC patients enrolled across seven U.S. and European sites. Participants in this pilot study were from the ColoCare site in Tampa, Florida who had available pre-treatment blood DNA. Young adult (YA, aged 18-39) and early onset (EO, aged 40-49) participants were matched with average onset (AO, aged 50-64) and late onset (LO, aged &amp;gt;64) participants on stage, sex, race and microsatellite instability status. Genome-wide DNA methylation profiles were assayed on buffy coat DNA using MethylationEPIC v2 BeadChips. PhenoAgeAccel and GrimAgeAccel were calculated on all samples to quantify the difference between DNA methylation-predicted biological age and chronological age (i.e., age acceleration). Linear regression models were used to estimate the associations of age at diagnosis and treatment with PhenoAgeAccel and GrimAgeAccel, adjusted for sex, race, and site (rectal, colon). Results: The sample (n=60) included n=19 YA, n=15 EO, n=11 AO, and n=15 LO participants with pre-treatment blood DNA. Over half (n=15 YA/EO, n=20 AO/LO) had a paired post-treatment blood sample available. Half of participants were female and had colon tumors, and 76% were diagnosed with stage I-III disease. Pre-treatment, PhenoAgeAccel and GrimAgeAccel were similar across age groups (P &amp;gt; 0.05). In the subset of participants with pre- and post-treatment samples, age acceleration appeared to increase post-treatment (pre- and post-treatment differences, PhenoAgeAccel: 1.44, SD: 5.55, P= 0.13; GrimAgeAccel: 0.92, SD: 2.80, P= 0.06). Increases were largest among YA/EO participants. In adjusted models, the predicted differences in pre-to post-treatment PhenoAgeAccel were 2.89 (95% CI: -0.13, 5.90) in YA/EO and 0.36 (95% CI: -2.25, 2.96) in AO/LO (P-difference= 0.20). The predicted differences in GrimAgeAccel were 1.75 (95% CI: 0.25, 3.25) in YA/EO and 0.30 (95% CI: -1.00, 1.60) in AO/LO (P-difference= 0.15). Conclusions: In this pilot study of CRC patients, pre-treatment age acceleration did not vary by age at diagnosis. Post-treatment, patients diagnosed at age 49 or younger had larger increases in age acceleration than patients diagnosed at age 50 or older. These findings warrant further investigation in larger samples and to determine if increases in post-treatment age acceleration as associated with patient outcomes and treatment response. Citation Format: Erin M. Siegel, Jacob K. Kresovich, Amanda M. Bloomer, Anders Berglund, Esther Jean-Baptiste, Gillian Trujillo, Rachel Carmella, Julaxis Love, Seth Felder, Jennifer Ose, Biljana Gigic, Christopher I. Li, Jane C. Figueiredo, Adetunji T. Toriola, Cornelia M. Ulrich, David Shibata, Laura B. Oswald. Increased epigenetic age acceleration in young adult and early onset colorectal cancer patients post-treatment: A ColoCare Pilot Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7017.

Meaningful Patient Engagement in Adolescent and Young Adult (AYA) Cancer Research: A Framework for Qualitative Studies.

Over the last two decades, patient engagement in cancer research has evolved significantly, especially in addressing the unique challenges faced by adolescent and young adult (AYA) cancer populations. This paper introduces a framework for meaningful engagement with AYA cancer patient research partners, drawing insights from the "FUTURE" Study, a qualitative study that utilizes focus groups to explore the impact of cancer diagnosis and treatment on the sexual and reproductive health of AYA cancer patients in Canada. The framework's development integrates insights from prior works and addresses challenges with patient engagement in research specific to AYA cancer populations. The framework is guided by overarching principles (safety, flexibility, and sensitivity) and includes considerations that apply across all phases of a research study (collaboration; iteration; communication; and equity, diversity, and inclusion) and tasks that apply to specific phases of a research study (developing, conducting, and translating the study). The proposed framework seeks to increase patient engagement in AYA cancer research beyond a supplementary aspect to an integral component for conducting research with impact on patients.

Abstract 2254: A population-based study exploring health care self-efficacy and fertility preservation, family planning, and reproductive concerns among diverse adolescent and young adult cancer survivors

Abstract Purpose: To examine the relationship between health care self-efficacy (HCSE) and fertility experiences among diverse adolescent and young adult (AYA) cancer survivors. Methods: Project Milestones is an ongoing cancer-registry derived cohort survey study recruiting AYAs through the SEER-affiliated Los Angeles Cancer Surveillance Program. Respondents were diagnosed with cancers prototypical for AYAs between 21-39 years and had a 5-year survival probability of ≥50% at diagnosis. Results: Overall, 1442 AYAs responded of which 57.9% reported the highest possible HCSE (totally confident; score of 3; lower scores reflect greater HCSE), while 42.1% were somewhat or not at all confident in some areas (score of 4-9; Table 1). Compared to AYAs with lower HCSE, AYAs with the highest HCSE were more likely to report preserving fertility (13.8% vs. 10.3%, p&amp;lt;.05) and were less likely to report highly negative change (11.9% vs. 15.5%, p&amp;lt;.01) and more likely to report highly positive change (16.3% vs. 9.4%, p&amp;lt;.01) to family planning due to cancer. On average, AYAs with the highest HCSE had lower reproductive concerns (range 5-25, lower scores reflect lower concern; 13.3 vs. 14.2, p&amp;lt;.01) and were less likely to report worry about: passing on a genetic cancer risk to their child (49.6% vs. 56.6%; p&amp;lt;.01), telling their partner they may be unable to have children (13.8% vs. 21.5%, p&amp;lt;.01), their ability to become a biological parent (22.7% vs. 28.0%, p&amp;lt;.01), and caution having children because they may not be around to raise them (18.5% vs. 24.1%, p&amp;lt;.01) than AYAs with lower HCSE. Discussion: Greater HCSE was associated with higher rates of preservation, lower impacts to family planning, and lower reproductive concerns in this population-based study. As one quarter of AYAs have suboptimal HCSE, accessible avenues for obtaining fertility care are needed to temper possible impacts of low HCSE on preserving fertility. Table 1: Sample characteristics - N (%) or M (SD) Total Hispanic Non-Hispanic 1442 622 (43.1) 820 (56.9) Age at survey 39.5 (5.8) 39.3 (5.8) 39.6 (5.7) Female 1007 (69.8) 429 (69.0) 578 (70.5) White 850 (62.4) 301 (55.0) 549 (67.3) Had employee-sponsored insurance 909 (63.0) 347 (55.8) 562 (68.5) Age at diagnosis 31.0 (5.2) 30.8 (5.2) 31.2 (5.1) Discussed fertility 717 (50.3) 327 (53.4) 390 (48.0) Preserved fertility 176 (12.3) 48 (7.8) 128 (15.7) Impacts to family planning due to cancer Highly negative change 202 (14.3) 91 (15.0) 111 (13.7) Somewhat negative change 128 (9.0) 50 (8.3) 78 (9.6) No change 788 (55.6) 315 (52.1) 472 (58.2) Somewhat positive change 111 (7.8) 43 (7.1) 68 (8.4) Highly positive change 189 (13.3) 106 (17.5) 83 (10.2) Reproductive Concerns After Cancer (RCAC) score 14.1 (3.9) 14.3 (4.2) 14.0 (3.8) HCSE score 3.9 (1.4) 4.0 (1.4) 3.9 (1.3) Could ask doctor or health care provider about things that concern you? Totally confident 1088 (75.9) 466 (75.5) 622 (76.1) Somewhat confident 303 (21.1) 130 (21.1) 173 (21.2) Not at all confident 43 (3.0) 21 (3.4) 22 (2.7) Could schedule and attend your doctor appointments or decide when you needed care? Totally confident 1057 (73.8) 454 (73.5) 603 (74.1) Somewhat confident 310 (21.7) 130 (21.0) 180 (22.1) Not at all confident 65 (4.5) 34 (5.5) 31 (3.8) Could get the cancer related follow-up care you need over the next 2 years? Totally confident 1006 (70.6) 410 (67.3) 596 (73.1) Somewhat confident 328 (23.0) 149 (24.4) 179 (22.0) Not at all confident 90 (6.3) 50 (8.2) 40 (4.9) Citation Format: Julia Stal, Kimberly A. Miller, Joel E. Milam, Molly Quinn, Sue E. Kim, Rachel C. Ceasar, David R. Freyer. A population-based study exploring health care self-efficacy and fertility preservation, family planning, and reproductive concerns among diverse adolescent and young adult cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2254.

Abstract 2253: Cancer-related follow-up health care utilization and fertility discussion, preservation, and reproductive concerns among diverse adolescent and young adult cancer survivors: A population-based study

Abstract Purpose: To examine cancer-related follow-up (CRFU) health care utilization associated with fertility experiences among diverse adolescent and young adult (AYA) cancer survivors. Methods: Project Milestones is an ongoing survey study evaluating life outcomes among AYAs diagnosed with cancer at age 21-39 in Los Angeles (LA) County. AYAs had an initial 5-year survival probability of ≥50% and are currently 3-10 years post-diagnosis. A registry-based recruitment strategy through the SEER-affiliated LA Cancer Surveillance Program was used. Results: Overall, 1442 AYAs responded (Table 1). Compared to AYAs who did not, AYAs who saw: (1) their treating provider for CRFU were more likely to report a fertility discussion (56.0% vs. 41.2%, p&amp;lt;.01); (2) another provider for CRFU were less likely to report a fertility discussion (38.1% vs. 52.0%, p&amp;lt;.01); (3) their treating provider for CRFU were more likely to report preserving fertility (14.7% vs. 8.4%, p&amp;lt;.01); (4) a primary care provider for CRFU were less likely to report preserving fertility (10.1% vs. 13.6% p&amp;lt;.05). Compared with AYAs who reported a CRFU visit 1+ years ago or never, AYAs with a visit &amp;lt;1 year ago: (1) had on average greater reproductive concerns (range 5-25, higher scores reflect greater concern, 13.8 vs. 13.4, p&amp;lt;.05); and were more likely to report (2) worry passing on a genetic risk for cancer to their child (55.6% vs. 47.8%, p&amp;lt;.01); and (3) caution about having children because they may not be around to raise them (23.6% vs. 16.6%, p&amp;lt;.01). Discussion: Iatrogenic infertility concerns persistent into survivorship, yielding a need to optimize oncofertility care throughout the reproductive lifespan. Receiving CRFU care from the treating provider is related to better outcomes, and higher reproductive concerns among AYAs with a recent visit may reflect greater awareness of risk due to more points of contact with a provider. Table 1: Sample characteristics - N (%) or M (SD) Total Hispanic Non-Hispanic 1442 622 (43.1) 820 (56.9) Age at survey 39.5 (5.8) 39.3 (5.8) 39.6 (5.7) Female 1007 (69.8) 429 (69.0) 578 (70.5) White 850 (62.4) 301 (55.0) 549 (67.3) Had employee-sponsored insurance 909 (63.0) 347 (55.8) 562 (68.5) Age at diagnosis 31.0 (5.2) 30.8 (5.2) 31.2 (5.1) Cancer type Leukemia/Lymphoma 396 (27.5) 173 (27.8) 223 (27.2) Reproductive 382 (26.5) 208 (33.4) 174 (21.2) Thyroid 184 (12.8) 86 (13.8) 98 (12.0) Breast 179 (12.4) 61 (9.8) 118 (14.4) Skin 130 (9.0) 21 (3.4) 109 (13.3) Colorectal 86 (6.0) 35 (5.6) 51 (6.2) Other 85 (5.9) 38 (6.1) 47 (5.7) Discussed fertility 717 (50.3) 327 (53.4) 390 (48.0) Preserved fertility 176 (12.3) 48 (7.8) 128 (15.7) Reproductive Concerns After Cancer (RCAC) score 14.1 (3.9) 14.3 (4.2) 14.0 (3.8) Last visit with a health care provider for cancer related follow-up care Within the past year 862 (60.3) 343 (56.2) 519 (63.4) 1-2 years ago 218 (15.3) 90 (14.8) 128 (15.6) More than 2 years ago 303 (21.2) 152 (24.9) 151 (18.4) Never 46 (3.2) 25 (4.1) 21 (2.6) Provider seen for cancer related follow-up care Same doctor who treated me 885 (61.4) 369 (59.3) 516 (62.9) Primary care provider 539 (37.4) 224 (36.0) 315 (38.4) Another type of provider 179 (12.4) 65 (10.5) 114 (13.9) Cancer survivorship clinic 88 (6.1) 46 (7.4) 42 (5.1) Citation Format: Julia Stal, Kimberly A. Miller, Joel E. Milam, Molly Quinn, Sue E. Kim, Rachel C. Ceasar, David R. Freyer. Cancer-related follow-up health care utilization and fertility discussion, preservation, and reproductive concerns among diverse adolescent and young adult cancer survivors: A population-based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2253.

Abstract 1085: Exploiting bioenergetic vulnerabilities in chemotherapy resistant osteosarcoma

Abstract BACKGROUND: Osteosarcoma (OS) is the most common bone cancer in children and young adults. Standard treatment involves chemotherapy and surgical resection, yet nearly 4 in 10 patients experience disease relapse, and almost all of these patients are resistant to additional chemotherapy. Therefore, there is an urgent need to understand the biology of chemo-resistant OS and identify new therapeutic strategies to treat this therapy-resistant disease state. METHODS: Using a CRISPR-Cas9 based lineage tracing system, RNA sequencing, and Seahorse XF assays in chemo-naïve, -resistant, and -released human 143b and patient-derived 173x OS cell lines, we modeled the evolution of chemoresistance and release from the selective pressure of chemotherapy in osteosarcoma. The phenotype of each cell state was assessed through in vitro and ex vivo cell proliferation assays, a comparison of cell viability upon re-challenge to standard-of-care chemotherapy, and comparison of cell viability in response to novel therapies targeting alterations in cell respiration. RESULTS: Chemo-resistant OS cells demonstrate a decrease in expression of proliferation-associated gene pathways and shift their resources toward expression and maintenance of multi-drug resistance ABC transporters. Chemo-released cells maintain elevated expression of ABC transporters while re-activating proliferation. Across the spectrum of chemotherapy exposure, OS cells demonstrate changes in respiratory capacity, with unique bioenergetic phenotypes observed in chemo-naïve, -resistant, and -released cells. CONCLUSIONS: Chemo-resistant and chemo-released OS cells demonstrate unique bioenergetic patterns that correlate with gene expression signatures and growth phenotypes. Evolution imposed by the selective pressure of chemotherapy may render OS cells vulnerable to therapies that disrupt cellular energetics and exploit multi-drug resistant ABC transporters. Citation Format: Valerie U. Nguyen, Laurie Graves, Veronica Colmenares, Abol Macabangon, Casey Syal, Kelsey Fisher-Wellman, William C. Eward, So Young Kim, Jason A. Somarelli. Exploiting bioenergetic vulnerabilities in chemotherapy resistant osteosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1085.

Stop and Think: A Case Study Illustrating the Implementation of Bright IDEAS-YA Being Delivered via Telehealth to a Young Adult Cancer Patient.

Bright IDEAS-Young Adults (Bright IDEAS-YA) is a problem-solving skills training intervention that has been adapted for young adults with cancer. Presently, a multisite randomized control trial is being conducted to determine Bright IDEAS-YA's efficacy in supporting a young adult population. This case study demonstrates the young adult adaptation of Bright IDEAS - Bright IDEAS-YA - being delivered to a young adult cancer patient via telehealth. Telehealth is a novel delivery method for Bright IDEAS and Bright IDEAS-YA that was established due to COVID-19 safety precautions. The patient, who reported challenges in several life domains, was taught how to apply the Bright IDEAS-YA framework over six telehealth sessions. After completing the Bright IDEAS-YA framework, the patient reported increased feelings of confidence in managing new stressors, which was corroborated through outcome measures delivered during and following intervention. This case illustrates how early psychosocial intervention following a cancer diagnosis, delivered via telehealth, can help patients develop and implement personal strategies to reduce stress levels.

Perceptions of Infertility and Reproductive Concerns in Adolescent and Young Adult Female Cancer Survivors.

This cross-sectional survey study explores the fertility perceptions of adolescent and young adult female cancer survivors (n = 111) and relationships to fertility counseling and reproductive distress. Satisfaction with post-treatment fertility counseling (β = -0.20, p = 0.04), perceived consequences of cancer-related fertility changes (β = 0.26, p = 0.03), and understanding of one's reproductive health (β = -0.22, p = 0.03) correlated with reproductive distress, controlling for covariates (F(10, 88) = 3.50, p < 0.001). Findings suggest that post-treatment counseling may be important to addressing survivors' perceptions of fertility and reproductive potential, which influences levels of distress and to create a greater sense of control on their road to parenthood.

Usability and Acceptability of a Web Platform to Host the Group-Based TOGETHER-YA Quality of Life Intervention for Young Adult Cancer Survivors.

Young adult (YA) cancer survivors aged 18-39 frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). Our team has developed a supportive care intervention, titled TOGETHER-YA, to improve YA cancer survivors' stress management skills. TOGETHER-YA is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. The purpose of this two-part study was to design and test a website to host the TOGETHER-YA intervention for YA cancer survivors aged 18-39. TOGETHER-YA is a 10-week, group-based program designed to promote health-related quality of life. In Part 1, we leveraged an existing online platform and adapted it to meet the needs of TOGETHER-YA. We conducted three iterative waves of usability testing with three YAs per wave to refine the website. In Part 2, we conducted a single-group feasibility trial of TOGETHER-YA using the website. Primary outcomes were feasibility (i.e., recruitment, retention, attendance) and acceptability (i.e., satisfaction). Usability testing participants (N=9) indicated that the TOGETHER-YA website was easy to use (M=5.9, SD=1.3) and easy to learn (M=6.5, SD=0.9) (possible ranges: 1-7). Qualitative feedback identified needed revisions to the aesthetics (e.g., images), content (e.g., session titles), function (e.g., clarity of functionality), and structure (e.g., expandable sections), which were implemented. In the feasibility trial, participants (N=7) were an average of 25 years old (SD=4.7) and mostly non-Hispanic White (57%). Recruitment (70%) and retention (71%) rates and average session attendance (M=7.1, SD=4.2) supported feasibility. Participant agreement with positive statements about TOGETHER-YA and average satisfaction ratings (M=5.06, SD=1.64; possible range: 1-7) demonstrated acceptability. Results supported the usability, feasibility, and acceptability of the TOGETHER-YA program and website. By hosting the content online, the program effectively addresses YAs' expressed preference for convenience. Future studies are needed to increase TOGETHER-YA's efficiency and explore its efficacy for improving targeted outcomes. NCT05597228, October 24, 2022.