Young Adult Oncology Patients Research Articles

Meeting Challenges in the Long-Term Care of Children, Adolescents, and Young Adults with Acute Lymphoblastic Leukemia.

To discuss the long-term view of treating and following pediatric, adolescent, and young adult patients with acute lymphoblastic leukemia (ALL) - with review of what can be done to prevent, monitor for, and treat complications of therapy. Pediatric, adolescent, and young adult oncology patients, including those with ALL, are living longer with higher overall survival rates as treatments and supportive care for these patients continue to improve. These patients are burdened by the risk of significant health and quality of life consequences as a result of their treatment.. For these patients, the late effects of treatment can be life-threatening, such as secondary cancers or cardiotoxicity, or life-altering with respect to quality of life. The goal of this paper is to review the current literature, research, and surveillance guidelines regarding the late effects of ALL therapy, to outline what can be done to mitigate the toxic effects of oncology treatment, and to extend life expectancy and improve quality of life for our patients. We review risk factors and interventions available to prevent and treat cardiovascular disease, secondary malignancies, endocrine complications (obesity, osteoporosis, infertility, and premature menopause), cognitive effects, and effects on functioning and mortality.

Skeletal muscle mass as a marker to predict outcomes in children and young adults with cancer.

Nutrition is an important outcome predictor in oncology patients including treatment response, physical disability, quality of life, and overall survival. Sarcopenia (loss of skeletal muscle mass and function) is a demonstrated marker of nutritional status in adults, but data are more limited in children. The purpose of this study was to evaluate whether total psoas muscle area (tPMA) measured at the time of cancer diagnosis predicts overall survival (OS), disease free survival (DFS), or number of days neutropenic. A retrospective study was performed. tPMA was measured at the L3 and L4 mid-lumbar vertebral body level by a single reviewer on cross-sectional imaging studies performed within 2weeks of primary oncologic diagnosis for all oncology patients who received their primary therapy at Cincinnati Children's Hospital between 1/1/2000 and 12/31/2013. Spearman's correlation was used to assess the association between tPMA and OS, DFS, days neutropenic, and adjusted days neutropenic. Subanalysis was performed assessing the relationship of tumor type and age at diagnosis with each parameter. 164 patients (median age 9.9years; 89M/75 F) were included in the study. Days neutropenic and normalized days neutropenic were significantly but weakly negatively correlated with tPMA at L3 (r = - 0.24, p < 0.002 and r = - 0.18, p < 0.05 respectively) and L4 (r = - 0.25, p < 0.002; and and r = - 0.19, p < 0.02 respectively). At subanalysis, the correlation between anthropometric features and normalized days neutropenic was only seen with brain tumors. There was no statistically significant relationship between sarcopenia at diagnosis and DFS or OS overall or in subanalysis. There is a weak inverse relationship between days neutropenic and psoas muscle bulk in pediatric and young adult oncology patients suggesting a relationship between nutritional status and cell recovery. Measures of sarcopenia, however, did not correlate with DFS or OS.

Impact of primary care providers (PCPs) on care receipt and satisfaction in adolescent and young adult (AYA) oncology patients.

e13512 Background: While there has been ongoing work to define the role of primary care providers (PCPs) in adolescent and young adult (AYA) survivorship models, little has been done to understand the role of PCPs earlier in the care continuum. As PCP-shared models of care have been theorized to help address morbidity related to the physical and psychosocial effects of cancer and its treatment, there is a need to better understand the impact of PCPs on AYAs. Given this, we sought to study the influence of PCPs in the care of AYAs with cancer, comparing care receipt and satisfaction during treatment versus in survivorship. Methods: Electronic health record query identified adult AYA cancer patients 19-39 years with at least two visits at the University of Wisconsin from 3/30/2019-3/29/2020. Identified patients were sent an electronic survey to assess care team members and impact on care. Responses were categorized based on patient-reported presence of a PCP as part of their cancer care team. For the data analysis, all patients who did not self-identify as long-term survivors, defined as 5+ years since diagnosis, were defined as active patients. Given survey answers were not mandated for all questions, the denominator was unique for each question. Results: We found a minority of AYAs responding to our survey considered a PCP as part of their cancer care team (71/173, 41%). PCP presence led to improved satisfaction in all AYAs with addressing the impact of diagnosis/treatment on peer interactions and independence, with 67% (45/67) AYAs with a PCP very or some satisfied versus 55% (53/97) without a PCP. PCPs also decreased the likelihood that supportive care services weren’t received by patients due to a lack of knowledge of the services, seen in 64% (56/88) AYAs without a PCP versus 52% (32/62) with a PCP. As seen in table, there were several findings suggesting that PCP involvement in AYA care was more critical to active patients than long-term survivors, including supportive care service receipt and satisfaction with such services. Conclusions: Overall, we found PCP involvement on cancer care teams was important for AYAs defined as both active patients and long-term survivors. Despite this, less than half of all patients identified PCPs as part of their care team. Our data suggest PCP-shared models of cancer care may improve care utilization and satisfaction in AYAs and support efforts to incorporate PCPs as meaningful members of the care team throughout all phases of care. Survey responses based on PCP inclusion as cancer care team member and patient treatment status.[Table: see text]

Clinical Trial Availability by Location for 1000 Simulated AYA Patients.

Purpose: Adolescent and young adult (AYA) oncology patients are less likely to enroll in clinical trials than pediatric patients. After two decades of effort to improve enrollments, challenges remain. We sought to explore where phase II and phase III trials are available for an AYA cohort.Methods: Based on the epidemiology of AYA cancers and outcomes, we assembled a simulated data set of 1000 patients (AYAsims). Available phase II and phase III trials were matched to diseases and treatment setting (relapsed or newly diagnosed) and characterized by sponsor (industry, National Clinical Trials Network [NCTN], investigator initiated) and location (Moffitt Cancer Center [MCC], community or pediatric).Results: The majority of AYAsims had potential first line (64.4%) and/or relapsed (68.1%) trials. The majority of these opportunities were industry-sponsored trials available at MCC. Phase II trials for relapsed cancer were most often at the MCC and more likely to be investigator-initiated trials. Trial availability for histologies varied widely, likely reflective of the overall epidemiology of cancers beyond the AYA age range. Pediatric hospitals offered trials for select cancers but had a trial portfolio that matched the fewest number of AYAsims.Conclusions: In general, newly diagnosed AYA patients have trial enrollment opportunities in both the community and comprehensive cancer center setting with select diagnoses having more trials in pediatric hospitals. Relapsed AYA patients have the most trial opportunities at a comprehensive cancer center. A facile system that navigates patients across health systems would maximize potential AYA trial enrollments.

The incidence and risk factors for venous thromboembolism in adolescent and young adult oncology patients

Venous thromboembolism (VTE) is a known complication among pediatric and adult cancer patients. Adolescent and young adult oncology (AYAO) patients have unique biological and physiological characteristics that make them distinct from other populations. Our objective was to study the VTE incidence, risk factors, and outcomes, which have been understudied in this population. A retrospective case-control study was conducted on AYAO participants with new or relapsed cancer and an imaging confirmed VTE from January 2011 to November 2016 at our institution. Eligible AYAO participants without a history of VTE were designated as controls and were randomly selected from our institution's tumor registry. Demographics, medical history, surgeries, central venous catheter (CVC) data, VTE diagnosis and treatment, relapses, and deaths were abstracted. Thirty-five VTE cases and 70 controls were included in this analysis. Eighty percent of cases had leukemia or lymphoma (vs. a solid tumor) compared to 58% of controls. The majority of VTEs (57%) were CVC associated, and more than 70% of cases had more than one CVC placed during their cancer treatment versus 34% of controls. Infection was associated with increased VTE risk (OR=6.35, 95% CI=2.30, 17.55, p<.0001). VTE cases had increased cancer relapse (23% vs. 10%) and mortality rates (29% vs. 16%) than controls. AYAO participants with a VTE were more likely to have leukemia or lymphoma, more than one CVC or infection. Further studies are needed to identify patients who would benefit from modifiable prevention measures, such as limiting to one CVC, preventing infections, or considering prophylactic anticoagulation for those with a liquid tumor.

A qualitative investigation assessing whether implementing a Teenage Young Adult information evening, within a radiotherapy department, would improve the information support and treatment pathway for 18–24-year-old cancer patients

IntroductionThis study evaluated the current information services provided to 10 Teenage Young Adult (TYA) oncology patients within a single radiotherapy department through retrospective patient views. Additionally, the participants provided valuable perspectives on the aptness and merit of implementing a dedicated information evening within the radiotherapy department. MethodsFocus group sessions and open-ended questionnaires were used as the primary data collection tools for this study, producing rich and informative data. The transcriptions from the focus groups, along with the questionnaire responses were then analysed using coding techniques, resulting in 6 distinct themes. ResultsThe participants felt they received adequate information about their radiotherapy treatment and its side effects. However, participants did report some gaps within the service provision that need to be addressed to improve treatment pathways in future. Furthermore, the information was always supplied in paper format which was often undesirable to the cohort with a more interactive format preferred. The participants disclosed very strong feelings of being different to “usual cancer patients” and displayed a desire for more opportunities to meet other TYA patients to be provided within their pathway. Conclusion and Implications for practiceThe findings of this study suggest that the implementation of a dedicated TYA open evening would improve the information support and treatment pathway for 18-24-year-old cancer patients. The evening could offer a wanted opportunity where TYA patients could meet each other and additionally, treatment information and age appropriate support information could be provided in a different and more suitable format than current paper-based literature.

The Australia and New Zealand Cardio-Oncology Registry: evaluation of chemotherapy-related cardiotoxicity in a national cohort of paediatric cancer patients.

Cancer therapy related cardiac dysfunction (CTRCD) is an area of increasing focus, particularly during the survivorship period, for paediatric, adolescent and adult cancer survivors. With the advent of immunotherapy and targeted therapy, there is a new set of mechanisms from which paediatric and young adult patients with cancer may suffer cardiovascular injury. Furthermore, cardiovascular disease is the leading cause of morbidity and mortality in the survivorship period. The recently established Australian Cardio-Oncology Registry is the largest and only population-based cardiotoxicity database of paediatric and adolescent and young adult oncology patients in the world, and the first paediatric registry that will document cardiotoxicity caused by chemotherapy and novel targeted therapies using a prospective approach. The database is designed for comprehensive data collection and evaluation of the Australian practice in terms of diagnosis and management of CTRCD. Using the Australian Cardio-Oncology Registry critical clinical information will be collected regarding predisposing factors for the development of CTRCD, the rate of subclinical left ventricular dysfunction and transition to overt heart failure, further research into protectant molecules against cardiac dysfunction and aid in the discovery of which genetic variants predispose to CTRCD. A health economic arm of the study will assess the cost/benefit of both the registry and cardio-oncology clinical implementation. Finally, an imaging arm will establish if exercise cardiac magnetic resonance imaging and VO2 max testing is a more sensitive predictor of cardiac reserve in paediatric and adolescent and young adult oncology patients exposed to cardiac toxic therapies.

Evaluating Perspectives of a Smartphone Medication Application in the Adolescent and Young Adult Oncology Population: A Qualitative Study

Purpose: Medication adherence research involving adolescent and young adult (AYA) oncology patients has consisted of small, retrospective studies demonstrating poor adherence rates. Technology plays an active role in attempt to improve medication adherence. There is a growing body of literature investigating the role of smartphone applications (apps). We hypothesized a medication phone app, MedActionPlan Pro (MPP), leads to perceived improvement in medication adherence. Methods: Thirty AYA oncology patients actively receiving treatment (AYA defined as 15-30 years) at Nationwide Children's Hospital were enrolled. Participants downloaded the MPP app on their smartphone for 3 months, during which time participants were provided text messages and alerts to encourage medication adherence. Post-app use, participants completed semi-structured interviews. Interviews were audio-recorded, transcribed, and independently coded to determine consensus thematic content. Results: Thirty AYA oncology participants (16 male), median age 17.5 (range: 15-30 years), participated in the study, with 22 participants (55% male) with a median age of 18 years (range: 15-30 years) participated in the final qualitative survey interview. Participants reported positive views about app utilization and perceived improved medication adherence. Additional themes included perceived decreased forgetfulness, improved organization, and identified customization for medications within the app was most important to AYAs. Conclusion: AYA oncology patients reported improvement in perceived medication adherence utilizing MPP and identified several features they thought would lead to improved medication adherence. These findings, integrated with previous literature, support the further need to investigate the utility of medication adherence apps that fit the unique needs of AYA oncology patients.

Experience using intravenous posaconazole in paediatric and young adult oncology patients.

Posaconazole exhibits broad-spectrum antifungal activity. An IV formulation became available in 2014. Few studies describing the use of this formulation exist in patients under the age of 18 years. This study describes our experience using IV posaconazole in paediatric and young adult cancer patients. This single-centre retrospective chart review evaluated patients who received IV posaconazole and had at least one posaconazole plasma concentration obtained after five or more days with a consistent dosage. Relationships between doses required to achieve a plasma concentration of ≥1 µg/mL and patient age, weight and body surface area (BSA) were evaluated. The clinical record was reviewed to identify descriptions of any adverse events. Twenty-five patients were analysed, with a median age of 10.5 years (range 1.9-22.9 years; 92% were <18 years). All patients were able to achieve a posaconazole plasma concentration ≥1 µg/mL during their treatment course. The daily mg/kg/day dose required to achieve the target concentration decreased significantly with increasing age of the patient (P = 0.018). Assessment of dosage based on BSA suggested a requirement of 225 mg/m2/day across all age groups <18 years. Adverse events documented in the clinical record were consistent with those described with the oral formulations. No CNS toxicities were observed with use of IV posaconazole. Concentrations ≥1 µg/mL are achievable and a BSA-based dosing approach may allow a consistent empirical dose for patients <18 years of age. Therapeutic drug monitoring is recommended to ensure patients achieve therapeutic concentrations.

Transfusion reactions in pediatric and adolescent young adult haematology oncology and immune effector cell patients.

BackgroundActive surveillance for transfusion reactions is critically important among pediatric patients undergoing chemotherapy. Among pediatric-adolescent-young-adult (AYA) hematology/oncology patients, who have been typically excluded from transfusion reaction studies, this profile remains poorly characterized.MethodsWe assessed the incidence and clinical characteristics of transfusion reactions (n = 3246 transfusions) in this population (n = 201 patients) at our center.FindingsThe incidence of adjudicated transfusion reactions was 2·04%. The incidence was higher for platelet (2·78%) compared to packed red blood cell transfusions (1·49%) (p = 0·0149). The majority (61·4%) of all reactions were classified as febrile non-haemolytic transfusion, while 35·7% were considered allergic, and 2·9% were classified as transfusion-associated circulatory overload. The incidence of transfusion reactions in patients who were pre-medicated was higher (2·51%) than in patients who were not (1·52%) (p = 0·0406). Sub-set analysis revealed a 3·95% incidence of adjudicated transfusion reactions among recipients of immune effector cells (IECs) (n = 3), all of which occurred during the potential window for cytokine release syndrome; two-thirds of these reactions were severe/potentially life-threatening.InterpretationThe incidence of transfusion reactions among pediatric-AYA hematology/oncology patients may be lower than the general pediatric population. Patients with a prior history of transfusion reactions and those receiving platelet transfusions may be at higher risk for reaction. From our limited sample, IEC recipients may be at risk for severe transfusion reactions. Large multi-center prospective studies are needed to characterize transfusion reactions in this population. Appropriate characterization of reactions in this population may inform risk stratification and mitigate missed opportunities for prompt recognition and appropriate management.FundingNone.

Quantifying the psychosocial impact of a weekend retreat on adolescent and young adult (AYA) oncology patients

Objective This study aimed to determine if AYA oncology patients experienced a quantifiable improvement in psychosocial outcomes after attending a weekend retreat with their peers. Methods AYA oncology patients attended a weekend retreat. They completed the Functional Assessment of Cancer Therapy – General (FACT-G) before, 1 month after, and 6 months after the weekend retreat. Controls were age-matched oncology patients who did not attend the retreat. Findings Retreat participants’ scores did not significantly change over time; however, retreat participants’ scores at 1-month follow-up were significantly higher than control group scores. Conclusions AYA oncology patients may experience transient improvement in psychological well-being after attending a retreat, but benefits may not be durable. Work remains needed to examine the impact of retreat attendance on specific aspects of psychosocial well-being. Implications for psychosocial oncology: Work is needed to decrease perceived attendance barriers for AYA oncology patients who have a low quality of life. Future retreat planners may consider modifying retreat activities and consider alternative retreat locations that appeal to campers with limited mobility, chronic pain, and/or other quality of life limitations. Additional study is needed to determine whether brief overnight or weekend retreats can be as effective as week-long camps in enhancing oncology patients’ quality of life. Future researchers should compare changes in weekend retreat attendees’ quality of life to changes in quality of life for a control group (e.g., via a waitlist control study design).

Transfusion Reactions in Pediatric and Young Adult Hematopoietic Stem Cell Transplant and Oncology Patients

Background Patients undergoing chemotherapy and especially hematopoietic stem cell transplantation (HSCT) require frequent transfusions, and thus, transfusion reaction (TR) vigilance is critical in this population. The reported incidence of TRs across all patients is 2%, and pediatric patients may experience 2-2.6 times more reactions than adults. However, the TR profile may differ in the immunocompromised population. There is a paucity of data in this area, as pediatric oncology and HSCT patients are often excluded from TR studies. Our goals were to assess the prevalence and describe TRs among immunocompromised pediatric patients and to improve recognition of TRs across this population. Methods Pediatric clinical providers completed a TR training module in May – June, 2019. A single-institution retrospective review was conducted. All TRs in patients aged less than 25 years were reviewed over a 3-month period from July 1, 2019 to October 1, 2019. Results Over a 3-month period, 1,786 transfusions were administered in our designated population. Of those, 50.4% were platelets, 44.0% were red blood cells (RBC), 3.4% were cryoprecipitate, 1.4% were thawed plasma, and 0.8% were granulocytes. Those undergoing HSCT consumed 27.7% of total transfusions. Of all transfusions, there were 48 (2.7%) reported as possible TRs by nursing. Of those, 30 (1.7% of all transfusions) were adjudicated as true TRs. Fourteen (46.7%) of these true TRs were in patients with leukemia, 9 (30.0%) with HSCT, 5 (16.7%) with solid tumors, and 2 (6.7%) with aplastic anemia. Of the 9 reactions in HSCT patients, 4 occurred in allogeneic transplant recipients (3 umbilical cord blood and one matched unrelated donor) and 5 were in those receiving autologous HSCT. In HSCT patients, 1.8% of transfusions resulted in TRs compared to 1.6% in non-HSCT patients. Of the products triggering reactions, platelets accounted for 22 TRs (73.3%) and RBCs accounted for 8 TRs (26.7%). Of all 30 TRs, 15 (50%) were classified as febrile non-hemolytic transfusion reactions (FNHTR), 14 (46.7%) were considered allergic reactions, and 1 (3.3%) was diagnosed as transfusion-associated circulatory overload. Pre-medication was given in 22 (76.7%) of transfusions causing reactions. Of the 18 reports that were not adjudicated as true TRs, most (n=15) were generated for fever, but deemed unrelated to transfusion. Conclusions Our baseline analysis revealed a higher prevalence than our historical institutional prevalence (1.7% vs. 1.3%), consistent with higher rates of TRs in the pediatric population, but lower than the 2% quoted in the literature, suggesting either underreporting or a different TR phenotype in this population. This population had a higher prevalence of FNHTR than the general pediatric population (50.0% vs. 31.5%). High rates of pre-medication and comorbidities (resulting in fevers) may influence TR presentation in this population.

Recollection of Fertility Discussion in Adolescent and Young Adult Oncology Patients: A Single-Institution Study.

Purpose: With increasing number of childhood cancer survivors, focus has recently shifted to improving future quality of life and long-term complications, such as infertility. Despite national guidelines, fertility preservation is discussed in less than half of the eligible patients. In this study, we sought to discover if education gaps regarding fertility exist within our practice, in efforts to address these gaps to improve the quality of cancer care we provide. Methods: A retrospective electronic survey was administered to eligible adolescent and young adult oncology patients. Results: Of the 63 patients approached, 47 responded to the survey. Before initiation of antineoplastic therapy, 22/47 (46.8%) stated that they were concerned about their fertility to some degree; however, only 11/47 (23.4%) report pursuing fertility preservation. When asked why they decided against steps to preserve fertility, 15/36 (41.6%) reported that they did not know they had options. Of all patients that completed the survey, 28/47 (59.6%) requested additional information regarding their fertility. Conclusion: Majority of respondents recall having a discussion regarding the impact of antineoplastic therapy on their fertility at the time of diagnosis, which was initiated by their oncologist. However, less than half reported satisfaction with these discussions. Although this study did not demonstrate statistical significance, it has resulted in development of a multidisciplinary oncofertility team for fertility preservation referrals, at our institution, as well as education materials for all newly diagnosed oncology patients.

Medical Cannabis Certification in a Large Pediatric Oncology Center.

In Minnesota, medical cannabis was approved for use in 2014. From July 2015 to February 2019, our center certified 103 pediatric and young adult patients for the use of medical cannabis under the qualifying conditions of cancer and treatment-related symptoms. Here, we provide a review of the literature on medical cannabis use in pediatric and young adult cancer patients. We also provide demographic data on our patients certified for medical cannabis. The most common diagnoses were leukemia/lymphoma (36%), brain tumors (37%), and malignant solid tumors (26%). The most common indications were chemotherapy-related nausea, pain, and cancer cachexia. The age range at certification was 1.4–28.7 years (median 15.3 years). The time from cancer diagnosis to certification ranged from 0.5–197 months (median 8.9 months). The majority (94%) were certified during their first line of treatment. In the 32 patients who died from recurrent or progressive cancer, the time from certification to death was 1.3–30.3 months (median 4.4 years). Despite requesting certification, a subset (24%) never had medical cannabis dispensed. In our experience, pediatric and young adult oncology patients are interested in medical cannabis to help manage treatment-related symptoms. Ongoing analysis of this data will identify the therapeutic efficacy of medical cannabis.

QIM19-122: Quality Improvement Initiatives in the Second Year of an Adolescent and Young Adult Oncology Clinic

Background: Adolescent and young adult (AYA) oncology patients have a distinctive set of needs that are often not addressed by primary providers in busy clinical practices. Genetic counseling, fertility preservation, clinical trial enrollment, and individualized psychosocial support are a few key issues to address in this group. The AYA Oncology Program was created in August 2016 to specifically address these issues and mitigate the disparity in care and outcomes often seen in the AYA population. After the first year, we identified several areas in our program that required improvement. These included increasing referrals to our clinic, increasing appropriate referrals to genetics and fertility specialists, and improving clinical trial enrollment. Several quality improvement initiatives were created to address these issues. Methods: The study assessed patients actively under treatment between ages 15–39 from September 1, 2016 to September 1, 2018 that were seen in the AYA clinic. Starting in year 2, patients seen in the AYA clinic as well as AYAs not seen in the AYA clinic were screened weekly by the AYA team for clinical trial eligibility. Additionally, a weekly email was sent to all physicians and nurse practitioners listing patients for the week that were eligible for AYA referral as well as the clinical trials they were eligible for. The research staff was also included on these emails to facilitate communication and enrollment. Results: In year 2 of the program, 66 patients were seen in the AYA clinic, a 16% increase from the prior year. 65% of patients were referred to genetics, increased from 61% the prior year. 39% of patients were referred to fertility, increased from 37% the prior year. Of patients seen in the AYA clinic, 22% were on a clinical trial in year 1, which increased to 28% in year 2. The AYA team screened all patients at the cancer center regardless of whether they were referred to AYA starting in year 2, and over this year, 17% of AYA patients throughout the cancer center were enrolled on a clinical trial. Conclusion: In our quality improvement initiative in year 2, we increased referrals to the AYA clinic, referrals to specialist services, and clinical trial enrollment. Screening AYA patients on a weekly basis is productive in increasing clinical trial referrals and enrollment. The use of a weekly reminder email to providers also increased AYA clinic referrals.

3245 Comparison of Health Outcomes in Adolescent and Young Adult (AYA) Oncology Patients Treated at a Pediatric versus Adult Institute

OBJECTIVES/SPECIFIC AIMS: Objectives: To examine the differences in health outcomes of adolescents and young adults treated for malignancy at a pediatric cancer center compared to an adult cancer center. To determine the differences in receipt of supportive care for adolescents and young adults with malignancy who are treated at a pediatric cancer center compared to an adult cancer center. METHODS/STUDY POPULATION: Methods: This will be a retrospective cohort study of patients from the ages of 15 to 39 years who are diagnosed with a malignancy common between adult and pediatric facilities within 2013-2017. Data will be abstracted from an existing database at MCW containing patient information at the adult and pediatric centers. Study population: Patients ages 15-39 years of age who are categorized as young adolescent and adult patients (AYAs). Patients are eligible for the cohort if they have a diagnosis that is common between adult and pediatric oncology centers and that is made within the years 2013-2017. These diagnoses will include ALL, AML, Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Germ cell tumors, Osteosarcoma, Ewing Sarcoma, other sarcomas, and CNS tumors. RESULTS/ANTICIPATED RESULTS: There will be a difference in health care utilization, clinical trial enrollment and toxicity of therapy in AYAs with malignancies treated at an adult facility than AYAs treated for similar malignancy at pediatric facility. DISCUSSION/SIGNIFICANCE OF IMPACT: There will be a difference in receipt of supportive care referrals, including psychology, social work, sperm banking, initiation of palliative care, in AYAs treated at a pediatric facility compared to AYAs treated at adult facility.

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients.

Adolescent and young adult patients with cancer (AYAs) identify sexual and reproductive health (SRH) as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to explore AYA perceptions and experiences of SRH communication with oncology clinicians. Twenty-three AYA patients and survivors ages 15-25 years from a large academic oncology center participated in semistructured qualitative interviews investigating their experiences discussing SRH issues, including specific topics discussed, conversation barriers and facilitators, suggestions for clinicians on how to improve conversations, and education and resource needs. Interviews were audio recorded, transcribed, and coded using a thematic analysis approach. Interviews with AYAs revealed two primary themes-a need for oncology clinicians to discuss SRH and critical gaps in current SRH communication practices. AYAs reported a need for improved SRH communication for the purposes of general education, addressing specific SRH issues experienced, and understanding the long-term impact of cancer and treatment on SRH. The current communication gaps are exacerbated by patient discomfort initiating conversations and the presence of family members. AYAs shared six key recommendations for clinicians on how to improve SRH communication. AYAs identify a role for oncology clinicians in discussing SRH as a primary aspect of comprehensive health care during cancer treatment and in survivorship; however, multiple gaps and barriers interfere with such discussions. Future efforts must focus on clinician education and training in SRH as well as education and intervention opportunities for AYAs to optimize the care provided.

Ethical issues in the care of adolescent and young adult oncology patients.

The diagnosis and treatment of cancer leads to short-term and long-term challenges for every patient. This is especially true for adolescents and young adults (AYAs) with cancer who strive to gain independence, autonomy, confidence, and social status while developing into adulthood. In this article, we review prominent ethical issues in AYA oncology that are related to autonomy, shared decision-making, care refusal or abandonment, end-of-life care, truth telling, and fertility preservation. Clinicians should recognize that AYA patients develop at their own pace; the onus lies with clinicians to determine the patient's interests, values, maturity, and desire to participate in decision-making.

Future health of AYA survivors.

Adolescent and young adult (AYA) oncology patients (ages 15-39) have been identified as a group with healthcare disparities including gaps and challenges in diagnosis, access to care, research, clinical trial participation, and cure rates. Like other patient groups with cancer or other chronic illnesses, disparities can lead to poor future health and outcomes, which is a well-recognized concern within the AYA population. Cancer is the leading disease-related cause of death in this age range. Numerous interested groups including the National Cancer Institute have met to address the research and cancer care needs of AYAs. This review highlights how these gaps in care during and after treatment can affect future health of this population of patients. Access to care, models of survivorship care, and lack of provider education are discussed. Survivorship care and use of guidelines, and promotion of psychosocial support and health behaviors during treatment and beyond are essential to optimizing future health of AYA patients.

Referral rates and supportive care metrics for a first-year community oncology AYA program.

63 Background: Adolescent and young adult (AYA) oncology patients have a unique set of needs compared to younger and older patients that are often not addressed by primary providers in a busy clinical setting. Genetic counseling, fertility preservation, clinical trial enrollment and psychosocial support are a few of the key needs to address in this group. The AYA Cancer Program was created to specifically address these issues and mitigate the disparity in care and outcomes often seen in the AYA cohort. This study examines the number of patients referred to the AYA Cancer Program in its first year and evaluates the role of the program in addressing the supportive care needs of AYA patients. Methods: The study assessed patients actively under treatment between ages 15-39 from September 1, 2016 to September 1, 2017. The number of referrals to the AYA program, participation in the AYA program, and met supportive care needs (fertility, genetics, clinical trial participation) were examined. Results: During the first year of the clinic, 63 (22%) of the 288 AYA patients seen throughout the whole institution were seen in the AYA clinic. An additional 34 (12%) patients were referred but did not come to the appointment. 192 (69%) patients were not referred. Compared to non-referred patients, AYA clinic patients were more likely to be enrolled on a clinical trial (54% vs. 18%), have a documented fertility counseling discussion (94% vs. 16%) and receive a genetics referral (69% vs. 43%). Patients that were referred to the clinic but did not come were slightly more likely than non-referred patients to be offered the above services as well but still trailed the group of patients seen in the AYA clinic. Conclusions: Patients that were seen in the AYA program were more likely to receive fertility referrals, genetic referrals and had increased clinical trial participation compared to patients that were not referred. This highlights the essential role of the AYA clinic in meeting these under addressed needs in the AYA population. [Table: see text]