Clinical Pregnancy Outcomes in Adolescent and Young Adult Female Cancer Survivors

青少年和年轻女性癌症幸存者的临床妊娠结局

• 批准号: 10196976
• 负责人: Hazel B Nichols
• 金额: $ 62.66万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10196976
• 关键词: Address; Adolescence; Adolescent and Young Adult; Adoption; Adult; Affect; Aftercare; Age; Algorithms; Assisted Reproductive Technology; Biological; Birth; Birth Certificates; Birth Records; Breast Melanoma; California; Cancer Survivor; Case Series; Characteristics; Child; Clinic; Clinical; Clinical Oncology; Computerized Medical Record; Continuance of life; Continuity of Patient Care; Counseling; Data; Data Sources; Database Management Systems; Development; Diagnosis; Enrollment; Epidemiologist; European; Female; Fertility; Future; Guidelines; Health system; Healthcare Systems; High Prevalence; Infant; Integrated Health Care Systems; Link; Low Birth Weight Infant; Low income; Lymphoma; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Malignant neoplasm of thyroid; Maternal-fetal medicine; Medical; Menstrual cycle; Minority; Modernization; North Carolina; Outcome; Patients; Pattern; Population; Population Control; Population Study; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy loss; Premature Birth; Privatization; Procedures; Puberty; Records; Registries; Reporting; Reproduction; Reproductive History; Research; Risk; Sampling; Site; Small for Gestational Age Infant; Societies; Specialist; Spontaneous abortion; Survivors; System; Time; Treatment Protocols; Woman; Women' s Group; adverse birth outcomes; age group; body system; cancer care; cancer diagnosis; cancer recurrence; cancer site; cancer therapy; cancer type; child bearing; childhood cancer survivor; clinical risk; cohort; comparison group; data registry; delivery complications; evidence base; fertility preservation; innovation; malignant breast neoplasm; melanoma; mullerian-inhibiting hormone; multidisciplinary; neoplasm registry; offspring; prenatal; reproductive; reproductive outcome; screening; survivorship; treatment strategy; volunteer; young adult

PROJECT SUMMARY / ABSTRACT In the U.S., more than 45,000 women are diagnosed with cancer during adolescence and young adulthood (AYA, ages 15-39 at diagnosis) each year. Fertility and reproductive outcomes are critical issues for AYA cancer survivors but little is known about the effect of diagnosis and treatment on the clinical course and outcome of future pregnancy. Our study will leverage existing data sources to assess clinical pregnancy outcomes among women with the most common AYA cancers (lymphoma, breast, melanoma, thyroid and gynecologic cancer) that account for >70% of all diagnoses. Our findings will provide urgently needed answers that can be directly applied to fertility preservation, preconception, and prenatal counseling. Data for this study come from the Kaiser Permanente (KP) Northern and Southern California integrated healthcare systems and from an innovative linkage of the North Carolina Central Cancer Registry, public and private administrative cancer treatment claims, and North Carolina birth certificates. We will also use information from the nation-wide Society for Assisted Reproductive Technology Clinic Outcome Reporting System to identify fertility and assisted reproductive procedures among all women (with a cancer diagnosis or without) in our study. This research has 3 aims—we will: (1.) Assess pregnancy risks among >7,000 female AYA cancer survivors enrolled in the KP California health care systems using a validated algorithm to identify pregnancies and outcomes (miscarriage, termination, livebirth) in the electronic medical record. Next we will: (2.) Assess risk of adverse infant birth outcomes (low birth weight, small for gestational age, preterm birth) among 2,700 births to 13,500 AYA cancer survivors enrolled in the KP California health care systems or living in North Carolina. The final aim is to: (3.) Examine factors that may contribute to risk of pregnancy loss or adverse birth outcomes including cancer type, age at diagnosis, time since diagnosis, cancer treatment, minority or low income status, and use of fertility preservation or assisted reproductive technologies. Pregnancy and birth risks among AYA cancer survivors will be compared to women without a prior cancer diagnosis at each site and also among survivors to compare specific treatment or diagnosis characteristics. This research uses multiple, existing data sources that include detailed information on cancer treatment and fertility procedures in the U.S. during recent years (2000-2016). Our population-level study will inform survivorship planning as fertility and parenthood are addressed more widely across the cancer care continuum. In the future, the AYA cancer survivor population identified as part of this proposal can be followed to assess cancer recurrence risk, non-reproductive organ system effects of cancer treatment or pregnancy, and developmental outcomes in offspring. Results from this study will provide an important evidence base for counseling women who must make difficult decisions about future childbearing intentions while simultaneously confronting a cancer diagnosis.

项目总结/摘要 在美国，超过45，000名女性在青春期和青年期被诊断患有癌症 (AYA诊断时年龄为15-39岁）。生育率和生殖结果是AYA的关键问题 癌症幸存者，但很少有人知道的诊断和治疗的影响， 未来怀孕的结果。我们的研究将利用现有的数据来源来评估临床妊娠 最常见的AYA癌症（淋巴瘤、乳腺癌、黑色素瘤、甲状腺癌和 妇科癌症）占所有诊断的>70%。我们的发现将提供迫切需要的答案 可以直接应用于生育力保存、孕前和产前咨询。 本研究的数据来自Kaiser Permanente（KP）北方和南方加州的综合数据。 医疗保健系统，并从北卡罗来纳州中央癌症登记处，公共和 私人行政癌症治疗索赔，和北卡罗来纳州出生证明。我们还将使用 来自全国辅助生殖技术临床结果报告协会的信息 在所有妇女中确定生育能力和辅助生殖程序的系统（诊断为癌症或 在我们的研究中。本研究有三个目的：（1）评估> 7，000名女性的妊娠风险 在KP加州医疗保健系统登记的AYA癌症幸存者使用经过验证的算法来识别 电子病历中的妊娠和结局（流产、终止妊娠、活产）。接下来我们将： （2.）评估不良婴儿出生结局的风险（低出生体重、小于胎龄儿、早产） 在2，700名新生儿和13，500名AYA癌症幸存者中，有13，500名AYA癌症幸存者登记在KP加州医疗保健系统或生活中 在北卡罗来纳州。最终目标是：（3）检查可能导致流产风险的因素，或 不良出生结果，包括癌症类型、诊断时的年龄、自诊断以来的时间、癌症治疗， 少数民族或低收入地位，以及使用生育力保护或辅助生殖技术。 AYA癌症幸存者的妊娠和生育风险将与既往未患癌症的女性进行比较 在每个站点以及幸存者之间进行诊断，以比较特定的治疗或诊断特征。 这项研究使用了多个现有的数据源，包括癌症治疗的详细信息， 近年来（2000-2016）美国的生育程序。我们的人口水平研究将告诉我们 生存规划，因为生育和生育在整个癌症护理连续体中得到更广泛的解决。 在未来，作为本提案的一部分，AYA癌症幸存者人群可以遵循 评估癌症复发风险、癌症治疗或妊娠对非生殖器官系统的影响，以及 后代的发育结果。本研究的结果将为以下方面提供重要的证据基础： 为那些必须对未来生育意愿做出艰难决定的妇女提供咨询，同时 面对癌症诊断

项目成果

Financial hardship differences by LGBTQ+ status among assigned female at birth adolescent and young adult cancer survivors: a mixed methods analysis.

按 LGBTQ 身份划分的出生时女性青少年和年轻成年癌症幸存者的经济困难差异：混合方法分析。

• DOI: 10.1007/s10552-023-01740-9
• 发表时间: 2023
• 期刊: Cancer causes & control : CCC
• 作者: Waters,AustinR;Kent,ErinE;Meernik,Clare;Getahun,Darios;Laurent,CecileA;Xu,Lanfang;Mitra,Sara;Kushi,LawrenceH;Chao,Chun;Nichols,HazelB
• 通讯作者: Nichols,HazelB