Project 1: Fertility and Cancer Care Delivery for Adolescents and Young Adults

摘要-项目1，AYAs的生育和癌症护理交付 未来的生育能力是许多患有癌症的青少年和年轻人（AYAs）的关键问题。国家 指南普遍建议在潜在的性腺毒性之前为AYA癌症患者提供生育咨询 治疗开始。然而，先前的研究表明，患者通常不会接受生育咨询。 长期目标是研究生育咨询如何提高癌症治疗的依从性， 结果，本研究将调查：1）在接受生育咨询和获得 生育力保护策略;以及，2）生育力问题如何影响推荐癌症的接受 治疗患有乳腺癌、睾丸癌或淋巴瘤的AYA。 有限的专家访问和无意识的偏见，在提供者转介可能会导致人口， 在接受生育咨询和保存服务方面存在社会经济和与疾病有关的差距。 如果常规提供，转诊到生育专家可以很快，保存策略可以 在几周内完成。通过咨询未解决生育相关问题的AYA 和/或生育力保存策略可能会花费更多的时间来寻求生育力信息或进行医学检查。 自己的预约。他们可能会避免或推迟潜在的性腺毒性治疗， 与以下患者相比，治疗延迟或不开始或不持续癌症治疗的风险 与生育有关的问题得到解决。我们的研究将调查生育咨询服务的差距 可能会产生超出满足患者生殖目标的影响， 治疗AYA。虽然一些小型研究部分评估了年轻女性的这些问题， 乳腺癌，他们仍然没有研究在AYA与大多数其他癌症。 在本P01中，我们计划调查约5，000名AYA癌症幸存者。在这个项目中，我们将收集 关于生育问题的信息，接受生育咨询，使用生育保护技术，以及 可能影响生育服务使用的因素。调查参与者将是2-10岁的AYA癌症患者 在北卡罗来纳州癌症信息与人口健康大学的癌症诊断后， 资源部（CIPHR）、Kaiser Permanente北方加州（KPNC）和Kaiser Permanente南方 加州（KPSC）。这些设置提供了将调查数据与电子健康记录或 行政索赔数据，记录接受癌症治疗的情况。 这项研究将确定生育咨询服务和生育保护策略使用的差异， 为干预措施的制定提供信息，以改善以生育为重点的AYA护理，包括针对患者的干预措施 以及临床医生对使用生殖技术的舒适度。这个项目为我们的 更大的计划，解决AYA癌症患者从诊断过渡到 从治疗到生存

ABSTRACT – Project 1, Fertility and Cancer Care Delivery in AYAs Future fertility is a critical concern for many adolescents and young adults (AYAs) with cancer. National guidelines universally recommend fertility counseling for AYA cancer patients before potentially gonadotoxic treatment begins. However, prior studies have shown that patients often do not receive fertility counseling. With the long-term goal of examining how fertility counseling may enhance cancer treatment adherence and outcomes, this study will investigate: 1) potential disparities in receipt of fertility counseling and access to fertility preservation strategies; and, 2) how fertility concerns impact the receipt of recommended cancer treatments for AYAs with breast cancer, testicular cancer, or lymphoma. Limited access to specialists and unconscious biases in provider referrals may result in demographic, socioeconomic, and disease-related disparities in receipt of fertility counseling and preservation services. When routinely provided, referrals to fertility specialists can be rapid and preservation strategies can be completed within a few weeks. AYAs whose fertility-related concerns are not addressed though counseling and/or fertility preservation strategies may spend more time seeking fertility information or making medical appointments on their own. They may avoid or postpone potentially gonadotoxic therapies, increasing their risk of treatment delays or non-initiation or non-persistence of cancer therapies compared to patients whose fertility-related concerns are addressed. Our study will investigate how gaps in delivery of fertility counseling may have an impact beyond meeting patients’ reproductive goals, by contributing to suboptimal cancer treatments for AYAs. While several small studies have partially assessed these issues in young women with breast cancer, they remain unstudied in AYAs with most other cancers. In this P01, we plan to survey approximately 5,000 AYA cancer survivors. For this Project, we will collect information on fertility concerns, receipt of fertility counseling, use of fertility preservation techniques, and factors that may influence use of fertility services. Survey participants will be AYA cancer patients 2–10 years after a cancer diagnosis from the University of North Carolina Cancer Information & Population Health Resource (CIPHR), Kaiser Permanente Northern California (KPNC), and Kaiser Permanente Southern California (KPSC). These settings provide the opportunity to link survey data with electronic health records or administrative claims data that document receipt of cancer treatment. This study will identify disparities in fertility counseling delivery and use of fertility preservation strategies, informing development of interventions to improve fertility-focused AYA care, including those that target patient and clinician comfort with the use of reproductive technologies. This project adds a critical element to our larger program addressing the unique challenges of AYA cancer patients transitioning from diagnosis to treatment to survivorship.