Project Milestones: Young Adult Cancer Survivorship

摘要 每年有超过70，000名青少年和年轻人（AYAs;年龄15-39岁）被诊断患有癌症， 美国年轻患者数量的8倍多。AYA癌症的幸存者是独一无二的， 他们的生活阶段和缺乏适当的服务，这一人口（例如，生育力保护、保险 覆盖面和教育/职业支持）。与儿童癌症的年轻成年幸存者相比， 在AYA癌症幸存者中进行了系统的研究，以了解他们的健康相关 结果。在诊断和治疗期间，AYA面临着获得适当护理的延迟和有限， 较低的临床试验入组率、较高的治疗相关毒性和发病率以及较差的生存率。早期后- 对AYA癌症幸存者的治疗研究表明，有许多经济、社会和个人负担 与癌症诊断和治疗相关。然而，长期的癌症生存经验 AYA癌症的幸存者在很大程度上是未知的。癌症在年轻的成年可能会导致损失或 延迟达到成年的里程碑（例如，全职工作，财务健康，婚姻，拥有 儿童）癌症治疗后。此外，年轻的西班牙裔癌症幸存者被研究不足， 尽管有证据表明西班牙裔在健康相关结果方面存在显着差异。 “里程碑”项目将通过招募和调查一个基于人口的队列来填补这些研究空白 （n= 2，000，约42%西班牙裔）代表最流行的长期（诊断后3-10年）存活者 在21-39岁之间诊断的老年AYA中发现的癌症。我们的具体目标是：（1）评估风险， 成年期里程碑成就的保护因素及里程碑成就的比较 AYA癌症幸存者和非癌症对照者之间的差异;（2）评估AYA癌症的风险和保护因素， 长期健康和健康相关的生活质量（HRQOL）;（3）评估风险和保护因素 参与癌症相关的后续护理。对于所有结果，我们将检查年龄，癌症类型， 种族差异。在西班牙裔幸存者中，我们将研究与研究相关的文化因素， 结果。 这项以人群为基础的研究将包括通过洛杉矶癌症中心确定的典型AYA癌症病例。 县癌症监测计划癌症登记处。自我报告调查将评估 成年、健康、HRQOL和癌症相关随访护理。多变量回归分析将 确定里程碑、HRQOL和癌症相关随访护理的保护性和风险因素。比较 分析将确定西班牙裔和非西班牙裔AYA幸存者之间以及AYA病例之间的差异 和非癌症对照参与者（来自加州健康访谈调查）。结果将通知 制定支持AYA癌症幸存者的指南和计划，包括解决和 减少影响西班牙裔的健康差距。

ABSTRACT Over 70,000 adolescents and young adults (AYAs; age 15-39 years) are diagnosed with cancer every year in the United States, more than 8 times the number of younger patients. Survivors of AYA cancer are unique due to their life stage and lack of appropriate services for this population (e.g., fertility preservation, insurance coverage, and educational/vocational support). In contrast to young adult survivors of childhood cancer, little systematic research has been conducted among survivors of AYA cancer to understand their health-related outcomes. At diagnosis and during treatment, AYAs face delayed and limited access to appropriate care, lower clinical trial enrollment, greater treatment-related toxicity and morbidity, and inferior survival. Early post- treatment studies of AYA cancer survivors indicate numerous financial, social, and personal burdens associated with cancer diagnosis and treatment. However, the long-term cancer survivorship experience among survivors of AYA cancer is largely unexplored. Cancer during young adulthood likely leads to loss or delay in achieving milestones of adulthood (e.g., full-time employment, financial health, marriage, having children) following cancer treatment. Additionally, young adult Hispanic cancer survivors are understudied, despite evidence that Hispanics experience significant differences in health-related outcomes. Project Milestones will address these research gaps by recruiting and surveying a population-based cohort (n=2,000, ~42% Hispanic) representing long-term (3-10 years post-diagnosis) survivors of the most prevalent cancers found in older AYAs diagnosed between ages 21-39. Our specific aims are: (1) To assess risk and protective factors of the achievement of milestones of adulthood and to compare achievement of milestones between survivors of AYA cancer and non-cancer comparators; (2) To assess risk and protective factors of long-term well-being and health related quality of life (HRQOL); and, (3) To assess risk and protective factors of engagement in cancer-related follow-up care. For all outcomes, we will examine age, cancer type, and ethnic differences. Among Hispanic survivors, we will examine cultural factors associated with study outcomes. This population-based study will include prototypical AYA cancer cases ascertained through the Los Angeles County Cancer Surveillance Program Cancer Registry. Self-report surveys will assess milestones of adulthood, well-being, HRQOL, and cancer-related follow-up care. Multivariable regression analyses will identify protective and risk factors for milestones, HRQOL and cancer-related follow-up care. Comparative analyses will identify differences between Hispanic and non-Hispanic AYA survivors and between AYA cases and non-cancer comparator participants (from the California Health Interview Survey). Results will inform the development of guidelines and programs supporting survivors of AYA cancer, including addressing and reducing health disparities affecting those of Hispanic ethnicity.