Assisted Reproductive Technology Use After Adolescent and Young Adult Cancer in North Carolina

项目总结/摘要 改善青少年和年轻人（AYAs）的癌症生存趋势迫切需要 解决他们独特的生存问题，并努力实现NCI的科学优先事项，以“确保癌症 幸存者有最高的生活质量。”该研究金将解决妇女面临的生育挑战， 患有癌症的女性，并为我提供培训和专业知识，使我成为一名新兴的癌症患者 研究员目前与辅助生殖技术（ART）相关的癌症结局研究的差距- 特别是用于生育能力恢复的ART-可能导致缺乏患者和提供者的知识， 利用率低，特别是在边缘化群体中。关键证据差距包括：（1） 在使用生育保留方面存在哪些差异;（2）生育保留对癌症发生时间的影响 治疗;（3）ART后的生殖成功，说明癌症前的生育能力保留 治疗研究目标将通过利用创新和可推广的人口数据来弥补这些差距 北卡罗来纳州（NC）中央癌症登记处、辅助生殖协会 技术临床结果报告系统和NC出生证明。此链接捕获AYA（年龄 2004-2015年期间，NC中诊断患有癌症并使用ART（有或无生育能力）的15-39岁女性 癌症治疗前保存）至2016年（n=370名估计女性）。审查在以下方面的差异： 生育保留利用率（目标1），将比较AYA女性与 在癌症治疗前接受生育保留的癌症患者和在癌症治疗前接受生育保留的AYA癌症患者 不，考虑到临床癌症特征。为了检验生育能力保留对癌症的影响， 治疗延迟（目标2），将比较AYA和AYA之间至开始性腺毒性癌症治疗的时间 在癌症治疗前开始ART以保持生育力的癌症女性和 癌症谁没有，占临床癌症的特点。最后，怀孕率和出生率将 在癌症前开始ART以保持生育能力的AYA癌症女性之间进行比较 治疗后开始抗逆转录病毒治疗的AYA女性和患有癌症的AYA女性（目标3）。研究结果可以提高 卫生保健提供者和患者可用于指导生育相关决策的证据基础， 癌奖学金培训将在一个支持性的、资源丰富的环境中进行， 与临床和研究为重点的观点与艺术;积极参与社区参与 研究;多层次数据分析的专业知识;传播我的研究的各种机会;加强 道德研究行为;并将促进我作为一个新兴的癌症成果研究人员的发展。 这个奖学金将是一个宝贵的贡献，我的职业目标成为终身职位的轨道研究员 重点是改善幸存者护理，特别是在弱势群体中。

PROJECT SUMMARY/ABSTRACT Improving cancer survival trends among adolescent and young adults (AYAs) present an urgent need to address their unique survivorship concerns and strive toward NCI's scientific priority to “ensure that cancer survivors have the highest possible quality of life.” This fellowship will address the fertility challenges faced by females with cancer and provide me with training and expertise to become an emerging cancer outcomes researcher. Current gaps in cancer outcomes research related to assisted reproductive technology (ART)— and specifically ART for fertility preservation—may contribute to lack of patient and provider knowledge and low utilization rates, particularly among marginalized groups. Key evidence gaps include: (1) the extent to which disparities exist in use of fertility preservation; (2) the impact of fertility preservation on time to cancer treatment; and (3) reproductive success after ART, accounting for fertility preservation prior to cancer treatment. Study aims will address these gaps by utilizing innovative and generalizable population-based data linkages between the North Carolina (NC) Central Cancer Registry, the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System, and NC birth certificates. This linkage captures AYA (aged 15-39 years) females diagnosed with cancer in NC during 2004-2015 who utilized ART (with or without fertility preservation prior to cancer treatment) through 2016 (n=370 estimated women). To examine disparities in fertility preservation utilization (Aim 1), sociodemographic factors will be compared between AYA females with cancer who underwent fertility preservation prior to cancer treatment and AYA females with cancer who did not, accounting for clinical cancer characteristics. To examine the effect of fertility preservation on cancer treatment delay (Aim 2), time to initiation of gonadotoxic cancer treatment will be compared between AYA females with cancer who initiated ART for fertility preservation prior to cancer treatment and AYA females with cancer who did not, accounting for clinical cancer characteristics. Lastly, pregnancy and birth rates will be compared between AYA females with cancer who initiated ART for fertility preservation prior to cancer treatment and AYA females with cancer who initiated ART after treatment (Aim 3). Study results can enhance the evidence-base available to health care providers and patients to guide fertility-related decisions after cancer. The fellowship training will take place in a supportive, resource-rich environment and will provide me with clinical- and research-focused perspectives related to ART; active involvement with community-engaged research; expertise in multilevel data analysis; diverse opportunities to disseminate my research; reinforcement of ethical research conduct; and will promote my development as an emerging cancer outcomes researcher. This fellowship will be an invaluable contribution to my career goal of becoming a tenure track researcher focused on improving survivorship care, particularly among disadvantaged populations.