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

项目摘要/摘要 改善青少年和年轻人(AYA)的癌症存活率趋势提出了迫切需要 解决他们独特的生存问题，并努力实现NCI的科学优先事项，即“确保癌症 幸存者拥有尽可能最高的生活质量。该奖学金将解决妇女面临的生育挑战 女性癌症患者，并为我提供培训和专业知识，成为一个新兴的癌症成果 研究员。目前在与辅助生殖技术(ART)相关的癌症结果研究方面存在差距- 尤其是保留生育能力的艺术--可能会导致缺乏耐心和提供者的知识 利用率低，特别是在边缘化群体中。关键证据差距包括：(1) 在使用保留生育能力方面存在哪些差异；(2)保留生育能力对癌症发生时间的影响 治疗；以及(3)抗逆转录病毒治疗后的生殖成功，考虑到癌症前的生育保护。 治疗。研究目标将通过利用创新和可推广的基于人口的数据来解决这些差距 北卡罗来纳州(北卡罗来纳州)中央癌症登记中心、辅助生殖学会之间的联系 技术临床结果报告系统，以及NC出生证明。这个链接捕捉到了阿雅(年迈 15-39岁)2004-2015年间在北卡罗来纳州接受抗逆转录病毒治疗(有或无生育能力)的被诊断为癌症的女性 癌症治疗前保存)至2016年(n=370名估计妇女)。检查不同方面的差异 生育保护利用(目标1)，社会人口学因素将比较阿雅女性和 在癌症治疗前接受生育保护的癌症患者和患有癌症的女性患者 不是，考虑到临床癌症的特点。检查保留生育能力对癌症的影响 治疗延迟(目标2)，开始性腺毒性癌症治疗的时间将与阿亚进行比较 癌症女性在癌症治疗前发起了保留生育能力的ART，Aya女性在癌症治疗前 癌者未见，占临床癌变特点。最后，怀孕和出生率将是 Aya癌症女性在癌症前启动了保留生育能力的ART的比较 治疗和治疗后启动抗逆转录病毒治疗的女性癌症患者(目标3)。学习结果可以提高 医疗保健提供者和患者可用来指导与生育相关的决定的证据基础 癌症。奖学金培训将在支持性的、资源丰富的环境中进行，并将为我提供 与ART相关的以临床和研究为重点的观点；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；并将促进我作为一名新兴的癌症结果研究员的发展。 这笔奖学金将对我成为终身教职研究人员的职业目标做出无价的贡献 重点是改善生存护理，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.