Pilot Project 1: Creating Bridges to Reproductive Health Care for Rural Adolescent and Young Adult Cancer Survivors

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PROJECT SUMMARY/ ABSTRACT – PILOT PROJECT Reproductive health care in cancer patients is an unmet need in Imperial County, a medically underserved, rural region of the Cancer Research and Education to Advance HealTh Equity (CREATE) Partnership’s catchment area with a predominantly Hispanic population. Reproductive health is a major issue for adolescent and young adult (AYA) cancer survivors because they can experience higher risks of infertility, adverse pregnancy outcomes, and unmet informational needs. Reproductive health care effectively reduces risks, but uptake is low because there are no scalable interventions to support the implementation of routine reproductive health care in underserved, geographically remote communities. Guided by the Cancer Survivorship Care Quality Framework, this pilot proposal seeks to adapt and pilot test a multi-component intervention to improve reproductive health care uptake by female AYA cancer survivors. The intervention has three components derived from our prior work: 1) a reproductive risk summary (RS) and survivorship care plan on reproductive health (SCP-R), 2) navigation, and 3) telehealth reproductive consults. In Aim 1, we will adapt the RS and SCP-R in English and Spanish to be responsive to the cultural, health literacy, and socio-ecological needs of Latina AYA survivors through focus groups with AYA survivors and parents/guardians, and semi-structured interviews with healthcare providers. We will also systematically evaluate barriers and facilitators to reproductive health care in Imperial County and examine how to fit the multi-component intervention to this setting, through focus groups with survivors and parents/guardians and interviews with healthcare providers and clinic staff. In Aim 2, we will conduct feasibility testing of the multicomponent intervention in a single arm pilot hybrid type 1 trial (evaluating effectiveness and observing implementation). The primary outcome is engagement in reproductive health care by 15 newly diagnosed and 15 post-treatment AYA survivors. Secondarily, we will qualitatively assess effectiveness, fit and implementation outcomes with AYA survivors, healthcare providers and health clinic staff. The proposal directly targets a critical health disparity faced by female AYA survivors in our catchment area and need for partnership between rural community health professionals and urban specialists to deliver quality reproductive survivorship care. We will generate a novel, scalable intervention and preliminary data to support a future multi-site trial on intervention effectiveness in increasing reproductive care in rural, medically underserved oncology settings. The partnership between SDSU, CRCD and UCSD researchers will be strengthened with collaborative learning, community engagement, and increased capacity of trainees to support future cancer research in Imperial County.