Fertility experiences among ethnically diverse adolescent and young adult cancer survivors: A population-based study

项目总结/摘要 治愈性癌症治疗模式（例如，化疗）是性腺毒性的（即，破坏精子和卵子）， 经常导致不孕。因此，临床实践指南旨在促进最佳的肿瘤生育护理 表明肿瘤学家应该全面讨论所有癌症可能与治疗相关的不孕症， 育龄患者。这种讨论对青少年和年轻人特别重要（AYA; 15-39岁）的癌症患者，他们正处于生育年龄的黄金时期，并赞同与生育有关的痛苦 治疗后，将肿瘤生育作为AYAs的优先研究领域。不幸的是， 指导方针的实施损害了其有效性，AYA很少被告知 生育力保存选项，知识，成本和保险障碍阻碍了保存的采用 在AYA中。癌症护理连续体是一个多层次的系统，描述了一个层次的干预 影响癌症护理提供的水平。肿瘤生育护理特别适合在以下情况下进行干预： 各种级别的影响（例如，提供者/团队、组织/实践环境、健康政策），作为患者， 提供者、系统和政策层面的因素影响最佳护理的提供和接受。因此，我的目标是 通过检查癌症护理的多层次影响来调查AYA中的肿瘤生育能力 连续体大多数现有的AYA肿瘤生育研究都集中在临床样本上（例如，学术医学， 综合癌症中心）和非西班牙裔白色患者，限制了结果的普遍性，缺乏 民族和种族的多样性，可能没有捕捉到处于危险中的AYA的经验。为了弥补这些差距，我 论文（F99阶段）将使用SEER数据全面检查不同， AYAs的基于人口的样本，以提高外部效度，并捕捉护理经验的 底层人口。我将了解（F99培训目标1）生育的临床考虑因素 问题，（2）癌症登记数据的定量分析，（3）定性研究方法（F99目标1.1） 研究社会人口统计学和（目标1.2）保健相关的AYA '生育经验（生育 讨论、保存、计划生育、生殖问题），并将（目标1.3）探讨障碍/促进因素 为AYAs提供指南一致的生育讨论。检查环境 对肿瘤生育护理的影响，（K 00阶段）我将寻求博士后职位进行研究（K 00培训目标1） 实施科学和干预研究和（2）卫生政策检查（K 00目标2.1）提供者 对生育指导方针的认知和认知的可操作性以及（目标2.2）保险公司遵守立法 任务和保护覆盖面的障碍。应遵循公平和公正的原则， 协调一致的护理，以改善生殖结果。因此，了解多层次的影响， 影响肿瘤生育能力对于制定可操作的、基于证据的干预措施至关重要，这些干预措施可以改善护理， 确保AYA不会受到癌症经历的不成比例的影响。

PROJECT SUMMARY/ABSTRACT Curative cancer treatment modalities (e.g., chemotherapy) are gonadotoxic (i.e., destroy sperm and eggs) and frequently cause infertility. Thus, clinical practice guidelines intended to facilitate optimal oncofertility care indicate that oncologists should comprehensively discuss possible treatment-related infertility with all cancer patients of reproductive age. Such discussions are particularly relevant for adolescent and young adults (AYA; 15-39 years) with cancer who are in the prime of their reproductive years and endorse fertility-related distress following treatment, situating oncofertility as a priority research area for AYAs. Unfortunately, barriers to the implementation of guidelines compromise their effectiveness and AYAs are infrequently informed of fertility preservation options, with knowledge, cost, and insurance barriers hindering uptake of preservation among AYAs. The cancer care continuum is a multilayer system that describes a hierarchy of intervention levels that are influential in cancer care delivery. Oncofertility care is particularly amenable to intervention at various levels of influence (e.g., provider/team, organization/practice setting, health policy), as patient-, provider-, system-, and policy-level factors impact the delivery and uptake of optimal care. Thus, I aim to investigate oncofertility among AYAs by examining the multilevel influences of the cancer care continuum. Most existing AYA oncofertility research is focused on clinical samples (e.g., academic medical, comprehensive cancer centers) and on non-Hispanic white patients, limiting generalizability of findings, lacking ethnic and racial diversity, and likely not capturing the experiences of at-risk AYAs. To address these gaps, my dissertation (F99 Phase) will use SEER data to comprehensively examine oncofertility among a diverse, population-based sample of AYAs to improve external validity and capture the care experiences of the underlying population. I will gain an understanding of (F99 Training Goal 1) clinical considerations of fertility issues, (2) quantitative analysis of cancer registry data, and (3) qualitative research methods to (F99 Aim 1.1) examine sociodemographic and (Aim 1.2) healthcare correlates of AYAs’ fertility experiences (fertility discussion, preservation, family planning, reproductive concern) and will (Aim 1.3) explore barriers/facilitators to delivering guideline-concordant fertility discussions for AYAs among providers. To examine environmental influences on oncofertility care, (K00 Phase) I will seek a postdoctoral position to study (K00 Training goal 1) implementation science and intervention research and (2) health policy to examine (K00 Aim 2.1) provider perceptions and perceived actionability of fertility guidelines and (Aim 2.2) insurer adherence to legislative mandates and barriers to coverage for preservation. AYAs should receive equitable and guideline- concordant care to improve reproductive outcomes. Therefore, understanding the multilevel influences impacting oncofertility is critical to develop actionable, evidence-based interventions that improve care and ensure AYAs are not disproportionately affected by their cancer experience.