Abstract 2253: Cancer-related follow-up health care utilization and fertility discussion, preservation, and reproductive concerns among diverse adolescent and young adult cancer survivors: A population-based study
Authors: Stal Julia , Miller Kimberly A. , Milam Joel E. , Quinn Molly , Kim Sue E. , Ceasar Rachel C. , Freyer David R. 
Published: March 2024

Purpose: To examine cancer-related follow-up (CRFU) health care utilization associated with fertility experiences among diverse adolescent and young adult (AYA) cancer survivors.

Methods: Project Milestones is an ongoing survey study evaluating life outcomes among AYAs diagnosed with cancer at age 21-39 in Los Angeles (LA) County. AYAs had an initial 5-year survival probability of ≥50% and are currently 3-10 years post-diagnosis. A registry-based recruitment strategy through the SEER-affiliated LA Cancer Surveillance Program was used.

Results: Overall, 1442 AYAs responded (Table 1). Compared to AYAs who did not, AYAs who saw: (1) their treating provider for CRFU were more likely to report a fertility discussion (56.0% vs. 41.2%, p&lt;.01); (2) another provider for CRFU were less likely to report a fertility discussion (38.1% vs. 52.0%, p&lt;.01); (3) their treating provider for CRFU were more likely to report preserving fertility (14.7% vs. 8.4%, p&lt;.01); (4) a primary care provider for CRFU were less likely to report preserving fertility (10.1% vs. 13.6% p&lt;.05). Compared with AYAs who reported a CRFU visit 1+ years ago or never, AYAs with a visit &lt;1 year ago: (1) had on average greater reproductive concerns (range 5-25, higher scores reflect greater concern, 13.8 vs. 13.4, p&lt;.05); and were more likely to report (2) worry passing on a genetic risk for cancer to their child (55.6% vs. 47.8%, p&lt;.01); and (3) caution about having children because they may not be around to raise them (23.6% vs. 16.6%, p&lt;.01).

Discussion: Iatrogenic infertility concerns persistent into survivorship, yielding a need to optimize oncofertility care throughout the reproductive lifespan. Receiving CRFU care from the treating provider is related to better outcomes, and higher reproductive concerns among AYAs with a recent visit may reflect greater awareness of risk due to more points of contact with a provider.

Table 1: Sample characteristics - N (%) or M (SD) Total Hispanic Non-Hispanic 1442 622 (43.1) 820 (56.9) Age at survey 39.5 (5.8) 39.3 (5.8) 39.6 (5.7) Female 1007 (69.8) 429 (69.0) 578 (70.5) White 850 (62.4) 301 (55.0) 549 (67.3) Had employee-sponsored insurance 909 (63.0) 347 (55.8) 562 (68.5) Age at diagnosis 31.0 (5.2) 30.8 (5.2) 31.2 (5.1) Cancer type Leukemia/Lymphoma 396 (27.5) 173 (27.8) 223 (27.2) Reproductive 382 (26.5) 208 (33.4) 174 (21.2) Thyroid 184 (12.8) 86 (13.8) 98 (12.0) Breast 179 (12.4) 61 (9.8) 118 (14.4) Skin 130 (9.0) 21 (3.4) 109 (13.3) Colorectal 86 (6.0) 35 (5.6) 51 (6.2) Other 85 (5.9) 38 (6.1) 47 (5.7) Discussed fertility 717 (50.3) 327 (53.4) 390 (48.0) Preserved fertility 176 (12.3) 48 (7.8) 128 (15.7) Reproductive Concerns After Cancer (RCAC) score 14.1 (3.9) 14.3 (4.2) 14.0 (3.8) Last visit with a health care provider for cancer related follow-up care Within the past year 862 (60.3) 343 (56.2) 519 (63.4) 1-2 years ago 218 (15.3) 90 (14.8) 128 (15.6) More than 2 years ago 303 (21.2) 152 (24.9) 151 (18.4) Never 46 (3.2) 25 (4.1) 21 (2.6) Provider seen for cancer related follow-up care Same doctor who treated me 885 (61.4) 369 (59.3) 516 (62.9) Primary care provider 539 (37.4) 224 (36.0) 315 (38.4) Another type of provider 179 (12.4) 65 (10.5) 114 (13.9) Cancer survivorship clinic 88 (6.1) 46 (7.4) 42 (5.1)

Citation Format: Julia Stal, Kimberly A. Miller, Joel E. Milam, Molly Quinn, Sue E. Kim, Rachel C. Ceasar, David R. Freyer. Cancer-related follow-up health care utilization and fertility discussion, preservation, and reproductive concerns among diverse adolescent and young adult cancer survivors: A population-based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2253.