Abstract 2254: A population-based study exploring health care self-efficacy and fertility preservation, family planning, and reproductive concerns among diverse adolescent and young adult cancer survivors
Authors: Stal Julia , Miller Kimberly A. , Milam Joel E. , Quinn Molly , Kim Sue E. , Ceasar Rachel C. , Freyer David R. 
Published: March 2024

Abstract
Purpose: To examine the relationship between health care self-efficacy (HCSE) and fertility experiences among diverse adolescent and young adult (AYA) cancer survivors.
Methods: Project Milestones is an ongoing cancer-registry derived cohort survey study recruiting AYAs through the SEER-affiliated Los Angeles Cancer Surveillance Program. Respondents were diagnosed with cancers prototypical for AYAs between 21-39 years and had a 5-year survival probability of ≥50% at diagnosis.
Results: Overall, 1442 AYAs responded of which 57.9% reported the highest possible HCSE (totally confident; score of 3; lower scores reflect greater HCSE), while 42.1% were somewhat or not at all confident in some areas (score of 4-9; Table 1). Compared to AYAs with lower HCSE, AYAs with the highest HCSE were more likely to report preserving fertility (13.8% vs. 10.3%, p&lt;.05) and were less likely to report highly negative change (11.9% vs. 15.5%, p&lt;.01) and more likely to report highly positive change (16.3% vs. 9.4%, p&lt;.01) to family planning due to cancer. On average, AYAs with the highest HCSE had lower reproductive concerns (range 5-25, lower scores reflect lower concern; 13.3 vs. 14.2, p&lt;.01) and were less likely to report worry about: passing on a genetic cancer risk to their child (49.6% vs. 56.6%; p&lt;.01), telling their partner they may be unable to have children (13.8% vs. 21.5%, p&lt;.01), their ability to become a biological parent (22.7% vs. 28.0%, p&lt;.01), and caution having children because they may not be around to raise them (18.5% vs. 24.1%, p&lt;.01) than AYAs with lower HCSE.
Discussion: Greater HCSE was associated with higher rates of preservation, lower impacts to family planning, and lower reproductive concerns in this population-based study. As one quarter of AYAs have suboptimal HCSE, accessible avenues for obtaining fertility care are needed to temper possible impacts of low HCSE on preserving fertility.
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) Discussed fertility 717 (50.3) 327 (53.4) 390 (48.0) Preserved fertility 176 (12.3) 48 (7.8) 128 (15.7) Impacts to family planning due to cancer Highly negative change 202 (14.3) 91 (15.0) 111 (13.7) Somewhat negative change 128 (9.0) 50 (8.3) 78 (9.6) No change 788 (55.6) 315 (52.1) 472 (58.2) Somewhat positive change 111 (7.8) 43 (7.1) 68 (8.4) Highly positive change 189 (13.3) 106 (17.5) 83 (10.2) Reproductive Concerns After Cancer (RCAC) score 14.1 (3.9) 14.3 (4.2) 14.0 (3.8) HCSE score 3.9 (1.4) 4.0 (1.4) 3.9 (1.3) Could ask doctor or health care provider about things that concern you? Totally confident 1088 (75.9) 466 (75.5) 622 (76.1) Somewhat confident 303 (21.1) 130 (21.1) 173 (21.2) Not at all confident 43 (3.0) 21 (3.4) 22 (2.7) Could schedule and attend your doctor appointments or decide when you needed care? Totally confident 1057 (73.8) 454 (73.5) 603 (74.1) Somewhat confident 310 (21.7) 130 (21.0) 180 (22.1) Not at all confident 65 (4.5) 34 (5.5) 31 (3.8) Could get the cancer related follow-up care you need over the next 2 years? Totally confident 1006 (70.6) 410 (67.3) 596 (73.1) Somewhat confident 328 (23.0) 149 (24.4) 179 (22.0) Not at all confident 90 (6.3) 50 (8.2) 40 (4.9)
Citation Format: Julia Stal, Kimberly A. Miller, Joel E. Milam, Molly Quinn, Sue E. Kim, Rachel C. Ceasar, David R. Freyer. A population-based study exploring health care self-efficacy and fertility preservation, family planning, and reproductive concerns among diverse adolescent and young adult cancer survivors [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 2254.