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

不同种族青少年和年轻成年癌症幸存者的生育经历：一项基于人群的研究

• 批准号: 10744412
• 负责人: Julia Stal
• 金额: $ 4.92万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10744412
• 关键词: Address; Adherence; Adolescent and Young Adult; Adolescent and young adult cancer patients; Affect; Age; American; American Society of Clinical Oncology; Area; Awareness; Biological; Cancer Patient; Cancer Survivor; Caring; Child; Clinical; Clinical Practice Guideline; Community Clinical Oncology Program; Comprehensive Cancer Center; Continuity of Patient Care; Counseling; Data; Diagnosis; Disparity; Distress; Effectiveness; Ensure; Equity; Evidence based intervention; Family Planning; Female; Fertility; Future; Goals; Guidelines; Health Insurance; Health Policy; Healthcare; Impairment; Infertility; Influentials; Insurance; Insurance Carriers; Insurance Coverage; Intervention; Intervention Studies; Knowledge; Malignant Neoplasms; Medical; Mentors; Minority; Modality; Modification; Not Hispanic or Latino; Oncologist; Outcome; Patient Care; Patients; Perception; Phase; Policies; Population; Population Study; Positioning Attribute; Postdoctoral Fellow; Practice Guidelines; Prevalence; Provider; Qualitative Research; Quality of Care; Radiation; Recommendation; Reporting; Reproductive Medicine; Research; Research Methodology; Research Personnel; Research Priority; Resources; Risk; SEER Program; Sampling; Self Efficacy; Societies; Specialist; Survivors; System; Training; Translating; United States; Work; cancer care; cancer therapy; care delivery; care providers; career; chemotherapy; clinical practice; cost; curative treatments; data registry; egg; ethnic diversity; evidence base; experience; fertility preservation; health care service utilization; implementation barriers; implementation intervention; implementation science; improved; male; neoplasm registry; oncofertility; population based; practice setting; preservation; provider adherence; provider factors; racial diversity; reproductive; reproductive outcome; sociodemographics; sperm cell; uptake

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.

项目摘要/摘要 治愈性癌症治疗方式（例如，化学疗法）是促性腺毒性（即破坏精子和卵子）和 经常引起不育症。这是旨在促进最佳良好护理的临床实践指南 表明肿瘤学家应与所有癌症彻底讨论与治疗相关的不育症 生殖年龄的患者。这样的讨论与青少年和年轻人特别相关（Aya； 15 - 39年）患有癌症，他们处于生殖年份并认可与生育有关的困扰 治疗后，将妇科构成作为AYA的优先研究领域。不幸的是，障碍 指南的实施损害了其有效性，而AYA很少被告知 生育保存选择，具有知识，成本和保险障碍，阻碍了保存的吸收 在Ayas中。癌症护理继续是一个多层系统，描述了干预的层次结构 对癌症护理提供影响的水平。 Oncertority护理特别适合干预 各种影响力的影响（例如提供者/团队，组织/实践设置，卫生政策），作为患者 - 提供者，系统和政策级别的因素会影响最佳护理的交付和吸收。那我的目标是 通过检查癌症护理的多层次影响，研究AYAS之间的肿瘤性 连续。大多数现有的AYA Oncoferity研究都集中在临床样本上（例如，学术医学， 全面的癌症中心和非西班牙裔白人患者，限制了发现的普遍性，缺乏 种族和种族多样性，可能不会捕捉到高危Ayas的经历。为了解决这些差距，我的 论文（F99阶段）将使用SEER数据来全面检查潜水员， 基于人群的AYA样本，以提高外部有效性并捕获的护理经验 潜在的人口。我将了解（F99培训目标1）生育的临床考虑因素 问题，（2）癌症注册表数据的定量分析，以及（3）定性研究方法（F99 AIM 1.1） 检查社会人口统计学和（AIM 1.2）AYAS生育经历的医疗保健（生育能力） 讨论，保存，计划生育，生殖问题）并将（AIM 1.3）探索障碍/促进者 在提供者中为AYA提供指导方针的生育讨论。检查环境 对oncofertility护理的影响（k00阶段）我将寻求博士后研究（K00培训目标1） 实施科学与干预研究以及（2）卫生政策（K00 AIM 2.1）提供者 生育准则的看法和可操作性以及（目标2.2）保险公司遵守立法 保存覆盖范围的授权和障碍。 AYA应获得公平和指导 - 一致的护理以改善副本的结果。因此，了解多层次的影响 影响野牛对于制定可行的，基于证据的干预措施，以改善护理和 确保AYA不会受到其癌症经验的影响不成比例。