Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Background Adolescent and young adult patients with cancer (AYAs) identify sexual and reproductive health (SRH) as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to explore AYA perceptions and experiences of SRH communication with oncology clinicians. Methods Twenty‐three AYA patients and survivors ages 15‐25 years from a large academic oncology center participated in semistructured qualitative interviews investigating their experiences discussing SRH issues, including specific topics discussed, conversation barriers and facilitators, suggestions for clinicians on how to improve conversations, and education and resource needs. Interviews were audio recorded, transcribed, and coded using a thematic analysis approach. Results Interviews with AYAs revealed two primary themes—a need for oncology clinicians to discuss SRH and critical gaps in current SRH communication practices. AYAs reported a need for improved SRH communication for the purposes of general education, addressing specific SRH issues experienced, and understanding the long‐term impact of cancer and treatment on SRH. The current communication gaps are exacerbated by patient discomfort initiating conversations and the presence of family members. AYAs shared six key recommendations for clinicians on how to improve SRH communication. Conclusions AYAs identify a role for oncology clinicians in discussing SRH as a primary aspect of comprehensive health care during cancer treatment and in survivorship; however, multiple gaps and barriers interfere with such discussions. Future efforts must focus on clinician education and training in SRH as well as education and intervention opportunities for AYAs to optimize the care provided.

Section: Discussionmentioning

confidence: 99%

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients

Frederick

Revette

Michaud

et al. 2019

“…Survival rates, cancer‐related quality of life, and long‐term treatment‐related morbidities have not improved in AYAs to the same extent as in other age groups . Proposed hypotheses for these gaps include age‐related differences in disease and host biology, diagnosis delays, lower rates of clinical trial enrollment, treatment at facilities without young adult experience, and higher loss to follow‐up after therapy …”

Section: Epidemiologymentioning

confidence: 99%

Adolescent and young adult Hodgkin lymphoma: Raising the bar through collaborative science and multidisciplinary care

Kahn

Kelly

2018

Hodgkin lymphoma (HL) is one of the most common cancers in the adolescent and young adult (AYA) population (15-39 years). Despite continued improvements in HL outcomes, AYAs have not exhibited survival gains to the same extent as other age groups. At present, details about tumor biology, optimal therapeutic approaches, supportive care needs, and long-term toxicities in AYAs with HL remain understudied. Herein, we summarize the current state of the AYA population with HL, specifically focusing on how collaborations across the pediatric and medical oncology divide, coupled with multidisciplinary patient care, can further optimize outcomes for this group of patients.

“…Although fertility risk and education about potential fertility preservation opportunities is deemed a standard of care for all new pediatric oncology patients, it was striking that five PDs reported “not a required or expected part of the program” as a significant barrier for education about fertility 8 . A notably higher percentage of programs reported exclusion of sexual health and safe sex practices from fellow education due to the perception that these domains are “not a required or expected part of the program,” despite national guidelines established to highlight their importance in oncology patient care, notably in the AYA patient population 9,29 . Further education of PDs and hematology/oncology clinicians, with an emphasis on the guidelines set forth by ASCO, COG, AAP, and NCCN, will help bring these issues to the forefront.…”

Section: Discussionmentioning

confidence: 99%

Pediatric hematology and oncology fellow education in sexual and reproductive health: A survey of fellowship program directors in the United States

Frederick

Fine

Michaud

et al. 2020

Purpose Pediatric oncology clinicians identify a need for increased sexual and reproductive health (SRH) education with adolescent and young adult (AYA) cancer patients. By surveying pediatric oncology fellowship directors, this study clarifies the state of current fellowship education about SRH for the AYA patient. Methods A survey was sent to all pediatric oncology fellowship program directors (PDs) in the United States consisting of 13 questions pertaining to three primary SRH domains: sexual health, fertility, and safe sex practices. Descriptive statistics and χ2 were used in data analyses. Results Sixty‐three PDs responded to the survey (91% response rate). Of these, 88% reported having formal instruction regarding fertility, 41% reported curriculum regarding contraception and 30% reported some education regarding sexual health. The curriculum “being too full” was identified as a barrier to education on fertility (29%), sexual health (40%), and safe sex practices (38%). Not being a required or expected part of the program was more likely to be endorsed as a barrier for sexual health (26%) and safe sex practices (30%) compared with fertility (8%) (P < 0.005). Lack of experts to teach was a more frequently endorsed barrier to education on sexual health (47%) compared with either fertility (23%) or safe sex practices (25%) (P < 0.005). Conclusions This study identifies important gaps in oncology fellow education about SRH. Future research must explore optimal education strategies that are feasible and acceptable by PDs and fellow learners, and effective in optimizing AYA SRH care.