Date of Award

1-1-2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Julia Cron

Abstract

Introduction:

Adolescent and young adult women undergoing cancer treatment face unique reproductive health risks. The objectives of this study were to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify factors associated with these outcomes.

Methods:

After institutional review board approval, a retrospective chart review was conducted of female patients ages 15-25 receiving cancer treatment at Yale New Haven Hospital from 2013-2018. Univariate and multivariate analyses were used to assess the relationship between patient variables and the outcomes of counseling and contraception use. Additionally, with institutional review board approval, a cross-sectional survey was conducted to evaluate sexual health practices, as well as communication about sexual health with oncology providers. This survey included female patients ages 15-39.

Results:

In the retrospective chart review, 256 patients were included, and a subgroup analysis was completed of 157 patients who received cancer treatments besides surgery alone. In the full cohort, the average age was 20.7 and the most common cancer diagnoses were thyroid (39.0%) and hematologic malignancies (25.4%). In the subgroup, the average age was 20.5, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Treatments included combinations of surgery, chemotherapy, radiation, hormone therapy, targeted or biologic agents, and bone marrow transplant. 21.5% of the full cohort were documented as receiving reproductive health counseling and 48.8% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.10, 95% CI 0.03-0.31, P=0.000). Receiving counseling (OR 2.51, 95% CI 1.08-5.80, P=.032) and sexual activity (OR 43.88, 95% CI 1.85-8.12, P=.000) were significantly associated with contraception use. Of the subgroup who received treatment besides surgery alone, 33.1% were documented as receiving reproductive health counseling and 48.4% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P=.005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P=.009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P=.001) were significantly associated with contraception use. 8 patients completed the survey. None were treated with surgery alone. 50% reported engaging in sexual intercourse since starting cancer treatment. Of those, 50% reported using any method to prevent pregnancy at last intercourse. The majority (62.5%) reported never having discussed birth control or pregnancy prevention with their oncologist.

Conclusions:

Reproductive health counseling was documented infrequently during oncologic care for adolescent and young adult women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a clear need to improve rates of counseling in this high-risk setting, especially with adolescents who may be more vulnerable when it comes to reproductive health.

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