Prevalence and predictors for fertility-related distress among 1010 young adults 1.5 years following cancer diagnosis - results from the population-based Fex-Can Cohort study.

BACKGROUND: Cancer treatment during reproductive ages may negatively impact fertility and there is a need of firm knowledge about the prevalence and predictors of fertility-related distress. The aim was to examine fertility-related distress in a population-based sample of young women and men recently treated for cancer and to identify predictors for this outcome. MATERIAL AND METHODS: This nationwide cohort study included 1010 individuals (694 women and 316 men), mean age 34.5 ± 4.9 and 32.1 ± 5.5, respectively, diagnosed with breast, cervical, ovarian, testicular cancers, brain tumors or lymphoma at ages 18-39 in Sweden. Participants completed a survey 1.5-year post-diagnosis to assess fertility-related distress (RCAC), emotional distress (HADS) and self-efficacy, as well as sociodemographic and clinical factors and fertility preservation. Logistic regression was used to examine associations between explanatory factors and high fertility-related distress (RCAC subscale mean >4). RESULTS: Many participants (69% of women and 47% of men) had previous children and about half reported a wish for future children. High fertility-related distress was more prevalent among women (54%) than men (27%), and women were more likely than men to report distress concerning all but one RCAC dimension after adjustment for sociodemographic factors. Use of fertility preservation was unevenly distributed (15% of women and 71% of men) and was not associated with decreased fertility-related distress. In multivariable logistic regression models, a wish for future children, being single, not having previous children, symptoms of anxiety and low self-efficacy regarding one's ability to handle threats of infertility were associated with high fertility-related distress. CONCLUSION: This nationwide study found a high prevalence of fertility-related distress in young women and men recently treated for cancer and identified sociodemographic and psychological predictors. Fertility preservation was not found to act as a buffer against fertility-related distress, indicating the continuous need to identify strategies to alleviate fertility distress following cancer.

Feasibility of Mindful After Cancer: Pilot Study of a Virtual Mindfulness-Based Intervention for Sexual Health in Cancer Survivorship.

BACKGROUND: Mindfulness-based interventions (MBIs) are increasingly recognized as an effective strategy for supporting female cancer survivors experiencing sexual health concerns. AIM: To examine the feasibility of a sexual health MBI, Mindful After Cancer, which was adapted to meet the needs of breast and gynecologic cancer survivors in a community setting and for delivery via videoconference. METHODS: A mixed-methods approach was used to evaluate the acceptability, feasibility, and appropriateness of the 8-week virtual MBI. Weekly sessions were 1.5-2 hours in duration and included guided meditations and group discussion about sexuality after cancer and mindfulness in daily life. Home practice activities related to both mindfulness practice and sexual health. Participants completed online surveys at baseline and 1-month post-intervention. A purposive sample of 10 participants were invited to complete a follow-up interview 2-3 months post-intervention. OUTCOMES: Primary outcomes included both qualitative and quantitative assessments of acceptability, appropriateness, and feasibility of the Mindful After Cancer intervention for sexual health in cancer survivorship. RESULTS: Twenty-two women completed the intervention (Mean age 53.2 years, SD = 9.4, Range= 39-73), with time since diagnosis ranging from 1 to 27 years (Mean 6.0 years, SD = 5.9). Participants completed 6.8 sessions on average (Range = 2 - 8) and 77% reported that the time commitment was manageable. Both qualitative and quantitative findings support the feasibility, acceptability, and appropriateness of the intervention. CLINICAL IMPLICATIONS: Many cancer survivors experience sexual dysfunction and related distress after diagnosis and well after treatment ends, yet there are few interventions available. Improved access to effective interventions can improve the delivery of survivorship care and patient outcomes. STRENGTHS & LIMITATIONS: The sample size is small for this pilot study, and a control group was not included. The intervention was offered over two time periods, one prior to COVID-19 pandemic and one during the pandemic, resulting in both limitations associated with potential differences between the experiences of participants and the opportunity to learn more about the feasibility of the intervention during times of crisis. CONCLUSION: Results suggest that virtual delivery of the MBI is feasible, acceptable, and appropriate for breast and gynecologic cancer survivors. Gorman JR, Drizin JH, Smith E, et al. Feasibility of Mindful After Cancer: Pilot Study of a Virtual Mindfulness-Based Intervention for Sexual Health in Cancer Survivorship. J Sex Med 2022;19:1131-1146.

Challenges experienced and resources identified by young to midlife couples 1-3 years post-cancer diagnosis.

OBJECTIVE: The purpose of this study was to explore what young to midlife couples viewed as their strengths as a couple and the greatest challenges in their experience with cancer 1-3 years post-diagnosis. METHODS: We used qualitative content analysis to extract common themes from open-ended questions from 42 cancer survivors and their partners (aged 27-58). Patterns of themes by age and gender of the survivor were also explored. RESULTS: Couples described both positive and negative impacts of the cancer experience: (1) strengthened the relationship, bringing couples closer together; (2) brought emotional strain to many areas of life, especially for partners; (3) created positive changes in lifestyle and new priorities for the couple; (4) created strain in the couple's relationship and intimacy; and (5) altered the role of family in supporting the couple. Couples also described four key strengths in dealing with the cancer experience: (1) drawing strength from shared love and mutuality; (2) communicating openly, even about the difficult stuff; (3) working together as a team to support each other; and (4) drawing strength from shared values and goals. Couples reported unmet needs related to the emotional and relational strain of the cancer experience, managing longer term survivor symptoms, fertility and physical intimacy, and lack of support or attention to the partner who often assumed the role of care partner. CONCLUSIONS: Themes are discussed in light of current dyadic concepts and importance of couple-based interventions.

Dyadic support across contraceptive decision-making among young adult breast cancer survivors and their partners.

OBJECTIVE: The purpose of this study is to explore the role of dyadic support across the contraceptive decision-making process between young adult breast cancer (YABC) survivors and their partners. RESEARCH APPROACH: Semi-structured interviews with YABC survivors and their partners. PARTICIPANTS: Twenty-five young adult breast cancer survivors and their partners (n = 50). Survivors reported an average age of 36.9 years (SD = 4.30) and the majority self-identified as white (86.2%). METHODOLOGICAL APPROACH: Thematic analysis approach with dyads as the primary unit of analysis, guided by the dyadic decision-making framework and the Theory of Gender and Power. RESULTS: Perceived lack of contraceptive options due to a history of hormone-sensitive cancer, perceived infertility, and contraception as a result of cancer treatment (e.g., hysterectomy) contributed to the contraceptive decision context for survivors and their partners. Contraceptive support varied across couples depending on the cancer-specific context, where communication, sharing responsibility, and respecting bodily autonomy revealed as supportive behaviors. Other social influences including survivors' desire to conceive biologically and family planning desires also related to partner supportive behaviors. INTERPRETATIONS: YABC survivors face specific challenges to contraceptive decision-making where partners can offer supportive behaviors. Health care providers can also support couples by engaging in triadic communication about contraception and family planning. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY: Psychosocial providers can support couples by encouraging them to talk together about contraception and highlighting the importance of triadic communication with a healthcare provider to support shared decision-making and alignment of contraceptive decisions with family planning desires.

Higher reproductive concerns associated with fertility consultation: a cross-sectional study of young adult male cancer survivors.

PURPOSE: This study examined associations between fertility consultation (FC) and multiple dimensions of reproductive concerns among young adult (YA) male cancer survivors. METHODS: One hundred and seventy YA male cancer survivors (age 18 to 35) across the USA completed an online survey between 2016 and 2018. Participants reported demographics, receipt of FC, and reproductive concerns. Reproductive concerns were measured multidimensionally using the Reproductive Concerns after Cancer-Male scale. We used log binomial regression to examine associations between FC and high reproductive concerns across multiple domains. RESULTS: In multivariate analyses adjusting for desire for children, FC was associated with higher likelihood of having at least one high reproductive concern (relative risk [RR] 1.4, 95% CI 1.2-1.7). Across subscales, FC was associated with greater likelihood of having high concerns about fertility potential (RR 1.7, 95% CI 1.0-3.0), achieving pregnancy (RR 3.5, 95% CI 1.3-9.5), their (potential) child's health (RR 1.5, 95% CI 1.1-2.2), and disclosing infertility to a partner (RR 2.7, 95% CI 1.8-4.1). In contrast, associations were not observed between FC and likelihood of high concerns about personal health (RR 1.4, 95% CI 0.5-3.8) or acceptance of infertility (RR 1.8, 95% CI 0.8-3.9). CONCLUSIONS: YA male cancer survivors who received FC were more likely to have high reproductive concerns than those who did not receive FC. Men who seek out FC after cancer diagnosis may need additional support for their reproductive concerns. Research is needed to identify strategies to alleviate these concerns among this population.

Patient-Centered Communication to Address Young Adult Breast Cancer Survivors' Reproductive and Sexual Health Concerns.

Women faced with a diagnosis of breast cancer as young adults commonly experience negative effects of cancer and cancer treatment on their reproductive and sexual health (RSH) that are inadequately addressed by their healthcare providers (HCPs). The objectives of this study were to 1) identify approaches to improving RSH communication from YA breast cancer survivors' perspectives, 2) identify facilitators and barriers to the approaches identified, and 3) identify specific strategies to improve patient-centered RSH communication. We conducted individual telephone interviews with 29 women who were diagnosed with breast cancer under age 40 years. We used a grounded theory approach to identify themes, and explored how the themes related to the PCC framework to elucidate specific strategies for improving communication. Three main themes emerged: 1) Normalizing and integrating assessment of RSH concerns; 2) HCP conveying genuine caring and investment; and 3) Improving accessibility of comprehensive RSH services after cancer. Results revealed concrete strategies for improving patient-centered RSH communication at the patient-provider and health system levels. These included reminding patients that RSH concerns are common, routinely asking about RSH, using active listening, and connecting patients to HCP who can address their RSH concerns.

Navigating sexual health in cancer survivorship: a dyadic perspective.

PURPOSE: This qualitative study examined how young adult breast cancer survivors (YABCS) and their partners appraised and managed their sexual health and intimate relationships after cancer. METHODS: We conducted concurrent, individual telephone interviews with 25 YABCS and their male partners. We utilized a thematic, inductive analysis to examine individual interviews, followed by analysis within and across couples to identify dyadic themes. We explored how themes mapped on to the Theory of Dyadic Illness Management to build a conceptual model specific to the sexual health challenges of young adult couples living with cancer. RESULTS: Our analysis revealed five interconnected themes: (1) shared understanding of physical and psychological challenges of sexual health after cancer, (2) navigating role shifts and changes to sexual relationship, (3) getting through it as a team, (4) maintaining open communication, and (5) need for services and support for partners/caregivers and couples. CONCLUSION: Both survivors and their partners articulated physical (e.g., painful sex, decreased libido) and psychological (e.g., guilt, self-consciousness) challenges to their sexual health in survivorship. Our dyadic focus revealed a spectrum of ways that couples managed the changes to their relationships and sexual health, highlighting "open communication" and strategies for "working as a team" as critical. There is no "one size fits all" solution, as individuals and couples cope with and manage these challenges in different ways. Study results can inform couple-focused intervention strategies, such as creating shared understanding of sexual health after cancer and improving communication skills.

Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors.

BACKGROUND: Fertility counseling before cancer treatment has been advocated by clinical guidelines, though little is known about its long-term impact on the unique reproductive concerns of female adolescent and young adult (AYA) cancer survivors. The goal of this study was to measure the association between fertility counseling by fertility specialists before cancer treatment and subsequent reproductive concerns. METHOD: A cross-sectional analysis was performed among 747 AYA survivors aged 18-40 years who had been recruited from cancer registries and physician and advocacy group referrals between 2015 and 2017. Participants self-reported information on past fertility counseling at cancer diagnosis, cancer type and treatment, and current reproductive concerns, as measured using the multidimensional Reproductive Concerns After Cancer scale. Multivariable log-binomial regression models tested associations between fertility counseling and reproductive concerns. RESULTS: The mean age of the cohort was 33.0 years (standard deviation, 5.1 years), and the mean period since diagnosis was 7.7 years (standard deviation, 5.0 years). Seventy-three percent of participants were white, and 24% were Hispanic. Fertility counseling was reported by 19% of survivors; moderate to high overall reproductive concerns were reported by 44% of participants. In adjusted analysis, fertility counseling was significantly associated with moderate to high reproductive concerns (risk ratio, 1.22; 95% confidence interval, 1.02-1.45) and not modified by exposure to fertility-threatening treatments (Pinteraction = .23). CONCLUSION: A large proportion of AYA cancer survivors across cancer types and treatment exposures reported moderate to high reproductive concerns, suggesting that there is a need to address these cancer-specific reproductive health concerns after treatment. Higher concerns, even with counseling, suggests the need to improve the quality of fertility counseling throughout the cancer continuum.

Efficacy of a web-based women's health survivorship care plan for young breast cancer survivors: a randomized controlled trial.

PURPOSE: Breast cancer survivorship care plans (SCP) have limited content addressing women's health issues. This trial tested if young breast cancer survivors who receive a web-based, women's health SCP were more likely to improve on at least one of the four targeted issues (hot flashes, fertility-related concerns, contraception, and vaginal symptoms) compared to attention controls. METHODS: A randomized controlled trial recruited female survivors ages 18-45 at diagnosis, 18-50 at enrollment, completed primary cancer treatment, and had a significant women's health issue: moderate or higher fertility-related concerns; ≥ 4 hot flashes/day with ≥ 1 of moderate severity; ≥ 1 moderate vaginal atrophy symptoms; or not contracepting/using less effective methods. Survivors underwent stratified, block randomization with equal allocation to intervention and control groups. The intervention group accessed the online SCP; controls accessed curated resource lists. In intention-to-treat analysis, the primary outcome of improvement in at least one issue by 24 weeks was compared by group. RESULTS: 182 participants (86 intervention, 96 control), mean age 40.0 ± 5.9 and 4.4 ± 3.2 years since diagnosis, were randomized. 61 intervention group participants (70.9%) improved, compared to 55 controls (57.3%) (OR 1.82, 95% CI 0.99-3.4, p = 0.057). The following issue-specific improvements were observed in the intervention versus control arms: fertility-related concerns (27.9% vs. 14.6%, OR 2.3, 95% CI 1.1-4.8); hot flashes (58.5% vs. 55.8%, OR 1.1, 95% CI 0.57-2.2); vaginal symptoms (42.5% vs. 40.7%, OR 1.1, 95% CI 0.6-2.0); contraception (50% vs. 42.6%, OR 1.4, 95% CI 0.74-2.5). CONCLUSIONS: In young breast cancer survivors, a novel, web-based SCP did not result in more change in the primary outcome of improvement in at least one of the four targeted women's health issues, than the attention control condition. The intervention was associated with improved infertility concerns, supporting efficacy of disseminating accessible, evidence-based women's health information to this population.

Applying behavioral theory to understand fertility consultation uptake after cancer.

OBJECTIVE: The objective of this study was to examine the association between theoretical constructs from the Health Belief Model and fertility consultation status after cancer. METHODS: Reproductive-aged female cancer survivors self-reported their use of fertility consultation, perceived severity of and susceptibility to infertility, perceived barriers to and effectiveness of fertility consultation, and cues to action from family/peers and doctors, as well as demographics and cancer characteristics. Logistic regression was used to analyze the association between theoretical constructs and fertility consultation status. RESULTS: Fertility consultation uptake was more prevalent among survivors with higher incomes, those without children, those who wanted a (another) child, and those who were diagnosed more recently. In the final multivariate model, higher perceived severity of infertility, fewer perceived barriers to fertility consultation, and more cues to action from family/peers and doctors were significantly associated with fertility consultation uptake, controlling for income. Exploratory bivariate analyses of barriers to fertility consultation revealed that cost and trouble accessing services were significantly associated with not having a fertility consultation. CONCLUSIONS: The Health Belief Model is useful for understanding factors associated with fertility consultation uptake. Efforts should be made to reduce financial barriers and improve patient-centered assessment of family-building goals.

Revisiting the Reproductive Concerns After Cancer (RCAC) scale.

OBJECTIVE: The aims of this study were to examine the factor structure and reliability of the multidimensional Reproductive Concerns After Cancer (RCAC) scale in a sample of female cancer survivors during their reproductive years, younger than age 45. METHODS: Female reproductive-aged survivors (N = 238; current age, 18 to 44 y) with a variety of cancer diagnoses completed a web-based survey that included the RCAC scale. Three structural models were examined via confirmatory factor analysis: (a) one-factor, (b) higher-order with one second-order factor and six first-order factors, and (c) oblique six-factor. Reliability was examined using omega total and Revelle omega total. RESULTS: Only the oblique six-factor model of the RCAC scale fits well. Omega total and Revelle omega total estimates for all of the six three-item subscales were in the nearly satisfactory to good range (.66 to.87). CONCLUSIONS: The RCAC scale was found to have satisfactory factor structure and reliability when measuring a range of reproductive concerns experienced by female reproductive-aged survivors. The RCAC scale is a multidimensional measure of varying aspects of reproductive concerns, and results suggest that the scale may be best represented as a profile of subscale scores. The subscale scores would be useful for tailoring recommendations and interventions to more effectively address the diverse reproductive concerns of female reproductive-aged survivors.

Sexual dysfunction and reproductive concerns in young women with breast cancer: Type, prevalence, and predictors of problems.

OBJECTIVE: A dearth of studies focusing on young women (<40 years) with breast cancer have hampered the understanding of the type, prevalence, and predictors of sexual dysfunction and reproductive concerns in this population. METHODS: Data were collected from 181 women (response rate = 60%) diagnosed with breast cancer approximately 2 years previously (age 21-39) using the Swedish National Quality Registry for Breast Cancer and a survey including standardized measures of sexual dysfunction, reproductive concerns, body image, and health-related quality of life. Multivariable logistic binary regression analyses were used to identify predictors of sexual dysfunction and reproductive concerns. RESULTS: Sexual dysfunction in at least one domain was reported by 68% of the women, and a high level of reproductive concerns in at least one dimension was reported by 58%. Model results showed that current endocrine treatment was a significant predictor of dysfunction related to lubrication (OR 3.8, 95% CI 1.2-12.1) and vaginal discomfort (OR 8.7, 95% CI 1.5-51.5). Negative body image was related to satisfaction with sex life (OR 1.1, 95% CI 1.0-1.2). A high level of reproductive concerns was predicted by a wish for (additional) children in the future (OR 3.4, 95% CI 1.1-10.2) and by previous chemotherapy (OR 2.5, 95% CI 1.1-5.9). CONCLUSIONS: Sexual dysfunction and reproductive concerns are common in young women with breast cancer. Current endocrine treatment, previous chemotherapy, a negative body image, and a wish for children in the future predict higher level of problems.

Developing a post-treatment survivorship care plan to help breast cancer survivors understand their fertility.

PURPOSE: Reproductive-aged breast cancer survivors (BCS) who have completed initial cancer treatment frequently want to know about their future fertility potential. The purpose of this qualitative study was to assess if the fertility-related content presented in the survivorship care plan prototype met the informational needs of post-treatment BCS and to provide an opportunity for the target audience to review and react to the proposed content and design. METHODS: We conducted and analyzed transcripts from seven focus groups with BCS to evaluate their reactions to the survivorship care plan prototype. We independently coded transcripts for consistent themes and sub-themes and used a consensus-building approach to agree on interpretation of results. RESULTS: We identified five themes that describe the post-treatment BCS' responses to the prototype survivorship care plan in the context of their informational needs and experiences: (1) the prototype's fertility-related information is relevant; (2) desire for clinical parameters to help survivors understand their infertility risk; (3) fertility-related information is important throughout survivorship; (4) evidence-based content from a neutral source is trustworthy; and (5) the recommendation to see a fertility specialist is helpful, but cost is a barrier. CONCLUSIONS: BCS have concerns and needs related to their fertility potential after initial breast cancer treatment. The evidence-based information offered in our prototype survivorship care plan was acceptable to BCS and has significant potential to address these needs. Additional primary data that identify post-cancer treatment indicators of fertility would advance this effort.

Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.

Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.

Young female cancer survivors' use of fertility care after completing cancer treatment.

PURPOSE: The purpose of the present study is to investigate factors associated with female young adult cancer survivors' (YCSs) use of fertility care (FC), including consultation or fertility treatment, after completing their cancer treatment. METHODS: In this cross-sectional study, females between that ages of 18 and 35 years who had been diagnosed with childhood, adolescent, or young adult cancers completed a 20-min web-based survey that included demographics, reproductive history, use of FC, fertility-related informational needs, and reproductive concerns. RESULTS: A total of 204 participants completed the survey. Participants' mean age was 28.3 ± 4.5 years. Thirty (15 %) participants reported using FC after cancer treatment. The majority of participants recalled not receiving enough information about fertility preservation options at the time of cancer diagnosis (73 %). In multivariable analysis, those with higher concerns about having children because of perceived risk to their personal health (P = 0.003) were less likely to report use of FC after cancer treatment. Those who had used FC before cancer treatment (P = 0.003) and who felt less fertile than age-matched women (P = 0.02) were more likely to use FC after their cancer treatment. CONCLUSIONS: While most YCSs in this cohort believed that they did not receive enough information about fertility and most wanted to have children, the vast majority did not seek FC. The findings of this study offer further evidence of the need for improved education and emotional support regarding reproductive options after cancer treatment is completed. Targeted discussions with YCSs about appropriate post-treatment FC options may improve providers' capacity to help YCSs meet their parenthood goals.

Experiencing reproductive concerns as a female cancer survivor is associated with depression.

BACKGROUND: Young adult female cancer survivors have unmet reproductive concerns and informational needs that are associated with poorer quality of life. The purpose of this study was to examine the association between current reproductive concerns and moderate to severe depression among young survivors. METHODS: This cross-sectional study included 200 female cancer survivors between the ages of 18 and 35 years who completed a Web-based survey measuring reproductive history, parenthood desires, reproductive concerns after cancer, and quality-of-life indicators. RESULTS: The mean age of the participants was 28 years (standard deviation, 4.4 years), and almost two-thirds were diagnosed within 5 years of survey completion. A multivariate logistic regression analysis controlling for education, duration of survivorship, and social support revealed an association between experiencing reproductive concerns and moderate to severe depression (odds ratio for each 5-unit increase in the Reproductive Concerns After Cancer [RCAC] score, 1.30; 95% confidence interval, 1.06-1.60). Among those with moderate to severe depression, 23% had high RCAC scores, whereas 6% of those with minimal to mild depression did (P < .001). CONCLUSIONS: A higher level of reproductive concerns was associated with greater odds of experiencing moderate to severe depression. Almost a quarter of survivors in this sample reported moderate to severe depression, and addressing reproductive concerns represents one potential area of intervention for improving the psychosocial health of young survivors.

Effect of Depression on Risky Drinking and Response to a Screening, Brief Intervention, and Referral to Treatment Intervention.

We assessed alcohol consumption and depression in 234 American Indian/Alaska Native women (aged 18-45 years) in Southern California. Women were randomized to intervention or assessment alone and followed for 6 months (2011-2013). Depression was associated with risk factors for alcohol-exposed pregnancy (AEP). Both treatment groups reduced drinking (P < .001). Depressed, but not nondepressed, women reduced drinking in response to SBIRT above the reduction in response to assessment alone. Screening for depression may assist in allocating women to specific AEP prevention interventions.

Preventing alcohol-exposed pregnancy among an American Indian/Alaska Native population: effect of a screening, brief intervention, and referral to treatment intervention.

BACKGROUND: Fetal alcohol spectrum disorders are the result of alcohol-exposed pregnancies (AEP) and believed to be the leading known cause of developmental disabilities in the United States. Our objective was to determine whether a culturally targeted Screening, Brief Intervention, and Referral to Treatment (SBIRT) intervention may reduce risky drinking and vulnerability to AEP among American Indian/Alaska Native (AIAN) women in Southern California. METHODS: Southern California AIAN women of childbearing age who completed a survey including questions regarding alcohol consumption and contraceptive use were randomized into intervention or treatment as usual groups where the former group completed an online SBIRT intervention, and were followed up at 1, 3, and 6 months postintervention. RESULTS: Of 263 women recruited and 247 with follow-up data, one-third were at high risk of having an AEP at baseline. Both treatment groups decreased self-reported risky drinking behavior (drinks per week, p < 0.001; frequency of heavy episodic [binge] drinking episodes per 2 weeks, p = 0.017 and risk of AEP p < 0.001 at 6 months postintervention) in the follow-up period. There was no difference between treatment groups. Baseline factors associated with decreased risk of an AEP at follow-up included the perception that other women in their peer group consumed a greater number of drinks per week, having reported a greater number of binge episodes in the past 2 weeks, and depression/impaired functionality. CONCLUSIONS: Participation in assessment alone may have been sufficient to encourage behavioral change even without the web-based SBIRT intervention. Randomization to the SBIRT did not result in a significantly different change in risky drinking behaviors. The importance of perception of other women's drinking and one's own depression/functionality may have implications for future interventions.

"Just for pregnant women, not for you": a qualitative evaluation of the sexual and reproductive healthcare experiences of transgender and gender diverse cancer survivors.

PURPOSE: To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges. METHODS: We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health. RESULTS: Themes describing challenges were as follows: (1) Cancer treatment's impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns. CONCLUSIONS: TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS: Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors' support networks and implementing system-level changes in cancer care settings.

"Infertility Isn't a Choice!": Conversations on Twitter about the Financial Burden of Oncofertility Care.

This study aimed to evaluate how the adolescent and young adult (AYA) cancer community utilized Twitter to discuss the financial challenges of oncofertility care and to advocate for change. Tweets related to oncofertility and finances (n = 166), collected over a 12-week time period encompassing AYA Cancer Awareness Week, were thematically analyzed. Conversations highlighted how the high cost of care contributed to already high emotional and social distress. Proposed actions included providing timely information more equitably, improving access to financial support, and continued advocacy of policy changes to improve access to oncofertility care. Future research can explore the potential impact on policy change and clinical care.