Male pediatric, adolescent, and young adult reproductive survivorship.

As pediatric, adolescent, and young adult cancer survival rates increase, emphasis is placed on reducing late effects, including reproductive complications and potential impact to fertility. Male survivors are at risk of abnormalities in sperm, hormone deficiencies, and sexual dysfunction. This can impact one's progression into puberty and ability to have a biological child and impacts quality of life following treatment. Access to reproductive care is important and requires patient assessment and appropriate referral to reproductive specialists. This review addresses reproductive complications associated with therapy, standard-of-care testing, and therapeutic interventions. The psychologic impact on psychosexual functioning is also addressed.

Female reproductive health in pediatric, adolescent, and young adult cancer survivors.

An estimated 500,000 cancer survivors of reproductive age in the United States will live to experience the long-term consequences of cancer treatment. Therefore, a focused aspect of cancer care has appropriately shifted to include quality of life in survivorship. Infertility is a late effect of therapy that affects 12% of female survivors of childhood cancer receiving any cancer treatment in large cohort studies and results in a 40% decreased likelihood of pregnancy in young adults of ages 18-39 years. Nonfertility gynecologic late effects such as hypoestrogenism, radiation-induced uterine and vaginal injury, genital graft-versus-host disease after hematopoietic stem cell transplant, and sexual dysfunction also significantly affect quality of life in survivorship but are underdiagnosed and require consideration. Several articles in the special edition "Reproductive Health in Adolescent and Young Adult Cancer Survivorship" address infertility, genital graft-versus-host disease, and psychosexual functioning in survivorship. This review article focuses on other adverse gynecologic outcomes of cancer therapies including hypogonadism and hormone replacement therapy, radiation-induced uterovaginal injury, vaccination and contraception, breast and cervical cancer screening, and pregnancy considerations in survivorship.

Next Steps: Survivor Healthcare Passport - A Novel Form of Survivorship Care Plan in the Pediatric Population.

PURPOSE: Survivorship care plans (SCPs) have been instrumental in aiding transition from cancer treatment to survivorship care, which contains the diagnosis, treatment, potential late effects, and recommended follow-up. There has been paucity of research on its efficacy and lack of guidelines on development and delivery of SCPs. The Next Steps Survivorship Clinic at Children's Wisconsin uses a Survivorship Healthcare Passport (SHP), a SCP pocket-sized card. This study aims to improve understanding of patient and parent use of the SHP at a single institution. MATERIALS AND METHODS: An electronic survey was distributed to cancer survivors (14 to 28 y old) and parents/guardians who received the SCP. Data was analyzed with descriptive and correlation statistics. RESULTS: Older survivors were reliable in carrying their SHP, and endorsed greater confidence in understanding its contents leading to a notion of improved ability to coordinate care. Younger survivors tend to rely on their parents. A preference for a smartphone application as another platform was noted. CONCLUSIONS: This form of SCP has shown to benefit older survivors which directly impacts the notion of efficacy in care coordination. IMPLICATION FOR CANCER SURVIVORS: Providing easy-to-access information may encourage survivors to advocate for their health and to facilitate transition of care.

Developmental differences in health-related quality of life in adolescent and young adult cancer survivors.

PURPOSE: Adolescents and young adults (AYAs) experience developmental transitions. AYA survivors of cancer are at risk for chronic health conditions due to treatment. This study examined developmental differences in AYA survivors' health-related quality of life (HRQOL) between age groups and compared to population norms. METHODS: HRQOL was assessed in AYA survivors of cancer (diagnosed before age 30) in long-term follow-up. Cancer survivors who were 12-39 years old at survey completion and completed therapy ≥ 2 years ago were included. HRQOL was assessed using the PedsQL™ and FACT. RESULTS: Sample size was 155 survivors. PedsQL™ school functioning was worse in 15-17 year olds compared to 12-14 year olds (66.35 vs 77.60, p = 0.012). Compared to population norms, PedsQL™ outcomes were only worse in survivors' school functioning. Survivors' 18-39 years old had FACT scores that were better than population norms for overall HRQOL (91.33 vs 80.1, p < 0.001), and in physical (24.22 vs 22.7, p < 0.001), social (23.46 vs 19.1, p < 0.001), and functional well-being (22.94 vs 18.5, p < 0.001). Regression analysis identified that survivors who were < 15 years old and had not relapsed, and survivors who were 15-18 years old and had ≥ 2 late effects are at highest risk of lower HRQOL. For older survivors the highest risk group for lower HRQOL were < 21 years old at survey completion, > 7 years old at diagnosis and > 6 years post therapy. CONCLUSION: A trend in school functioning issues in older adolescent survivors emerged. Older survivors show improved HRQOL when compared to the general population. Those further off therapy are at risk of poor HRQOL.