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The COVID-19 pandemic may have exacerbated mental health conditions by introducing and/or modifying stressors, particularly in university populations. We examined longitudinal patterns, time-varying predictors, and contemporaneous correlates of moderate-severe psychological distress (MS-PD) among college students. During 2020–2021, participants completed self-administered questionnaires quarterly (T1 = 562, T2 = 334, T3 = 221, and T4 = 169). MS-PD reflected Kessler-6 scores ≥ 8. At T1 (baseline), most participants were cisgender women [96% vs. 4% transgender/gender non-conforming (TGNC)]. MS-PD prevalence was over 50% at all timepoints. MS-PD predictors included low self-rated health and perceptions of local pandemic control, verbal/physical violence experience, food insecurity, cohabitation dynamics, geographic location, and loneliness. Unique MS-PD correlates encompassed drug use and TGNC identity. Trajectories comprised Persistently (40%), Highly (24% MS-PD twice/thrice), Minimally (15% MS-PD once), and Never (21%) Distressed. Persistently Distressed students had low social support and self-rated health; high food insecurity, drug use, physical/verbal violence experience, need-based financial aid, and TGNC representation; and fluctuating self-rated health amid increasing COVID-19 symptomatology. In this sample, MS-PD prevalence was high, persistent, and associated with financial, behavioral, structural, experiential, and intra- and inter-personal factors. Given its complexity, improving and preserving college students' mental health necessitates comprehensive, multi-component activities to change adjustable stressors while attenuating the adverse effects of immutable influences. [ABSTRACT FROM AUTHOR]

Introduction: A comprehensive and innovative adolescent health care program focusing on adolescent health problems in low- and middle-income countries (LMICs) is lacking. We reviewed the research literature on models for adolescent and young adult (AYA)-friendly primary healthcare services (LMICs). Methods and analysis: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review. The PubMed, Embase, and Scopus databases were searched. The data were screened with COVIDENCE software® and extracted thematically. Results: Together, the search generated 1101 articles, 40 of which met the inclusion criteria. The significant domains identified for AYA-friendly healthcare care services in LMICs were health facilities, health literacy, and the environment and empowerment, which were derived from eight themes, namely, appropriate package of services, facility characteristics, data and quality improvement, providers' competencies, adolescent health literacy, equity and nondiscrimination, community support, and adolescent participation. Conclusion: The friendly primary health care services model in LMICs should pay attention to health facilities, literacy, and environmental support. The identified domains provide insight for advising and implementing primary healthcare services that provide a trusted, holistic, comprehensive, integrated, and ongoing health service to AYA, thereby closing the gap in healthcare services for AYA. [ABSTRACT FROM AUTHOR]

Testicular cancer predominantly affects adolescents and young adults (AYAs) aged 15–39 years. This study analyzed the global, regional, and national burden of testicular cancer among AYAs (1990 to 2021). Data from the Global Burden of Disease study was used to calculate age-standardized rates of incidence (ASIR), prevalence (ASPR), and disability-adjusted life years (ASDR). Trends were assessed using the Joinpoint regression and Bayesian age-period-cohort models, with projections up to 2035. Results showed the global ASIR of 4.05 (95% CI: 3.80–4.35), ASPR of 31.05 (95% CI: 28.88–33.68), and ASDR of 24.82 (95% CI: 22.99–26.91) per 100,000 in 2021, respectively. From 1990 to 2021, ASIR and ASPR increased, while ASDR remained relatively stable. Significant geographical disparities were observed, with Europe and Latin America showing higher burdens compared to Asia and Africa. The 25–29 age group had the highest age-specific rate of incidence (5.58; 95% UI: 5.25–5.97) and disability-adjusted life years (34.09; 95% UI: 31.55–37.11) per 100,000, while the 30–34 age group had the highest age-specific prevalence rate (43.12; 95% UI: 40.51–46.56) per 100,000 in 2021. By 2035, the global numbers of incidence and prevalence cases were projected to increase, with DALYs and age-standardized rates declining. These findings are crucial for informing global strategies in testicular cancer prevention. [ABSTRACT FROM AUTHOR]

Primary head and neck lymphoid neoplasms(PHNLN) are described as a series of lymphoid system-derived neoplasms which originally arising from head and neck region. Our study is aimed to present a panoramic view of PHNLN among adolescent and young adult(AYA) patients aged from 15 to 39 years-old. The individual patient information was obtained from Surveillance, Epidemiology and End Results(SEER) database. Male patients outnumbered female patients in most pathological subtypes, with noticeable male predilection observed in Burkitt lymphoma and diffuse large B-cell lymphoma(DLBCL). Classical Hodgkin lymphoma(CHL) accounted for 92.23% of Hodgkin lymphoma. Mature B-cell neoplasms constituted the majority of non-Hodgkin lymphoma(NHL). DLBCL was the most common pathological subtype, followed by follicular lymphoma(FL). Tonsil, salivary glands (especially parotid gland) and nasal cavity were the most three frequent extranodal organs involved. Patients with extranodal involvement exhibited worse prognosis compared to those with lymph node confinement. Patients who suffered from precursor NHL and mature T/NK-cell NHL exhibited prolonged disease-specific survival compared to those with HL, PCN and mature B-cell NHL. AYA patients with absence of other SPM showed dramatic lower risk of death than those with occurrence of SPM. Patients with HL had a favourable survival advantage over those with mature B-cell NHL. Patients with precursor NHL and mature T/NK-cell NHL were at remarkable higher risk of death than those with mature B-cell NHL. Our study elucidated the demographics, distribution of anatomic sites and pathological subtypes, and survival outcomes of PHNLN among AYA population, enhancing comprehension of this rare sort of cancer entities. [ABSTRACT FROM AUTHOR]

Social networks expand rapidly in adolescence, increasing HIV status disclosure considerations and concerns for young people living with HIV, especially in settings where HIV-related stigma is prevalent. This study examines HIV disclosure and enacted stigma among adolescents and young adults living with HIV in South Africa. This study uses survey data from a sample of 1186 youth living with HIV, aged 14–24, and enrolled in peer support groups led by community-based organizations in KwaZulu Natal and Gauteng provinces, South Africa. Study participants completed a questionnaire on sociodemographic details, physical health, school attendance, who knew the individual's HIV status, and experiences of HIV-related mistreatment. Mixed effects logistic regression examined the association between experiences of HIV-related mistreatment and factors that may inadvertently disclose one's status, such as poor physical health and missed school, and knowledge of an individual's HIV-positive status by their caregiver, household, friends, educators, and most recent sexual partner. Almost a quarter of the sample reported an experience of HIV-related mistreatment in the past six months. After controlling sociodemographic characteristics, missed school due to illness (AOR = 1.75, 95% CI = 1.27–2.43), and knowledge of HIV status by non-family members (AOR = 2.19, 95% CI = 1.60-3.00) were significantly associated with HIV-related mistreatment. Findings suggest that experiences of enacted stigma are common among youth and linked to poor physical health and knowledge of HIV status outside the family. Effective community-level stigma reduction interventions are urgently needed. In the meantime, adolescents need individualized disclosure counseling and support managing their physical health to prevent further inadvertent disclosure and discrimination. [ABSTRACT FROM AUTHOR]

Pediatric-type low-grade glioma (PLGG) encompasses a heterogeneous group of WHO grade 1 or 2 tumors and is the most common central nervous system tumor found in children. PLGG extends beyond pediatrics, into adolescents and young adults (AYA, ages 15–40). PLGG represents 25% of all gliomas diagnosed in AYA with differences in tumor location and molecular alterations compared to children, resulting in improved outcome for AYAs. Long-term outcome is excellent, though patients may suffer significant morbidity depending on tumor location. There are differences in treatment practices with radiation used to treat PLGG in AYAs more often than in children. Most PLGG in AYA harbor an alteration in the RAS/MAPK pathway, with limited insight into response to targeted therapy in this age group. This review discusses the epidemiology, current therapeutic approaches, and challenges in the management of PLGG in AYA. [ABSTRACT FROM AUTHOR]

Summary: The annual congress of the American Society of Hematology (ASH) in San Diego in 2023 was very well attended for the first time since the pandemic. In the following article, a brief summary of the highlights regarding acute lymphoblastic leukemia is presented. There were two main focuses in the education sessions: CAR T‑cells and the role of allogeneic stem cell transplantation, and the optimal treatment of adolescents and young adults patients. The oral and poster sessions provided exciting and clinically important data on the following: CAR T‑cells—real-world data; blinatumomab and inotuzumab as first-line therapy; chemo-free combinations for Philadelphia-chromosome-positive acute lymphoblastic leukemia (ALL), long-term side effects of total body irradiation, and new treatment options with venetoclax or revumenib. [ABSTRACT FROM AUTHOR]

Objective: To identify local and functional connectivity abnormalities in the brain's reward network in depressed adolescents and young adults with and without suicidal behavior. Methods: Magnetic resonance imaging data were obtained from 41 major depressive disorder (MDD) patients with suicidal behavior (sMDD, males/females: 12/29), 44 MDD patients without suicidal behavior (nMDD, males/females: 13/32), and 52 healthy controls (HCs, males/females: 17/35). The Young Mania Scale, Hamilton Depression Scale, Columbia Suicide Scale, and Scale for Suicide Ideation were used to evaluate emotional state and suicidal ideation and behaviors. The amplitude of low frequency fluctuations (ALFF), regional homogeneity (ReHo) and functional connectivity of 11 regions of interest (ROIs) in the reward network were determined. RESULTS: ALFF values in the vmPFC of the nMDD group were significantly lower than those in the HC group (p = 0.031). The ReHo values of the nMDD group were lower in the lVS but higher in the vmPFC than those of the HC group (P = 0.018 and 0.025, respectively). Functional connectivity of the AC with the vmPFC, lVS, rVS, and vmPFC was increased in the sMDD group compared with that in the nMDD group (P = 0.038, 0.034, 0.006, respectively). Conclusion: Local and functional connectivity abnormalities in the reward network were found in the MDD groups. However, increased functional connectivity was found in only the sMDD group. [ABSTRACT FROM AUTHOR]

Individuals with inherited cancer syndromes, such as Li-Fraumeni syndrome (LFS), may be motivated to adopt health-protective behaviors, such as eating more fruits and vegetables and increasing physical activity. Examining these health behaviors among young people with high lifetime genetic cancer risk may provide important insights to guide future behavioral interventions that aim to improve health-related quality of life (HRQOL). We used a self-regulatory framework to investigate relationships among diet and physical activity behaviors and psychosocial constructs (e.g., illness perceptions, coping, HRQOL) in adolescents and young adults (AYAs; aged 15–39 years) with LFS. This longitudinal mixed-methods study included 57 AYAs aged 16–39 years at enrollment), 32 (56%) of whom had a history of one or more cancers. Participants completed one or two telephone interviews and/or an online survey. We thematically analyzed interview data and conducted regression analyses to evaluate relationships among variables. AYAs described adopting healthy diet and physical activity behaviors to assert some control over health and to protect HRQOL. More frequent use of active coping strategies was associated with greater reported daily fruit and vegetable intake. Greater reported physical activity was associated with better quality of psychological health. Healthy diet and physical activity behaviors may function as LFS coping strategies that confer mental health benefits. Clinicians might emphasize these potential benefits and support AYAs in adopting health behaviors that protect multiple domains of health. Future research could use these findings to develop behavioral interventions tailored to AYAs with high genetic cancer risk. [ABSTRACT FROM AUTHOR]

We investigated the association between early sexual debut and HIV infection among adolescents and young adults. Analyzing data from nationally representative Population-Based HIV Impact Assessment (PHIA) surveys in 11 African countries, the research employed a multivariate logistic regression model to assess the relationship between the early sexual debut and new HIV infections in the age group of 10–24 years. The results revealed a significant and robust association, indicating that young individuals who experienced early sexual debut were approximately 2.65 times more likely to contract HIV than those who did not, even after accounting for other variables. These findings align with prior research suggesting that early initiation of sexual activity may increase vulnerability to HIV infection due to factors such as biological susceptibility and risky behaviors like low condom use and multiple sexual partners. The implications of these findings for HIV prevention strategies are substantial, suggesting that interventions aimed at delaying sexual debut could be an effective component in reducing HIV risk for this population. Targeted sex education programs that address the risks of early sexual debut may play a pivotal role in these prevention efforts. By employing a comprehensive approach, there is a possibility to advance efforts towards ending AIDS by 2030. [ABSTRACT FROM AUTHOR]

Purpose: Acute lymphoblastic leukemia (ALL) is a type of blood cancer that affects white blood cells. Here, we use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, to estimate the burden and incidence rate changes in adolescents and young adults (AYA) ALL in the Western Pacific Region and to reveal potential risk factors of incidence- and mortality rates. Methods: The GBD 2019 study data was stratified by sex, age, country, and territory. We calculated the Estimated annual percentage changes (estimated APC) in mortality and incidence rates for each of the 25 countries and territories of the western Pacific region from 1990 to 2019. Results: This study found global AYA ALL incidence rates had increased while the mortality rates had decreased between 1990 and 2019. Moreover, healthcare access and quality (HAQ), and government per capita health spending were identified as country-level risk factors of AYA ALL incidence rates, while HAQ, male education, and sex were identified as mortality rate predictors in 25 Western Pacific Region countries. Conclusion: To address and reduce the burden of incidence and mortality among AYA, various regions around the world, particularly developing countries, could revise their AYA prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is one of the most common cancers worldwide, and screening colonoscopy has led to a decreasing incidence rate. However, the incidence of CRC is increasing among young people, especially adolescents and young adults (AYAs) who are not routinely screened. Although CRC is the fourth most common cancer among AYAs, it is extremely rare. In younger patients, CRC is often diagnosed later, and the proportion of patients with advanced CRC is higher than that in older patients. We herein present a case of poorly differentiated mucinous carcinoma of the ascending colon complicated by bilateral ovarian mature cystic teratomas (MCTs) in an AYA. Case presentation: A 17-year-old female patient presented with a chief complaint of abdominal pain and diarrhea that had persisted for more than 3 years. Colonoscopy revealed circumferential wall thickening of the ascending colon, and colonic biopsy revealed a mucous mass and findings of adenocarcinoma, predominantly signet ring cell carcinoma. Abdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) showed bilateral ovarian tumors. Laparoscopic right hemicolectomy and enucleation of bilateral ovarian tumors were performed. Although the ascending colon cancer formed a large mass, there were no signs of peritoneal dissemination or direct invasion to the surrounding organs. Microscopically, the ascending colon was a poorly differentiated mucinous carcinoma with signet ring cell carcinoma and lymph node metastasis (9/42). The ovarian tumors were diagnosed as MCTs without any malignant components. The pathological diagnosis was ascending colon cancer (pT4aN2bM0, pStage IIIC) and bilateral ovarian MCTs. Microsatellite instability (MSI) testing was negative, and there were no gene mutations in either RAS or BRAF. Postoperative adjuvant chemotherapy with oxaliplatin and 5-FU was started. Conclusions: We presented a case of locally advanced ascending colon cancer in a 17-year-old female patient. CRC rarely occurs in AYAs. However, the incidence has gradually increased in recent years. It should be considered as a differential diagnosis for young patients with long-term abdominal symptoms of unknown cause. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was threefold: (1) to explore Danish adolescents and young adults’ (AYAs) thoughts concerning sexual health particularly focusing on sexuality, intimacy, and body image throughout a cancer trajectory, (2) to investigate how AYAs experience healthcare professionals address of- and respond to sexual health issues, and (3) to identify AYAs’ suggestions on how to support conversation about sexual health. Methods: A qualitative, single-center study was conducted, including AYAs (18–29 years) diagnosed with cancer recruited at the University Hospital of Copenhagen, Rigshospitalet. Individual semi-structured interviews were conducted from January–February 2023, recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Twelve participants were interviewed, aged 20–29; five were diagnosed with hematological- and seven with oncological cancer. Our analyses yielded three themes: (1) sexuality and body image as part of the identity, (2) excluding relatives in conversations about sexual health, and (3) uncertainty how to discuss sexual health with healthcare professionals. Finally, the AYAs’ suggestions to support conversations about sexual health were organized into six thematic categories. Conclusion: In this study, participants experienced altered sexual subsequent impacts on body image and self-esteem during their cancer trajectory. While some adapted to these changes, discussing them with healthcare providers was difficult, especially in the presence of relatives, as the AYAs wanted to shield them from additional concerns. To enhance support, AYAs suggest regular discussions on sexual health and the use of a dialog tool by healthcare professionals. [ABSTRACT FROM AUTHOR]

Introduction: Lesotho has the second-highest prevalence of HIV. Despite progress in achieving HIV epidemic control targets, inequities persist among certain groups, particularly associations between disability, HIV, and violence. We assessed the prevalence of disability and examined associations between disability and HIV and violence using data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS). Methods: Lesotho VACS was a nationally representative survey of females and males ages 13–24. We assessed the associations between disability status and HIV, sexual risk behaviours, and violence using logistic regression, incorporating survey weights. Results: Weighted functional disability prevalence was 14.1% for females (95% confidence interval [CI] 12.7–15.4) and 7.3% for males (5.3–9.2). Compared with females with no disabilities, females with disabilities had higher odds of being HIV positive (adjusted odds ratio [aOR] 1.92, 1.34–2.76), having transactional sex (aOR 1.79, 1.09–2.95), and experiencing any lifetime violence (aOR 2.20, 1.82–2.65), sexual violence (aOR 1.77, 1.36–2.31), emotional violence (2.02. 1.61–2.53), physical violence (aOR 1.85, 1.54–2.24), witnessing interparental violence (aOR 1.71, 1.46–2.01), and witnessing community violence (aOR 1.52, 1.26–1.84). Males with disabilities had higher odds of having transactional sex (aOR 4.30, 1.35–13.73), having recent multiple sex partners (aOR 2.31, 1.13–4.75), experiencing emotional violence (aOR 2.85, 1.39–5.82), and witnessing interparental violence (aOR 1.78, 1.12–2.84). HIV models for males did not converge due to low numbers. Conclusion: Findings emphasize the importance of inclusion and accessibility for adolescents and young adults with disabilities in prevention and services for violence and HIV. Ending HIV in Lesotho depends on addressing the vulnerabilities that lead to potential infection including violence and ensuring equitable services for all. [ABSTRACT FROM AUTHOR]

Objective: Peer support is an essential component of adolescence and is instrumental in reducing feelings of isolation and loneliness. Yet, many youth and young adults experiencing a chronic medical condition conceal or minimize aspects of their conditions due to feared rejection. Disclosure practices in adolescents with chronic illnesses are not well-studied with little known about the nature of information disclosed. This study sought to better understand the relationship between the depth of information disclosed to friends and health-related quality of life, response to stress, and coping strategies. Methods: The sample consisted of 140 patients between the ages of 15–21 years who were recruited from seven sub-specialty medical clinics. Quantitative data was collected from a baseline survey examining disclosure, coping, and health-related quality of life. Results: Three groups were created and compared based on participant responses to the types of information being disclosed to friends: No Disclosure, Facts, and Concerns/Emotions. Participants who disclosed the psychological impact and concerns related to their condition tended to be female and had a significantly higher number of friends to whom they disclosed. This group of participants also tended to endorse higher levels of illness-related stress and was engaging in more positive coping strategies than those who chose not to disclose information or only shared objective information about their conditions. Conclusion: Understanding of the nuances of the depth and decision-making of disclosure is necessary for providers to be able to support youth with chronic illness as they navigate their social environment and relationships. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent and young adult cancer survivors (AYAs) are at increased risk of long-term and late effects, and experience unmet needs, impacting their health-related quality of life (HRQoL). In order to provide and optimize supportive care and targeted interventions for this unique population, it is important to study HRQoL factors’ interconnectedness on a population level. Therefore, this network analysis was performed with the aim to explore the interconnectedness between HRQoL factors, in the analysis described as nodes, among long-term AYAs. Methods: This population-based cohort study used cross-sectional survey data of long-term AYAs, who were identified by the Netherlands Cancer Registry (NCR). Participants completed a one-time survey (SURVAYA study), including the EORTC survivorship questionnaire (QLQ-SURV111) to assess their long-term HRQoL outcomes and sociodemographic characteristics. The NCR provided the clinical data. Descriptive statistics and a network analysis, including network clustering, were performed. Results: In total, 3596 AYAs (on average 12.4 years post diagnosis) were included in our network analysis. The network was proven stable and reliable and, in total, four clusters were identified, including a worriment, daily functioning, psychological, and sexual cluster. Negative health outlook, part of the worriment cluster, was the node with the highest strength and its partial correlation with health distress was significantly different from all other partial correlations. Conclusion: This study shows the results of a stable and reliable network analysis based on HRQoL data of long-term AYAs, and identified nodes, correlations, and clusters that could be intervened on to improve the HRQoL outcomes of AYAs. [ABSTRACT FROM AUTHOR]

Purpose: Treatment advancements have improved life expectancy for adolescents and young adults (AYAs) with an uncertain and/or poor cancer prognosis (UPCP) and change clinical practice. This improved survival requires a different approach and specific expertise to meet the needs of this group. The aim of this study is to explore the health care experiences of AYAs with a UPCP. Methods: We conducted a multicenter qualitative study using semi-structured interviews and elements of the grounded theory by Corbin and Strauss. Results: Interviews were conducted with 46 AYAs with a UPCP. They were on average 33.4 years old (age range 23–44), and most of them were woman (63%). Additionally, five AYAs with a UPCP participated as AYA research partners in two focus groups. They were on average 31.8 years old and four of them were woman. AYAs with a UPCP reported four pillars for a satisfied healthcare experience: (1) trust, (2) tailored communication, (3) holistic empathic open attitude, and (4) care being offered (pro-)actively. They reported both optimal and suboptimal experiences about distrust based on a delay in diagnostic trajectory, lack of tailored communication and discussion of sensitive topics, preference for a holistic approach, and struggles with finding the way to get additional healthcare support. Conclusion: For AYAs with a UPCP, it is important that both age-specific issues and issues related to the UPCP are understood and addressed; however, this seems not yet optimally implemented in clinical practice. This emphasizes the importance of providing this patient group with tailored care incorporating both aspects. Healthcare professionals need to be supported with training and tools to understand the healthcare needs of AYAs with a UPCP. AYAs can be empowered to take more control over their own healthcare needs [ABSTRACT FROM AUTHOR]

The health-related quality of life (HRQoL) among long-term Adolescent and Young Adult Cancer Survivors (AYACS) and an age- and sex-matched normative population was examined. Although the HRQoL of AYACS was worse compared to the normative population before and during the COVID-19 pandemic, the scores of AYACS improved over time in contrast to the normative population. Presumably, AYACS are used to adjusting their lives to stressful life events. Furthermore, the lockdown may have been beneficial for AYACS who face difficulties fully participating in society due to the impact of cancer. AYACS who encounter HRQoL issues could benefit from support interventions to empower them and build resilience. [ABSTRACT FROM AUTHOR]

It is important to investigate whether subjective health mediated the relationship between personality and life satisfaction, and whether the rural-to-urban migration experience moderated this relationship via subjective health. The findings could inform ways to promote subjective health and improve life satisfaction for rural-to-urban migrant adolescents and young adults. However, few studies have examined these research questions, and the present study therefore investigated them. Participants were recruited from six high schools and universities, and were selected randomly at each school using the cluster random sampling method. A total of 943 Chinese adolescents and young adults participated in the study (17.18 ± 1.76 years old; 415 with rural-to-urban migration experience and 528 without migration experience). The NEO-Five-Factor inventory, the Satisfaction with Life Scale, and subjective health complaints were implemented. The results showed that subjective health was significantly correlated with both personality and life satisfaction. In addition, subjective health mediated the relationship between personality and life satisfaction. Moderated mediation analysis further indicated that the direct and indirect relationships between personality and life satisfaction were moderated by the rural-to-urban migration experience. The indirect effect of the extraversion dimension of personality on life satisfaction via subjective health was weaker for rural-to-urban migrant adolescents than for nonmigrant adolescents and young adults. In summary, subjective health mediated the relationship between personality and life satisfaction; further, the rural-to-urban migration experience moderated the relationship between personality and life satisfaction via subjective health, which fills the knowledge gaps. [ABSTRACT FROM AUTHOR]

Purpose: Nine hundred female adolescents and young adults (AYAs) aged 15–39 are diagnosed with cancer in Denmark annually. Advances in cancer therapy have led to increased long-term survival; however, a serious side effect of cancer therapy is reduced fertility. The aim of our study was to explore the thoughts about fertility among female AYAs with cancer. Methods: Our study was conducted from September 2020 to March 2021 at the Copenhagen University Hospital, Rigshospitalet. Inclusion criteria were female AYAs with cancer aged 18–39. Twelve individual, semi-structured, qualitative interviews were performed with female AYAs with cancer (20–35 years). Data were analysed using thematic analysis. Results: Four main themes were found: (1) the female AYAs held on to a hope of having children in the future; (2) the female AYAs experienced time pressure and waiting time as a sprint as well as a marathon; (3) the female AYAs faced existential and ethical choices about survival and family formation; and (4) the female AYAs felt a loss of control of their bodies. Conclusion: Our study contributes with knowledge on how important holding on to the hope of children in the future is among female AYAs with cancer. Meanwhile, they are frustrated by the rushed decision on fertility preservation at diagnosis. The female AYAs also have existential and ethical concerns related to the choice of cancer therapy and fertility preservation. Finally, they suffer from altered body image, loss of femininity, and body control due to hormone therapy. [ABSTRACT FROM AUTHOR]

A better understanding of the transition from child to adult community mental health services is important given the high rates of service drop-out. Conducting longitudinal research is challenging during a major service provider change. Developmentally-typical transition-to-adulthood instability can deter study engagement. This study examines the efficacy of creative technology-based strategies to recruit and engage adolescents and young adults (AYA) with serious mental health diagnoses in a qualitative study during their transition from child to adult services. Participants were recruited from one agency to complete three in-depth qualitative interviews and monthly surveys exploring mental health service experiences over 12-months. Participants received a smartphone and data plan for 6-months at initial interview, $50 at 6-month interview and $55 at 12-month interview. Four research assistants used a shared Google Voice account to text monthly online surveys and to communicate with participants. 19 participants enrolled; 74% remained enrolled across the 12-months. Smartphones and data plans were not effective in recruiting nor sustaining study engagement for most participants. Participants preferred a mix of texting and phone calls to prompt study engagement; 60% of online surveys were completed. Unanticipated participant-researcher communication outside of research scope suggests that the formation of strong relationships and additional support during this transitional time is critical for sustained study engagement. Study findings have practical implications for social work longitudinal research design and effective study implementation. Future social work research is warranted on innovative strategies to boost study and service engagement among AYA with serious co-occurring mental health and developmental instability. [ABSTRACT FROM AUTHOR]

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Background: Adolescents and young adults face various socio-emotional and behavioral challenges that can affect their medical and psychosocial outcomes. Pediatric patients with end-stage kidney disease (ESKD) often have extra-renal manifestations, including intellectual disability. However, limited data are available regarding the impact of extra-renal manifestations on medical and psychosocial outcomes among adolescents and young adults with childhood-onset ESKD. Methods: Patients born between January 1982 and December 2006 that had developed ESKD in 2000 and later at age < 20 years were enrolled in this multicenter study in Japan. Data for patients' medical and psychosocial outcomes were retrospectively collected. Associations between extra-renal manifestations and these outcomes were analyzed. Results: In total, 196 patients were analyzed. The mean age at ESKD was 10.8 years, and at last follow-up was 23.5 years. The first modality of kidney replacement therapy was kidney transplantation, peritoneal dialysis, and hemodialysis in 42, 55 and 3% of patients, respectively. Extra-renal manifestations were documented in 63% of patients and 27% had intellectual disability. Baseline height at kidney transplantation and intellectual disability significantly impacted final height. Six (3.1%) patients died, of which five (83%) had extra-renal manifestations. Patients' employment rate was lower than that in the general population, especially among those with extra-renal manifestations. Patients with intellectual disability were less likely to be transferred to adult care. Conclusions: Extra-renal manifestations and intellectual disability in adolescents and young adults with ESKD had considerable impacts on linear growth, mortality, employment, and transfer to adult care. [ABSTRACT FROM AUTHOR]

Vasculogenic mesenchymal tumor (VMT), a primitive mesenchymal neoplasm enriched by various-sized atypical vessels, is a new entity that develops in mediastinal germ cell tumors (GCTs) with yolk sac tumor (YST) components after chemotherapy. Notably, patients with VMT in the residual GCT have increased risk of developing sarcomas or hematopoietic malignancies. Here, we report a late-teenage male patient with residual teratoma and high-grade VMT after chemotherapy for a mediastinal mixed GCT, including YST. Whole-exome sequencing revealed biallelic inactivation of TP53 and extensive copy number alterations that suggested whole-genome doubling. The biopsy tissue of the mixed GCT before chemotherapy exhibited overlapping genetic alterations to those in the VMT. Immunohistochemical analyses of the VMT showed that the abnormal vessels were positive for cytokeratin, glypican 3, EZH2, and IMP3. The findings that VMT inherits the genetic alterations of pre-existing mixed GCT and exhibits a partly YST-like immunophenotype might contribute to its clinical aggressiveness. [ABSTRACT FROM AUTHOR]

Adolescents and young adults (AYAs) benefit from healthcare transition (HCT) programs. Despite the well-established literature reviewing HCT, a considerable heterogeneity exists on the involved healthcare professionals. This review aims to explore systematic reviews on the practices and recommendations on which disciplines of professionals should be involved in HCT. An umbrella review was performed using the MEDLINE, EMBASE, and Web of Science databases. To be eligible, systematic reviews had to report on the composition and/or the rationale of members of a transition team. Seventeen reviews were included in this systematic review. A healthcare professional that coordinates HCT was identified as a key caregiver in all reviews. Other reported members of a HCT team were nurses (75% of the reviews), social workers (44%), and peers/mentors (35%). The reported key responsibilities of a HCT team were to (i) manage communication, (ii) ensure continuity of care, and (iii) maintain contact with community services. Conclusions: A team responsible for HCT should be active on the organizational, medical, and social levels. Key members of a HCT team vary little between diseases and included a coordinator, social worker, and nurse. A coordinating physician could facilitate transition in complex conditions. At all times, the condition and needs of the AYA should determine who should be involved as caregiver. What is Known: • The psychosocial needs of adolescents and young adults during healthcare transition are largely similar between chronic diseases. What is New: • Coordinators, nurses and social workers were the most involved, independent of the condition. • A liaison team should be active on organizational-, medical- and social-levels. [ABSTRACT FROM AUTHOR]

Purpose: Radiation therapy (RT) is a critical component of treatment for adolescents and young adults (AYAs, age 15–39 years old) diagnosed with cancer. Limited prior studies have focused on AYAs receiving RT despite the potentially burdensome effects of RT. We reviewed the literature to assess health-related quality of life (HRQOL) in AYAs with cancer who received RT. Methods: The MEDLINE, EMBASE, and Web of Science databases were searched in January 2022 to identify studies that analyzed HRQOL measured by patient-reported outcomes in AYAs who received RT. After title (n = 286) and abstract (n = 58) screening and full-text review (n = 19), articles that met eligibility criteria were analyzed. Results: Six studies were analyzed. Two studies included AYAs actively receiving treatment and all included patients in survivorship; time between diagnosis and HRQOL data collection ranged from 3 to > 20 years. Physical and mental health were commonly assessed (6/6 studies) with social health assessed in three studies. AYA-relevant HRQOL needs were rarely assessed: fertility (1/6 studies), financial hardship (1/6), body image (0/6), spirituality (0/6), and sexual health (0/6). No study compared HRQOL between patients actively receiving RT and those post-treatment. None of the studies collected HRQOL data longitudinally. Conclusion: HRQOL data in AYAs receiving RT is limited. Future studies examining longitudinal, clinician- vs. patient-reported, and AYA-relevant HRQOL are needed to better understand the unique needs in this population. [ABSTRACT FROM AUTHOR]

Purpose: In the acute lymphoblastic leukemia (ALL) landscape, adolescents and young adults (AYA) often present high-risk diseases and increased chemotherapy-related toxicity. Studies analyzing the outcomes of AYA after hematopoietic stem cell transplantation (HSCT) are scarce. Our study aimed to compare the outcomes of children and AYA with ALL after HSCT and to determine the factors influencing potential differences. Method: 891 patients, from the SFGM-TC registry, aged between 1 and 25 years who received HSCT between 2005 and 2012 were included. The outcomes of AYA were compared to the ones of their younger counterparts. Results: Five-year OS and GRFS were lower in AYA: 53.1% versus 64% and 36% versus 47% (p = 0.0012 and p = 0.007, respectively). WhileCIR was similar in both groups, 5 year-treatment related mortality was higher in AYA: 19% versus 13% (p = 0.04). The lower GRFS in AYA was mainly explained by a higher chronic graft versus host disease (cGvHD) incidence: 32% versus 19% (p < 0.001). Use of peripheral blood stem cells and use of anti-thymoglobulin appeared to be the main factors impacting cGvHD occurrence in AYA. Conclusion: AYA have worse outcomes than children after HSCT for ALL because of a greater risk of TRM due to cGvHD. HSCT practices should be questioned in this population. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors. Methods: We conducted a cross-sectional survey of AYAs aged 18–49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia. Results: The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11–4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18–3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18–4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08–3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03–3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08–8.29) or unemployed (AOR 3.97, 95% CI 1.46–10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43–13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05–4.70) and being single (AOR 2.52, 95% CI 1.08–5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively. Conclusions: The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness. Implications for Cancer Survivors. Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes. [ABSTRACT FROM AUTHOR]

Encounters with discrimination are a normative experience for many Black and Latino adolescents and young adults (AYAs); these experiences may be even more common for expecting AYAs. While the harmful effects of discriminatory experiences on mental and physical health have been well explored, relatively little is known regarding the impact of discrimination on relationship quality and sexual health—specifically HIV/STI risk. Using the Actor Partner Interdependence Model, we examined both actor and partner effects of discrimination on relationship quality and willingness to be non-monogamous in a sample of 259 pregnant adolescent and young adult couples. There was a significant indirect actor effect, such that one's own discrimination was associated with a decrease in their own relationship quality which, in turn, was associated with their own greater willingness to be non-monogamous. The partner effect for the association of one's partner's discrimination on one's own relationship quality was not significant. Findings highlight the need for more attention to the implications of discrimination on relational and sexual health. [ABSTRACT FROM AUTHOR]

Background: The focus on cancer in adolescents and young adults (AYA) has increased in recent years. We participated in an event called AYA week 2021 as part of a research project of the Ministry of Health, Labour and Welfare (MHLW) and conducted a fact-finding survey to collect information for raising public awareness of AYA-generation cancers and to improve support for AYA-generation cancer patients. Methods: A 25-item questionnaire survey was conducted through requests sent to the deans of medical schools and presidents of related universities across Japan and by advertising on social networking sites and friendship networks. Furthermore, the effects of a lecture given by three cancer survivors on their cancer experience were examined. Results: A total of 1288 healthcare students participated. The most common age group was between 20 and 24 years, with the majority being medical students (83%). The AYA cancer-educated population had more knowledge about AYA-generation cancers than the overall group. At present, very few people are familiar with AYA-generation cancers (30.5%), which highlights the importance of school education. There were 163 participants who attended the lecture given by the cancer survivors, of whom 108 completed the questionnaire. The results showed high participant satisfaction related to the lecture given by cancer survivors, suggesting that such lectures could help educate and raise awareness about AYA-generation cancers. Conclusions: The knowledge survey and lecture given by cancer survivors had educational effects. Many healthcare students responded positively, suggesting the efficacy of these types of initiatives. [ABSTRACT FROM AUTHOR]

Bone sarcoma often occurs in childhood, as well as in adolescents and young adults (AYAs). AYAs differ from pediatric patients in that their bone is skeletally mature and the physis has almost disappeared with the completion of growth. Although AYAs spend less time outside, they often participate in sports activities, as well as driving, working, and raising a family, which are natural activities in daily living. Multidisciplinary approaches involving imaging, multi-agent chemotherapy, surgical procedures, and careful postoperative care has facilitated an increase in limb-sparing surgery for bone sarcoma. In addition, recent advances in imaging modalities and surgical techniques enables joint-preservation surgery, preserving the adjacent epiphysis, for selected patients following the careful assessment of the tumor margins and precise tumor excision. An advantage of this type of surgery is that it retains the native function of the adjacent joint, which differs from joint-prosthesis replacement, and provides excellent limb function. Various reconstruction procedures are available for joint-preserving surgery, including allograft, vascularized fibula graft, distraction osteogenesis, and tumor-devitalized autografts. However, procedure-related complications may occur, including non-union, infection, fracture, and implant failure, and surgeons should fully understand the advantages and disadvantages of these procedures. The longevity of the normal limb function for natural activities and the curative treatment without debilitation from late toxicities should be considered as a treatment goal for AYA patients. This review discusses the concept of joint-preservation surgery, types of reconstruction procedures associated with joint-preservation surgery, and current treatment outcomes. [ABSTRACT FROM AUTHOR]

Soft-tissue sarcoma is a rare cancer that accounts for approximately 1% of all malignant tumors. Although they occur in various age groups, soft-tissue sarcomas account for 8% of all malignant tumors developing in adolescents and young adults, suggesting that they are not rare in this age group. This study aimed to evaluate the clinical and pathological characteristics of soft-tissue sarcoma in adolescents and young adults. According to the Bone and Soft-Tissue Tumor Registry in Japan, myxoid liposarcoma is the most common type of soft-tissue sarcoma found in adolescents and young adults; alveolar soft part sarcoma, extraskeletal Ewing sarcoma, epithelioid sarcoma, clear cell sarcoma and synovial sarcoma occur predominantly in this age group among soft-tissue sarcomas. The analysis based on this registry demonstrated that age was not a prognostic factor for poor survival of soft-tissue sarcoma, although the prognosis in adolescents and young adults was better than that in older patients in the US and Scandinavia. Adolescent and young adult patients with soft-tissue sarcoma have age-specific problems, and a multidisciplinary approach to physical, psychological, and social issues is necessary to improve the management of these young patients both during and after treatment. [ABSTRACT FROM AUTHOR]

Background: Cancer development in adolescents and young adults (AYAs) has elicited recent interest. We investigated the surgical and functional outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) for renal cell carcinoma (RCC) in AYAs. Methods: We retrospectively reviewed the medical records of 1023 patients with clinical stage I RCC who underwent RAPN before January 2021. Patients were divided into two groups: AYAs (aged 18–39 years) and non-AYAs (aged 40–89 years). The trifecta criteria, defined as a negative surgical margin, no perioperative complications (Clavien–Dindo grade > 2), and preserved postoperative renal function (1-year postoperative estimated glomerular filtration rate > 90% of baseline), were used to compare outcomes. We performed 1:1 propensity-score matching on the patient cohort. Results: There were initially 125 and 898 patients in the AYAs and non-AYAs groups, respectively, and 108 patients were included in each group after propensity score matching. There were no significant differences in surgical factors (operation time, clamping ischemia time, estimated blood loss, length of hospital stay, surgical complication rate) or renal function in the early postoperative period. The mean postoperative renal function was better (p = 0.0200) and the decrease in estimated glomerular filtration rate was lower (p = 0.0026) in AYAs than in non-AYAs 12 months postoperatively. The trifecta achievement rates in the AYAs and non-AYAs groups were significantly different (67.6% and 53.7%, respectively, p = 0.0220). Conclusion: Although there was no difference in surgical burden between the groups, the estimated glomerular filtration rate was better preserved in AYAs than in non-AYAs at 6 and 12 months post-RAPN. [ABSTRACT FROM AUTHOR]

Introduction HD-MTX is a key drug in the treatment protocols for ALL. The regimen needs to be administered with appropriate supportive measures and serum methotrexate level monitoring. A limited testing strategy is relevant in resource constraint settings since it allows a shorter duration of hospitalization. We report our experience with this strategy and its impact on the patient safety outcomes. Methods This is a retrospective study of all patients ≥ 15 years of age with newly diagnosed ALL or Lymphoblastic lymphoma (LBL) who were administered HDMTX (part of BFM-90 ALL protocol) at our institute between March 2013 to November 2013.The medical records were reviewed for clinical characteristics, disease-related details, HDMTX dose and cycles administered, leucovorin rescue and toxicities. Results A total of 423 cycles of HD-MTX were administered to 106 patients during the study period. The median duration for completion of all 4 cycles of HDMTX was 53 (IQR 49–60) days. The grade 3 or higher toxicities were anemia in 9.6%, neutropenia 19.4%, febrile neutropenia 5.7%, thrombocytopenia 4.4% and mucositis in 0.7%. There was statistically significant correlation between the levels at 42 h (≤ 1 mmol/L vs > 1 mmol/L) and toxicity- anemia, FN and mucositis observed more in the late clearance group. With limited sampling strategy whereby if the 42- hour level MTX level are < 1 mmol/L, 57% of patients could be discharged early. Conclusion HD-MTX can be safely administered to adolescent and adult ALL patients. A limited methotrexate level monitoring is a safe strategy that can optimize the resources better. [ABSTRACT FROM AUTHOR]

Purpose: Resilience plays an important role in helping individuals to adapt to adversity and improve their psychosocial outcomes. This study aims to examine the mediating role of coping in the relationship between family function and resilience in adolescents and young adults (AYAs) who have a parent with lung cancer. Method: A total of 135 AYAs with a lung cancer parent were recruited from a tertiary grade A cancer center in southern China, and investigated using a self-designed general information questionnaire, the Resilience Scale for Chinese Adolescents, the Simplified Coping Style Questionnaire, and the Family Adaptation, Partnership, Growth, Affection, Resolve index. Results: The mean score of AYAs' resilience was (3.61 ± 0.49), and its influencing factors included AYAs' years in work, family function, and positive coping. The total effect of family function on resilience was significant (total effect = 0.38, 95% CI [0.048–0.115]), and a positive indirect effect was identified for family function on resilience via positive coping (indirect effect = 0.10, 95% CI [0.005–0.043]). Conclusion: Family functioning can facilitate resilience either directly or by promoting positive coping. This study suggests that individualized interventions can be made to improve resilience by promoting family function, or by enhancing positive coping in AYAs with a lung cancer parent. [ABSTRACT FROM AUTHOR]

Purpose: Hepatic sinusoidal obstruction syndrome (SOS) represents a serious complication following hematopoietic stem cell transplantation (HSCT). Our study aimed to investigate important risk factors of SOS in a pediatric population. Methods: This retrospective study analyzed 105 children, adolescents and young adults who underwent allogeneic HSCT at our pediatric HSCT center in Jena. The observation period was 12 years and SOS was defined by the pediatric criteria of the European Society for Blood and Marrow Transplantation (EBMT). Results: 15 out of all 105 patients developed SOS (14.3%). The median time from HSCT to SOS diagnosis was 12 days. The mortality rate of SOS was 20.0%. In univariate analyses, we identified the significant risk factors of patient age < 1 year [odds ratio (OR) = 7.25, p = 0.037], prior treatment with gemtuzumab ozogamicin (OR = 11.00, p = 0.020), high pretransplant ferritin levels above 1500 ng/mL (OR = 4.00, p = 0.033), 2000 ng/mL (OR = 4.69, p = 0.016), and 2400 ng/mL (OR = 5.29, p = 0.005) as well as international normalized ratio (INR) ≥ 1.3 (OR = 5.91, p = 0.009). The following risk factors could be confirmed in multivariate analysis: treatment with gemtuzumab ozogamicin (OR = 9.24, p = 0.048), ferritin > 2400 ng/mL (OR = 5.74, p = 0.023), and INR ≥ 1.3 (OR = 8.02, p = 0.007). Conclusion: Our study confirms several risk factors from the current literature. Additionally, this is the first report on the risk factor of high pretransplant INR. [ABSTRACT FROM AUTHOR]

Cervical cancer ranks high among the cancers that affect people in their 20s and 30s. Cervical cancer is characterized by the presence of precancerous lesions, which can be detected by cancer screenings; some precancerous lesions are amenable to treatment, which can halt the progression to invasive cancer. As a result, cervical cancer screening has been shown to reduce the incidence of invasive cancer and its mortality. On the other hand, many precancerous lesions do not progress to invasive cancer, but stagnate or disappear spontaneously. In Japan, there is a nationwide cytological screening program for residents, and the screening is performed every two years after the age of 20. There are also screening programs provided by the workplaces in Japan. According to the National Health Survey 2019, the checkup rates of any type of cervical cancer screenings are low: 15.1% for those aged 20–24, 36.6% for those aged 25–29, and 49.4% for those aged 30–34. Statistics are reported every year for the nationwide screening, and according to them, the positive screening rate is 2.1% for all ages, but 4.5% and 3.2% for those in their 20s and 30s, respectively. On the other hand, the percentage of people with positive test results who undergo follow-up examinations or confirmatory tests should be at least 90%, but it is 72.1% for all ages, 72.0% for those in their 30s, and even lower for those in their 20s, at 67.1%. Improving the rate of people getting screenings and subsequent examinations is a challenge even among the young. [ABSTRACT FROM AUTHOR]

Background: Adolescents and young adults (AYAs) diagnosed with cancer are at an increased risk of experiencing social isolation and loneliness secondary to their cancer and its treatment. The physical distancing measures implemented during the COVID-19 pandemic may have further increased loneliness among this group. This study examined the prevalence of loneliness and factors associated with loneliness among AYAs with cancer during this pandemic.Methods: We conducted a self-administered, online, cross-sectional survey of Canadian AYAs diagnosed with cancer between 15 and 39 between January and February 2021. Loneliness was measured using the 3-item UCLA Loneliness Scale. Factors associated with higher levels of loneliness were identified using multiple logistic regression.Results: The analysis included 805 AYAs. The prevalence of loneliness was 52.2% [N = 419, 95% CI (confidence interval) 48.7 to 55.6%]. Individuals who were 18-25 years old [AOR (adjusted odds ratio)1.60, CI 1.03-2.47, p = 0.035], currently undergoing cancer therapy (AOR 1.46, 95% CI 1.03-2.07, p = 0.035), who self-disclosed the presence of a pre-pandemic mental health condition (AOR 2.09, 95% CI = 1.22-3.58, p = 0.007), or were not in a relationship (AOR 2.22, 95% CI 1.57-3.14, p < 0.001) were more likely to report loneliness than others. Participants that lived in rural or remote locations were less likely to experience loneliness (AOR 0.59, 95%CI 0.40-0.87, p = 0.008).Conclusion: One in two AYAs with cancer are feeling lonely during the COVID-19 pandemic. Future studies for developing interventions to target loneliness, particularly for those at greater risk, are necessary to improve the health and quality of life of AYAs with cancer. [ABSTRACT FROM AUTHOR]

Oral HIV self-testing (HIVST) may expand access to testing among hard-to-reach reach adolescents and young adults (AYA). We evaluated community-based HIVST services for AYA in an urban settlement in Kenya. Peer-mobilizers recruited AYA ages 15–24 through homes, bars/clubs, and pharmacies. Participants were offered oral HIVST, optional assistance and post-test counseling. Outcomes were HIVST acceptance and completion (self-report and returned kits). Surveys were given at enrollment, post-testing, and 4 months. Log-binomial regression evaluated HIVST preferences by venue. Among 315 reached, 87% enrolled. HIVST acceptance was higher in bars/clubs (94%) than homes (86%) or pharmacies (75%). HIVST completion was 97%, with one confirmed positive result. Participants wanted future HIVST at multiple locations, include PrEP, and cost ≤ $5USD. Participants from bars/clubs and pharmacies were more likely to prefer unassisted testing and peer-distributers compared to participants from homes. This differentiated community-based HIVST strategy could facilitate engagement in HIV testing and prevention among AYA. [ABSTRACT FROM AUTHOR]

Purpose: Given the large number of adolescents and young adults (AYAs) impacted by parental cancer and the potential for negative psychosocial outcomes in this vulnerable population, this study examined the mediating role of offspring unmet needs with regard to parental cancer and the relation between AYAs psychosocial adjustment and perceived illness unpredictability. Methods: A total of 113 AYAs (aged 11–24 years) living with a parent diagnosed with cancer completed a questionnaire assessing illness unpredictability, offspring unmet needs, and psychosocial adjustment (i.e., health-related quality of life and internalizing problems). Results: Higher offspring unmet needs were associated with lower health-related quality of life (r = –0.24**) and higher internalizing problems (r = 0.21*). Offspring unmet needs mediated the relation between illness unpredictability and health-related quality of life (standardized indirect effect = –0.100* [–0.183, –0.018]) but not internalizing problems (standardized indirect effect = 0.067 [–0.015, 0.148]). In particular, higher illness unpredictability was related to higher unmet needs (β = 0.351**) which, in turn, predicted lower health-related quality of life (β = –0.286**). Conclusion: These findings identify offspring unmet needs and illness unpredictability as implicated in AYAs positive psychosocial adjustment to parental cancer. Given that AYAs are at greater risk of elevated psychosocial difficulties, interventions should target offspring unmet needs and perception of illness unpredictability to mitigate the adverse effects of parental cancer. [ABSTRACT FROM AUTHOR]

Purpose: Prior research shows that residential distance to a treatment facility may be an important factor in central nervous system (CNS) tumor outcomes. Our goal was to examine residential distance to the reporting hospital and overall survival in adolescents and young adults (AYA) diagnosed with CNS tumors. Methods: National Cancer Database data on AYA 15–39 years old diagnosed with CNS and Other Intracranial and Intraspinal Neoplasms (CNS tumors) from 2010 to 2014 were obtained. Distance between the case's residence at diagnosis or initial treatment and the reporting hospital was classified in miles as short (≤ 12.5), intermediate (> 12.5 and < 50), and long (≥ 50). Cox proportional hazards regression models were used for analyses. Results: Among 9335 AYA diagnosed with CNS tumors, hazard ratios (HRs) were 1.06 (95% CI 0.96–1.17) and 0.82 (95% CI 0.73–0.93) for those with residences at intermediate and long vs. short distances, respectively, after adjusting for age, sex, race/ethnicity, and zip-code level education and income. After adjusting for the facility volume of CNS tumor patients, the association was attenuated for long vs. short distance residences (HR 0.92, 95% CI 0.81–1.04). The HRs varied by tumor type, race/ethnicity, and zip-code level income with significantly lower hazards of death for those with residences at long vs. short distances for low-grade astrocytic tumors, ependymomas, non-Hispanic Whites, and those from higher-income areas. Conclusions: Living at long distances for CNS tumor care may be associated with better survival in AYA patients. This may be explained by travel to facilities with more experience treating CNS tumors. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors are at risk for late effects from therapeutic exposures, including cardiovascular complications. To improve outcomes among adolescents and young adults (AYA) with cancer, the National Comprehensive Cancer Network (NCCN) released guidelines for screening services (based on the Children's Oncology Group Long-Term Follow-Up [LTFU] guidelines) for survivors of AYA cancer. To better understand survivorship care gaps, we conducted a baseline evaluation of cardiomyopathy screening among survivors of AYA cancers. Methods: Members of Kaiser Permanente Southern California diagnosed with cancer between ages 15 and 39 from 2000 to 2010 with at least 5-year survival after diagnosis who were exposed to chest radiation and/or anthracyclines were included. We calculated the Prevention Index ([PI], proportion of person-time covered by receipt of preventive services relative to the total person-time eligible) to evaluate adherence to recommended cardiomyopathy screenings based on the LTFU through 2016. Predictors for screening were evaluated in multivariable logistic regression. Results: Among 479 survivors recommended for cardiomyopathy screening, 28 received at least one screening, and the mean PI was 2.38% (SD = 13.05%, median = 0.00%). Compared to stage I, survivors of stage II (odds ratio [OR] = 5.56 [1.05–29.46]) and stage III/IV cancer (OR = 6.08 [1.10–33.54]) were more likely to receive cardiomyopathy screening. Conclusions: Cardiomyopathy screening among survivors was low around the time when NCCN AYA oncology guidelines were released. Implications for Cancer Survivors: Our study highlights significant room for improvement for adherence to cardiomyopathy screening recommendations among survivors of AYA cancer. Attention is needed to ensure that recommended cardiomyopathy screenings are met for better management of cardiomyopathy late effects. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults (AYAs) with cancer report feeling ill-informed about their cancer treatment options. Tools are needed to inform AYAs about treatment choices and amplify the AYA's voice in medical decision-making. We developed MyPref, a conjoint-analysis based tool that quantifies AYA preferences for future cancer treatments. Methods: We conducted a staged pilot study of MyPref utilizing an intervention mixed methods design. AYAs and their parent or trusted person (PTP) completed MyPref and received a summary report of their preferences for treatment-related factors. Participants later completed the Preparation for Decision Making Scale and MyPref Experience Questionnaire and engaged in semi-structured interviews. Oncologists reported on the perceived accuracy and utility of MyPref. We used a weaving technique for presenting mixed methods data. Results: Fifteen AYAs with advanced cancer, 7 PTPs, and 12 providers participated in this pilot; 32 (94%) completed all study items. AYA/PTPs stated study participation was useful and believed MyPref allowed for improved understanding of treatment factors and consideration, organization, and visualization of preferences. All providers agreed that MyPref made them think about patient's preferences and 9 (75%) reported they planned to change their approach to discussions about preferences for future treatments. Conclusion: MyPref is an objective way to estimate AYA and PTP preferences for future treatment characteristics. This novel tool may be a useful way to engage AYAs and PTPs in discussions around preferences for treatment and prepare AYAs for future decision-making. We are currently evaluating this tool longitudinally to determine the impact on actual treatment decisions. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Understanding barriers to self-management behaviors and glycemic stability may inform specific needs for behavior change in adolescents and young adults with type 1 diabetes (T1D). The current review aims to systematically synthesize the literature on the relationships between executive functioning, self-management, and A1C in adolescents and young adults with T1D. Fifteen studies were retained in the current review. Study quality assessment for the majority of the studies were "Fair" or "Good."Recent Findings: This review highlights several advances in research design, including use of longitudinal designs, data from multiple informants, and use of objective measures. Adolescents and young adults reported that more executive functioning weaknesses were related to decreased self-management behaviors and higher A1C. The current review demonstrated that self-perceived executive functioning weaknesses negatively impact self-management behaviors and A1C. Future research is needed to determine the utility of objective measures in assessing the relationships between executive functioning, T1D self-management, and A1C. [ABSTRACT FROM AUTHOR]

Purpose: The successful transition of childhood cancer survivors from pediatric- to adult-focused long-term follow-up care is crucial and can be a critical period. Knowledge of current transition practices, especially regarding barriers and facilitators perceived by survivors and health care professionals, is important to develop sustainable transition processes and implement them into daily clinical practice. We performed a systematic review with the aim of assessing transition practices, readiness tools, and barriers and facilitators. Methods: We searched three databases (PubMed, Embase/Ovid, CINAHL) and included studies published between January 2000 and January 2020. We performed this review according to the PRISMA guidelines and registered the study protocol on PROSPERO; two reviewers independently extracted the content of the included studies. Results: We included 26 studies: six studies described current transition practices, six assessed transition readiness tools, and 15 assessed barriers and facilitators to transition. Conclusion: The current literature describing transition practices is limited and overlooks adherence to follow-up care as a surrogate marker of transition success. However, the literature provides deep insight into barriers and facilitators to transition and theoretical considerations for the assessment of transition readiness. We showed that knowledge and education are key facilitators to transition that should be integrated into transition practices tailored to the individual needs of each survivor and the possibilities and limitations of each country's health care system. Implications for Cancer Survivors: The current knowledge on barriers and facilitators on transition should be implemented in clinical practice to support sustainable transition processes. [ABSTRACT FROM AUTHOR]

Central nervous system tumors in adolescents and young adults (AYA) are rarely reported in the literature. The association with cancer predisposition syndrome is not established. Programmed death ligand 1 (PD-L1) can predict the potential response of patients to immunotherapy. A link between mismatch repair protein deficiency (MMRP-D) and response to immunotherapy is established. P53 is reported to be positive in MMRD-D cases. We aim to investigate the frequency of MMRP-D in AYA with high-grade glioma and any potential association with PD-L1. A total of 96 cases were tested including 49 (51.0%) cases of glioblastoma. Six cases (6.25%) were MMRP-D, 17 (17.7%) were PD-L1 positive, mostly in grade IV tumors (8.7% in grade III compared to 26% in grade IV, p value = 0.027), and 69 (71.9%) were P3 positive. None of the MMRP-D cases expressed PD-L1. P53-positive cases were mostly MMRP proficient (n = 67; 74.4%, p value 0.051). Fourteen cases (28.7%) were positive for both PD-L1 and P53, while p53-positive grade IV tumors were mostly associated with negative PD-L1 (n = 29, 58%, p value = 0.043). MMRP deficiency does not appear to be prevalent in high-grade glioma in AYA. Expression of PD-L1 in a quarter of cases might suggest a role for immunotherapy in high-grade glioma. [ABSTRACT FROM AUTHOR]

Purpose: This study uses the newly developed Bereaved Cancer Needs Inventory to identify the unmet psychosocial needs of adolescents and young adults who have experienced the death of a parent or sibling to cancer, and to explore the relationship between unmet needs and psychological distress.Methods: In total, 278 bereaved offspring and 38 bereaved siblings (12-25 years) completed the 58-item Bereaved Cancer Needs Inventory (BCNI) and the Kessler psychological distress scale (K10).Results: Bereaved offspring reported 27 unmet needs on average (SD = 16.87, range: 0-58); 94% indicated at least one unmet need, with 80% indicating 10 or more needs. Bereaved siblings reported 23 unmet needs on average (SD = 17.30, range: 0-57); 97% indicated at least one unmet need, with 68% indicating 10 or more needs. For both bereaved offspring and siblings, the needs for "support from other young people" and "time out and recreation" were most frequently reported as unmet. Approximately half of all participants reported high to very high levels of psychological distress. There was a significant positive relationship between the number of unmet needs and the psychological distress score on the K10 for both groups.Conclusions: Bereaved offspring and bereaved siblings report unmet psychosocial needs across many domains, which are associated with their levels of psychological distress. Findings suggest the BCNI may be used by healthcare professionals to identify unmet needs and direct clients to the appropriate services, resources, or support; with the intent to reduce their risk of mental illness and psychological distress. [ABSTRACT FROM AUTHOR]

Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14–24 years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56–90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs. [ABSTRACT FROM AUTHOR]