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Abstract

Objectives: To use multi-method approaches across quantitative and qualitative studies to comprehensively evaluate impacts of AYA cancer on sexual and reproductive health outcomes and experiences. Methods: I conducted: 1) Systematic reviews and meta-analyses; 2) Epidemiologic studies using administrative health databases to evaluate associations between female colorectal cancer (CRC), and reproductive and sexual health outcomes; and 3) Serial focus groups with AYA cancer patients, grouped by shared characteristics and analyzed with framework methodology. Results: 1) Systematic review and meta-analysis showed associations between AYA cancer and reproductive health outcomes: gestational diabetes (pooled odds ratio (pOR) 1.43; 95% confidence interval (CI): 1.03, 1.99) and fertility treatment (pOR 2.66; 95% CI: 1.71, 4.11); and sexual health outcomes: vaginal dryness (pOR 3.94; 95% CI: 2.02, 7.70), ejaculatory dysfunction (pOR 3.66; 95% CI: 2.20, 6.08), and testosterone level (mean difference = -2.56 nmol/l; 95% CI: -3.46, -1.66; p = 0.00001). 2) Exploring reproductive health outcomes, females with ≥2 births in the 5-year prodrome had 1.82x the odds of early-age onset CRC (EAO-CRC) compared to those with no births (OR 1.82; 95% CI: 1.19, 2.78). Post-diagnosis, females with EAO-CRC had lower odds of giving birth within 5 years (OR 0.23; 95% CI 0.15, 0.37) compared to females with no EAO-CRC. For sexual health outcomes, females diagnosed with CRC ≤39 years had higher risk of premature ovarian failure (HR 1.75; 95% CI: 1.40, 2.19), dyspareunia (HR 1.90; 95% CI: 1.58, 2.28), abnormal bleeding (HR 0.74; 95% CI: 0.59, 0.93), and pelvic inflammatory disease (HR 1.67; 95% CI: 1.08, 2.57) compared to females without CRC. 3) Eight focus group cohorts of AYA cancer patients, with 3 – 10 participants each (N = 38 females, 10 males). Themes described participants’ experiences as: internal impacts of AYA cancer on sexual and reproductive health and external impacts on relationships. Themes indicated health care systems enablers and individual-level factors influencing access to sexual and reproductive health resources and support. Conclusions: Findings offer critical insights into population and individual level impacts of AYA cancer on sexual and reproductive health and suggest intervention opportunities at patient, provider, and policy level to improve care, access, and outcomes.