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Background: Adolescent and young adult (AYA) women undergoing multiagent chemotherapy are at risk for heavy menstrual bleeding (HMB). There is a paucity of data on the experiences with menses of AYA women with cancer, their risk for HMB, and how they perceive menstrual suppression. Objective: This study aimed to (1) describe the attitudes and experiences of AYA women with a history of cancer regarding their menses and menstrual suppression and to (2) investigate facilitators and barriers to improve this aspect of oncologic care. Design/Methods: AYA women with a history of cancer completed individual semistructured interviews regarding their experiences, attitudes, and preferences around menstrual health. Two independent reviewers conducted a thematic analysis of transcribed interviews to elicit major themes. Results: We interviewed 20 young women with a history of cancer (mean age 19.9 years) who were treated with chemotherapy within the past 5 years. Themes included the following: (1) negative feelings and worry about menstrual bleeding; (2) positive attitudes toward menstrual suppression; (3) misconceptions about menstrual health; and (4) desire for tailored discussions about menstrual suppression. Conclusions: AYA women with a cancer history elucidate clear opinions regarding menstruation during chemotherapy, and many hold misconceptions regarding menses and menstrual suppression. Enhanced patient-provider communication and patient educational resources around menstrual health and menstrual suppression are needed to improve comprehensive oncologic care during chemotherapy.

1. Amita Ghuman, MD* 2. Allison Close, MD† 3. Lynn Malec, MD, MSc‡ 1. *Department of Pediatrics and 2. †Division of Hematology/Oncology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 3. ‡Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI; Division of Hematology/Oncology, Departments of Medicine and Pediatrics, Medical College of Wisconsin, Milwaukee, WI A 15-year-old Caucasian boy with autism, global developmental delay, chronic constipation, and oral aversion presents to the emergency department with parental concerns for worsening fatigue, weakness, and gait instability. Symptoms have been slowly progressive and accompanied by weight loss over the past 6 months. Whereas he used to run and jump, he is now unable to stand independently. His long-standing feeding difficulties have been refractory to intensive feeding programs, yet he continued to feed orally (with no previous attempts at enteral/parenteral nutrition). His daily diet consisted only of 50 to 60 oz of whole milk and 25 to 30 individual servings of butterscotch pudding per day (1,680–1,880 calories per day, 0.7 mg of iron per day). On presentation he is afebrile, with normal blood pressure and respiratory rate for age. His heart rate is 118 beats/min. Growth parameters are at the 2nd and 25th percentiles for weight and height, respectively. On physical examination the patient is well-appearing, thin with coarse facial features, and nonverbal but cooperative. Conjunctival pallor is present. Cardiovascular, respiratory, gastrointestinal, and dermatologic examination findings are normal other than mild tachycardia. On neurologic examination he has increased tone with extension in his upper and lower extremities, decreased muscle bulk, 3/4 deep tendon reflexes, and narrow-based gait with valgus deformity of the right leg, along with difficulty with dorsiflexion of his feet when walking. He …

Objective To evaluate pediatric subspecialists’ practices and attitudes regarding sexual and reproductive healthcare for adolescent and young adult women for whom they prescribe teratogens. Study design We surveyed pediatric subspecialists at 1 tertiary care pediatric hospital. Items assessed attitudes and practices related to sexual and reproductive healthcare for adolescent and young adult women prescribed teratogens, and barriers and facilitators to sexual and reproductive healthcare provision. We used descriptive statistics, χ2 tests, and logistic regression to analyze results. Results There were 200 subspecialists from 17 subspecialties who completed the survey; 77% reported prescribing teratogens to adolescent and young adult women and 18% reported caring for a patient who became pregnant while taking a teratogen. Overall, 99% indicated that it is important to address sexual and reproductive healthcare. Respondents endorsed confidence in sexual and reproductive healthcare skills, including contraceptive counseling (71%), although 29% never or rarely discuss sexual and reproductive healthcare, and one-third never speak privately to this population. Of providers who discuss sexual and reproductive healthcare, 26% never assess reproductive intentions and 36% do so less often than annually. Nearly one-half never or rarely ask about sexual activity, and 68% never or rarely assess contraceptive knowledge. Barriers to sexual and reproductive healthcare provision included available time (80%) and the presence of family or partners at clinic visits (61%). Facilitators included a quick referral process to sexual and reproductive healthcare providers (92%) and access to lists of local sexual and reproductive healthcare providers (90%). Conclusions Pediatric subspecialists from a single institution report suboptimal sexual and reproductive healthcare provision for adolescent and young adult women prescribed teratogens. Identified barriers and facilitators may guide intervention development to improve sexual and reproductive healthcare for this population.

BACKGROUND Adolescents and young adult (AYA) women with cancer are at risk of heavy menstrual bleeding (HMB) due to thrombocytopenia, coagulopathy, and/or disruption of the hypothalamic-pituitary-gonadal axis. Currently, little is known about current practices to help prevent and treat HMB in AYA women with cancer. METHODS We surveyed providers from 100 pediatric oncology centers. Face and content validity were assessed prior to distribution. Descriptive statistics, Chi-squared and Fisher exact tests were used for analysis. RESULTS Ninety-four percent of respondents have recommended preventative menstrual suppression. More than half of respondents agreed that patients with the following types of cancers should receive preventative menstrual suppression: sarcomas, acute leukemias, lymphomas, and germ cell tumors. The most preferred form of menstrual suppression was GnRH agonists. Almost 95% of respondents felt that it is important to consider menstrual suppression and that a formal guideline about initiation of menstrual suppression would be helpful. Only 46% felt comfortable personally managing menstrual suppression. CONCLUSIONS The vast majority of pediatric oncologists who responded to this national survey have used preventative menstrual suppression and feel that it is important to consider in many types of AYA cancers. Although pediatric oncologists are most often managing menstrual suppression, they do not feel comfortable doing so and desire guidelines to help with management. Future studies to assess which patients require menstrual suppression and which menstrual suppression is best tolerated and efficacious is needed.

e21533 Background: Adolescents and young adult (AYA) females with cancer are at risk of heavy menstrual bleeding (HMB) due to thrombocytopenia, coagulopathy, and/or disruption of the hypothalamic-pituitary-gonadal axis. Options for temporary menstrual suppression (MS) include combined oral contraceptives (OCPs), progestin-only therapy, GnRH agonists, and intrauterine devices. Currently, little is known about current practices to help prevent and treat HMB in AYA women with cancer. Methods: We conducted a national cross-sectional internet-based survey of providers from 100 pediatric oncology centers. Institutions were randomly selected to allow for even representation by program size and geography. Face and content validity were assessed prior to distribution. Descriptive statistics were used to analyze respondent characteristics, attitudes, and practices for managing menstrual suppression. Chi-squared test or Fischer’s Exact test (for small cell sizes across groups) were used for analysis of categorical data. Kruskal-Wallis one-way ANOVA tests were used to compare means. Results: The majority of respondents (94%) have recommended preventative MS. MS in pediatric oncology patients is most often managed by oncology (61%) versus gynecology (22%) or adolescent medicine (12%). Greater than 50% of respondents agreed that patients with the following types of cancer should receive preventative MS: sarcomas, acute leukemias, lymphomas, and germ cell tumors. GnRH agonists were the most preferred method of MS (52%). Most respondents agreed that it is important to consider MS (94%), and that a formal guideline about initiation of MS would be helpful (95%). Less than half (46%) of participants felt comfortable personally managing MS. Conclusions: The vast majority of pediatric oncologists have used preventative MS, most commonly GnRH agonists, and feel that it is important to consider in the majority of AYA cancers. Although pediatric oncologists are most often managing MS, they do not feel comfortable doing so and desire guidelines to help with management.

1570 Background: Adolescents and young adults (AYA) aged 15-39 years make up approximately 70,000 new oncology cases in the USA. Historically, mortality from cancer has smaller incremental improvements in AYA patients when compared to children and older adults, and not much is known about current sex-specific trends. We assessed overall and sex specific AYA mortality for the last 10 years (2007-2016). Methods: Trends in age-adjusted mortality rates per 100,000 (1972-2016) were obtained from the CDC’s National Center for Health Statistics (NCHS). Average annual percent changes (AAPCs) in relative survival were analyzed using NCI’s JPSurv webtool and mortality AAPCs were quantified using Joinpoint regression analysis. Results: Overall declines in mortality are similar in AYA men and women from 1972-2016, with 54% and 51% decline, respectively. In the most recent 10 years of data (2007 to 2016), combined sex AYA mortality AAPC’s declined by about 0.8% per year, slightly slower than declines in children 40 years (1.5% per year). Among AYA males there have been 10 year AAPC mortality declines in leukemia (-1.8%), Hodgkin lymphoma (HL) (-5.1%), Non-Hodgkin lymphoma (NHL) (-4.1%) and melanoma of the skin (-3.4%). For AYA females, 10 year AAPC mortality declines occurred in leukemia (-1.9%), ovarian (-1.5%), HL (-10%), NHL (-4.9%) and melanoma (-2.8%). These declines have been offset by stable or increasing mortality rates for several common AYA cancers, including colorectal cancer (CRC) (1.1%) and bone and joint cancer (0.6%) in AYA males. AYA females have experienced mortality increases for CRC (0.6%), bone and joint cancer (0.5%) and uterine corpus cancer (2.8%). Conclusions: In general, mortality rates for both AYA men and women have declined over the past 10 years due to decreased mortality in hematologic malignancies and melanoma. Despite overall improvement, tumor categories in both AYA males and female such as CRC, bone and joint cancer, and uterine corpus cancers show increasing mortality. These diseases require specific investigations by both pediatric and adult researchers.