Contraception Counseling and Use Among Adolescent and Young Adult Female Patients Undergoing Cancer Treatment: A Retrospective Analysis

Abelman, S. H.; Cron, J.

Study Objective Adolescent and young adult (AYA) women undergoing cancer treatment face unique reproductive health risks. This study aimed to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes. Design Retrospective chart review. Setting Yale New Haven Hospital from 2013-2018. Participants Female patients ages 15-25 receiving cancer treatment, excluding those treated with only surgery. Interventions None Main Outcome Measures Outcomes of documented sexual health counseling and contraception use were assessed for frequency. Associations between patient factors and these outcomes were assessed using Pearson χ2 and Fisher’s exact tests, and multivariate logistic regression was used to identify predictors of these outcomes. Results In this cohort (n=157), the median age was 20.5, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. 33.1% were documented as receiving sexual health counseling and 48.4% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P=.005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P=.009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P=.001) were significantly associated with contraception use. Conclusions Sexual health counseling was documented infrequently during oncologic care for AYA women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a need to improve rates of counseling in this high-risk setting, in which adolescents may be more vulnerable with regards to sexual health.