Objective This study aimed to evaluate the relationship between peripartum mean arterial pressure (MAP) and postpartum readmission for preeclampsia with severe features. Study Design This is a retrospective case-control study comparing adult parturients readmitted for preeclampsia with severe features to matched nonreadmitted controls. Our primary objective was to evaluate the association between MAP at three time points during the index hospitalization (admission, 24-hour postpartum, and discharge) and readmission risk. We also evaluated readmission risk by age, race, body mass index, and comorbidities. Our secondary aim was to establish MAP thresholds to identify the population at highest risk of readmission. Multivariate logistic regression and chi-squared tests were used to determine the adjusted odds of readmission based on MAP. Receiver operating characteristic analyses were performed to evaluate risk of readmission relative toMAP; optimal MAP thresholds were established to identify those at highest risk of readmission. Pairwise comparisons were made between subgroups after stratifying for history of hypertension, with a focus on readmitted patients with new- onset postpartum preeclampsia. Results A total of 348 subjects met inclusion criteria, including 174 controls and 174 cases. We found that elevated MAP at both admission ( adjusted odds ratio [OR]: 1.37 per 10 mm Hg, p< 0.0001) and 24-hour postpartum (adjusted OR: 1.61 per 10 mm Hg, p = 0.0018) were associated with increased risk of readmission. African American race and hypertensive disorder of pregnancy were independently associated with increased risk of readmission. Subjects with MAP> 99.5 mm Hg at admission or >91.5 mm Hg at 24- hour postpartum had a risk of at least 46% of requiring postpartum readmission for preeclampsia with severe features. Conclusion Admission and 24-hour postpartum MAP correlate with risk of postpartum readmission for preeclampsia with severe features. Evaluating MAP at these time points may be useful for identifying women at higher risk for postpartum readmission. These women may otherwise be missed based on standard clinical approaches and may benefit from heightened surveillance.

Background While all reproductive-aged individuals with cancer should be offered fertility preservation (FP) counseling, there is little guidance over offers to adolescent and young adults (AYA) with terminal diagnoses, especially when considering posthumous assisted reproduction (PAR). The Enriching Communication skills for Health professionals in Oncofertility (ECHO/ENRICH) trains Allied Health Professionals (AHPs) to improve communication with AYAs with cancer. Little is known about AHPs' role in assisting in FP and PAR decisions. Methods This is a cross-sectional survey of ECHO/ENRICH trainees' attitudes and experience with FP and PAR in AYA with terminal cancer. Results The response rate was 61% (365/601). While 69% felt comfortable discussing FP with terminal AYA after ECHO/ENRICH training, 85% desired further education. The majority (88%) agreed FP should be an option for AYA with cancer, though some agreed offering FP provided false hope (16%) or was a waste of resources (7%). Most shared that avoidance of FP discussions was common practice, especially in the medically fragile, late-stage disease, or among minors. Many attributed lack of conversations to oncology team goals. Only 9% had prior experience with PAR. Many were conflicted about how PAR reproductive material should be gifted and who should be permitted to use PAR. Several raised moral concerns for PAR, or discomfort advising family. Many voiced desire for additional PAR-specific education. Conclusion ECHO/ENRICH trainees had varied levels of exposure to FP in terminal AYA and limited experiences with PAR. Many expressed uncertainties with PAR, which may be alleviated with further training and transparent institutional policies.

BACKGROUND:The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community experiences health disparities. It is thus imperative that medical trainees receive training in the care of LGBTQ community. The objective of this study was to identify gaps in knowledge and comfort among medical school students in providing care for the LGBTQ community.METHODS:An online survey was administered to medical students at 3 institutions in the United States from December 2020 to March 2021. Using a Likert scale, the survey assessed attitudes, comfort, and knowledge in providing care for the LGBTQ community. The survey included questions for each specific LGBTQ population. Results were quantified using descriptive and stratified analyses, and an exploratory factor analysis was used to calculate attitude summary measure (ASM) scores. A total knowledge score was calculated, with higher values indicating greater knowledge.RESULTS:Among the 300 medical students who completed the survey, the majority were female (55.7%), White (54.7%), and heterosexual (64.3%). The majority of medical students felt comfortable (strongly agree/agree) participating in the care of lesbian (94.3%), gay (96.0%), and bisexual (96.3%) patients; this percentage dropped to 82.3% for non-binary and 71.3% for transgender patients. Only 27.0% of medical students reported confidence in their knowledge of health needs of transgender patients. LGBTQ self-identification, percent of core rotations completed in school, region of country, and friends and/or family who are part of the LGBTQ community were significantly associated with various ASM scores. Knowledge questions yielded high percentages of "neutral" responses, and medical students who identified as LGBTQ had significantly higher total knowledge scores.CONCLUSIONS:Overall, the surveyed medical students feel comfortable and willing to provide care for LGBTQ persons. But, there is limited knowledge about specific LGBTQ health needs. More education and training in the needs of transgender and non-binary patients, in particular, is indicated.

PURPOSE:While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework. METHODS:We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability. RESULTS:Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders' views. All interventions were implemented in real-world contexts, and only three discussed sustainability. CONCLUSIONS:This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.

Purpose: The lesbian, gay, bisexual, transgender, and queer (LGBTQ) Oncofertility Education (LOvE) module aims to improve knowledge on providing inclusive and affirming care for LGBTQ adolescents and young adults (AYAs) with cancer. The objective of this study is to evaluate the role of the module in improving reproductive health communication for the care of LGBTQ AYAs with cancer.Methods: A 10-item multiple-choice pre-test and post-test assessed learner knowledge, with total knowledge scores ranging from 0 (no correct responses) to 10 (all correct responses). A post-module survey and open-ended questions assessed relevance of the module, quality, and appropriateness to professional practice. Paired t-tests analyzed changes in knowledge before and after the module. Content analysis was applied to qualitative responses.Results: Thirty-seven learners completed both the pre-test and post-test. Around 8.1% correctly answered all pre-test questions; 59.5% correctly answered all posttest questions. The average pre-test score was 8.3, versus posttest score of 9.5 (p < 0.0001). Eighty-nine percent of learners strongly agreed that LOvE Enriching Communication Skills for Health Professionals in Oncofertility was relevant to their work; 95% strongly agreed that it was easy to understand and navigate. Open-ended responses highlighted how the module helped learners strengthen the provider-patient relationship in the context of oncofertility, create a safe space for patients, and understand the relevance of educational materials about fertility to LGBTQ patients.Conclusions: We found significant improvement in knowledge of reproductive health care for LGBTQ AYAs with cancer after completing the module. Improving provider knowledge may improve confidence in providing inclusive and affirming care for LGBTQ AYAs with cancer, resulting in improved whole-person care.

Background: Sexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes. Aim: The purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners. Methods: The analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age = 23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007. Outcomes: Age-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers. Results: Around half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR] = 1.30, 95% confidence interval [CI]: 1.22 -1.38), bisexual (RR = 1.30, 95% CI: 1.10-1.52), and lesbian (RR = 1.23, 95% CI: 1.00-1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b = 0.63, 95% CI: 0.25-1.02), work/school (b = 0.55, 95% CI: 0.17-0.93), and sex (b = 0.53, 95% CI: 0.05-1.00). Clinical Implications: Healthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women). Strengths & Limitations: Our study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women. Conclusion: Our key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities. Copyright (C) 2022, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Objectives: To assess training needs for providers who care for adolescent and young adult (AYA) lesbian, gay, bisexual, transgender/queer questioning (LGBTQ) cancer patients, we conducted a mixed-method survey. During their cancer care experience, AYA cancer patients experience physical, psychosocial, and reproductive health challenges. In addition to these challenges, AYA LGBTQ individuals are a diverse and medically underserved population who experience unique challenges and disparities in medical care. Methods: Health care providers (n = 351) who participated in our reproductive health in cancer training program completed a survey with 28 quantitative items and 4 open-ended items assessing knowledge, confidence discussing reproductive health, and confidence in knowledge specific to reproductive needs and general health needs among AYA LGBTQ patients. Results: Confidence discussing and confidence in knowledge of reproductive and general health needs are lower regarding transgender and nonbinary patients. Nearly half of providers (45%) demonstrated low knowledge, while 38% and 17% demonstrated moderate and high knowledge, respectively. Open comments indicated providers desired more training around the needs of Trans and nonbinary patients, and creating welcoming environments. Conclusions: The majority of our participants demonstrate low or moderate knowledge regarding factors that can influence AYA LGBTQ patient care, suggesting that this is a key area for improvement. Furthermore, improving provider knowledge may subsequently improve confidence in general and reproductive needs of LGBTQ patients, resulting in improved patient-centered care. Improving provider knowledge and confidence may then ultimately help reduce disparities in cancer care among this patient population.

Adolescent and young adults (AYA) with cancer have unique psychosocial needs, with reproductive health being a chief concern. While the American Society of Clinical Oncology recommend all reproductive aged individuals diagnosed with cancer should be offered counseling regarding fertility preservation (FP), there is little guidance and great controversy over such offers to AYA with terminal diagnoses, especially when considering posthumous assisted reproduction (PAR). Clinicians face unique ethical issues surrounding fertility discussions which may be misinterpreted in various ways — from false hope to mixed messages regarding prognosis to encouragement of PAR.

Abstract Background: The majority of US medical schools have a required curriculum related to the care of LGBTQ+ people, which varies in length and content across schools. All medical specialties and sub-specialties have a component of need for cancer care; either in prevention, treatment, or care planning. As such, it is imperative that medical trainees receive relevant training in the care of LGBTQ+ populations, a community experiencing significant cancer health disparities. Assessing trainees' knowledge and confidence in providing care is an important aspect of preparing the next generation of physicians. Methods: This abstract reports on survey results from 3 US medical schools (New York University, University of Miami, University of Texas San Antonio) assessing the knowledge, attitudes and comfort in providing care for LGBTQ+ people. The survey was comprised of 54 Likert response (1=strongly disagree; 7=strongly agree) choice questions on: attitudes (30), knowledge (10), student demographics (13) and desire for additional LGBTQ+ education (1). Results were analyzed using descriptive and quantitative analyses. Results: A total of 360 medical students completed the survey and analyses revealed the majority of students had positive attitudes towards caring for LGBTQ+ patients, but lacked comfort in providing care for transgender/non binary patients (TNB) in general (p=0.05); specific cancer prevention care for TNB (p< 0.01); reproductive care for TNB (p< 0.01) and sexual heath (p=0.01). There was a significant correlation between high knowledge scores and comfort in asking a patient's pronouns (p<0.01). More than 80% felt comfortable discussing cancer prevention care with LGB patients and 75% believed it was important to know the sexual orientation of patient to provide the best care. Eighty percent agreed there should be mandatory LGBTQ+ education in medical school. As in our prior studies, total knowledge scores did not correlate with attitudes. Conclusions: Medical students feel comfortable and willing to provide cancer prevention care for LGB patients but may need more education and training in the unique needs of TNB patients. Medical schools should consider specific education in cancer prevention and treatment for TNB populations. Citation Format: Gwendolyn P. Quinn, Christina Tamargo, Devin Murphy, Megan Sutter, Lydia Fein, Fabio Ferrari, Amani Sampson, Mia Charifosn, Matthew B. Schabath. Medical students' knowledge and comfort in participating in cancer prevention for LGBTQ+ patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-063.

11030 Background: The lesbian, gay, bisexual, transgender and queer (LGBTQ) community experiences cancer health disparities. It is thus imperative that medical trainees receive training in the care of LGBTQ populations. Identifying gaps in trainees’ knowledge and comfort in providing care for this population is important in preparing future physicians. Methods: A Likert-scale survey of US medical students at three institutions assessed attitudes, comfort and knowledge in providing care for LGBTQ patients. Results were quantified with descriptive and stratified analyses. Exploratory factor analysis found four factors in which attitude summary measure (ASM) scores were calculated; lower values indicate more agreeability with given attitude items. Total knowledge scores were calculated with higher values indicating greater knowledge. Results: Of 300 medical students who completed the survey, the majority were female (55.7%), white (54.7%), and heterosexual (64.3%). The majority of students felt comfortable (strongly agree/agree) participating in the care of patients who identify as lesbian (94.3%), gay (96.0%), and bisexual (96.3%); this percentage dropped to 82.3% for non-binary and 71.3% for transgender patients. Only 27.0% of students reported confidence in their knowledge of health needs of transgender patients. LGBTQ self-identification, percent of core rotations completed, and having LGBTQ friends/family were significantly associated with various ASM subscales (Table 1). Knowledge questions had high percentages of “neutral” responses, and students who identified as LGBTQ had significantly higher total knowledge scores. Conclusions: Overall, medical students feel comfortable and willing to provide care for LGBTQ patients. However, as in our prior study in oncologists, there is limited knowledge about specific LGBTQ health and cancer needs. More education and training in the needs of transgender and non-binary patients is indicated. [Table: see text]

To identify potential gaps in attitudes, knowledge, and practices towards LGBTQ2S + patients with a cancer diagnosis, a survey of clinical providers (CP) and allied health staff (AHS) was conducted to identify areas of improvement and guide development for future education and training. A previously published, validated survey was adapted at the direction of a LGBTQ2S + Patient and Family Advisory Council, and modified to include AHS. The survey was disseminated to all faculty and staff, and was adapted to the participants’ self-identified level of patient interaction/care responsibilities. Subsections consisted of questions related to demographics, knowledge, attitudes, and practice behaviors towards participating in the care of LGBTQ2S + patients. Results were quantified using stratified analysis and an attitude summary measure. Of the 311 respondents, 179 self-identified as CPs and 132 as AHS. There was high agreement in comfort treating or assisting LGBTQ2S + patients by CP and AHS respondents, respectively. CPs possessed significantly higher knowledge regarding LGBTQ2S + health when compared to AHS; however, there remained high percentages of “neutral” and “do not know or prefer not to answer” responses regardless of clinical role. There was high agreement regarding the importance of knowing a patient’s gender identity (GI) and pronouns (CP vs. AHS; 76.9

Historically, outcome measures for gender-affirming genital surgery have focused on medical and surgical outcomes, with limited attention to patients’ reports of post-surgical sexual function and sexual satisfaction. The aim of this scoping review was to assess the published literature on patients’ sexual function and sexual satisfaction following gender affirming genital surgery, identifying gaps in the evidence base and potential areas of focus for future research efforts. Our sample included English-language studies published in the past 20 years addressing measures of sexual health, sexual function, and/or sexual well-being for individuals who underwent gender affirming genital surgery. Systematic reviews, meta-analyses, and other forms of reviews were excluded. The final sample consisted of ten articles. All studies addressed sexual function through assessment of ability to orgasm. Overall, transgender women who underwent vaginoplasty and were sexually active post-operatively described improved sexual function after surgery. In one study, transgender men showed moderate improvement of sexual function while another indicated reduced sexual function compared to transgender men treated with hormones only. Prospective research is needed to improve understanding of patients’ values, goals and expectations for sexual function and sexual satisfaction following surgery, and to inform the development of validated outcomes measures.

Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. Yet, transvaginal ultrasound (TVUS) cervical length (CL) screening suboptimally predicts spontaneous PTB (SPTB). Abnormal remodeling of glandular crypts along the cervical canal may contribute to increased PTB risk via premature cervical ripening, which may correspond to no visualizable cervical gland area (CGA) on TVUS (Figure 1). This study aims to determine if no visualizable ("absent") CGA at CL screening is predictive of PTB. We performed a retrospective cohort study of pregnant women carrying a singleton gestation who had CL screening between 180/7 – 236/7 weeks gestation and delivered a live neonate at a single academic institution between 1/1/18 and 12/31/18. 1000 of the most recent deliveries in 2018 were screened for inclusion. Patients with uterine anomalies, cerclage, suboptimal imaging, or with indicated preterm delivery were excluded. TVUS images were assessed for CL, CGA visualization, and if present, quantitative CGA measurements were performed. The primary outcome was SPTB prior to 37 weeks. Absent and present CGA groups were compared using χ2, Fischer's exact, T-test, and logistic regression with significance at p<0.05. 784 women were included. Demographic and medical characteristics of the sonographically absent and present CGA groups were similar. The absent CGA group was more likely parous and to receive progesterone supplementation (77 vs 40% and 17 vs 4% respectively, p=0.03). Overall PTB rate was 2.7% and rate of absent CGA was 2.3%. Absent CGA was significantly associated with delivery <37, <34, and <32 weeks (p<0.005) (Table 1). Quantitative CGA width, length, and area did not individually correlate with PTB. A multiple logistic regression model demonstrated 8% improvement for prediction of PTB <37 weeks with the addition of CGA evaluation compared to CL alone (p<0.001). Patients with no visualizable CGA were more likely to experience spontaneous preterm delivery. Assessment of CGA visualization may improve the performance of CL screening for predicting SPTB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

While culturally competent best practices for treating LGBTQ populations have continued to evolve, few studies have assessed medical provider and support staff preparedness to treat LGBTQ patients, especially in an oncologic setting. To the best of our knowledge, this is one of the few studies assessing oncologic providers' knowledge and attitudes in caring for the LGBTQ community, and one of the first studies assessing oncologic non-provider staff knowledge and attitudes in assisting LGBTQ patients.

Burn injuries can cause significant morbidity and mortality; however, more effective medical interventions have resulted in a large proportion of individuals surviving. Individuals with burn injuries have an increased likelihood of psychological disorders. Burn severity and scar visibility have been tied to stigmatizing social reactions from others and, as a result, can negatively affect the mental health of individuals with burn injuries. Social support has been shown to be a buffer for mental health. The purpose of this study was to investigate the relations between stigma, mental health (anxiety and depression), and social support in individuals with burn injuries. A sample of 97 individuals with burn injuries was recruited from an outpatient burn specialty clinic. Stigma was positively related to depression and anxiety. Social support moderated the relationship between stigma and anxiety such that the statistical effect weakened for individuals with burn injuries who experience medium to high levels of social support. The same buffering effect approached significance for depression. Incorporating a focus on stigma and social support could augment behavioral health interventions that target mental health concerns after a burn injury.

OBJECTIVE:Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection. METHODS:Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI). RESULTS:Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001). CONCLUSION:Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing. PRACTICE IMPLICATIONS:Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.

AYAs with cancer have unique psychosocial needs, with reproductive health being a primary concern. Additionally, health disparities exist among SGM AYAs and there is a gap in clinician training. The NCI-funded R25 Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) provides reproductive health communication training to allied health professionals, including social workers, psychologists, nurses, and physicians assistants, who provide care for AYAs with cancer. The ECHO curriculum expanded to include the LGBT Oncofertility Education (LOvE) module. The module aims to improve knowledge on providing inclusive and affirming care, including collecting information about sexual orientation and gender identity, discussing reproductive health, and minimizing personal bias. The objective of this project is to evaluate the role of the module in improving reproductive health communication for the care of SGM AYAs with cancer. Module participants completed a 10-item multiple-choice pretest and posttest assessing knowledge of providing affirming reproductive health care to SGM AYAs with cancer. Total knowledge scores ranged from 0 (no correct responses) to 10 (all correct responses). A post-module survey assessed relevance of the module, quality, and appropriateness to professional practice on a 5-point scale of strongly agree to strongly disagree. Six open-ended items invited respondents to describe integrating this knowledge into their practice, barriers for implementation, and suggestions for improving training in SGM AYA cancer care. Paired t-tests were used to analyze changes in knowledge before and after the module. Content analysis was applied to qualitative responses. Of the 37 respondents completing both the pretest and posttest (73% of pretest group), 8.1% correctly answered all pretest questions. This is compared to 59.5% who correctly answered all posttest questions. The average pretest score was 8.3; the average posttest score was 9.5 (Δ=-1.2, t(36)=4.55, p<.0001). Eighty-nine percent of respondents strongly agreed that LOvE ECHO was relevant to their work and 95% strongly agreed that it was easy to understand and navigate. Open-ended responses focused on how the module helped respondents to strengthen the provider-patient relationship in the context of oncofertility, to create a safe space for patients, and to understand the relevance of educational materials about fertility to SGM patients. Our findings demonstrate significant improvement in knowledge of inclusive and affirming care for SGM AYAs with cancer after completing the LOvE ECHO module.

Objective: Patients with advanced or recurrent gynecologic malignancies occasionally take breaks from systemic treatment colloquially referred to as "treatment holidays" or "chemotherapy holidays." There are no data from the patient perspective that help describe this experience. Methods: Patients with recurrent or advanced primary gynecologic malignancies who had decided to enter a treatment holiday were recruited and interviewed. A treatment holiday was defined as a planned temporary break or delay in treatment for a patient with recurrent or advanced primary gynecologic malignancy for reasons other than pursuit of hospice or best supportive care, research protocol violation or unacceptable toxicity. Interviews were audiotaped, transcribed and then analyzed using an inductive thematic analysis. Results: Of 6 total patients identified for participation, 5 completed interviews with ages ranging from 57 to 80 years. Two participants returned to their previous treatment regimen after their holiday therapy, two switched therapies, and one remained on an extended break from systemic treatment. Treatment holidays were experienced as a break from the physical and psychological routine of being a cancer patient, but also brought about feelings of a lack of structure, uncertainty, and led to a confrontation with mortality issues. Overall, participants had favorable experiences which were initiated by their providers in whom they had a deep sense of trust. Conclusion: Patients experience treatment holidays as a positive and valuable break from the physical and psychosocial routine of cancer treatment and illness. These experiences produce distinct emotional needs that clinicians should address to best support patients electing treatment holidays.

OBJECTIVE:To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these associations. STUDY DESIGN:Data from 27 513 US high-school youth were analyzed from the Centers for Disease Control and Prevention's Youth Risk Factor Surveillance System from 2015 and 2017. We fit sex-stratified, weighted, adjusted log-Poisson models to compare past 30-day exclusive combustible, exclusive e-cigarette, and poly-tobacco use in across sexual orientation. Then, models were adjusted for past-year experiences of physical fighting, bullying, attempting suicide, and physical and sexual dating violence. RESULTS:Compared with heterosexual girls with other-sex partners, sexual minority girls were more likely to use exclusive combustible, exclusive e-cigarette, or poly-tobacco products. When adjusting for violence factors, most tobacco use associations were partially attenuated for all sexual minority girls, and completely attenuated for exclusive e-cigarette use among all sexual minority girls. CONCLUSIONS:Sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls. Tobacco interventions for sexual minority youth should address the risks of poly-tobacco use as well as violence-based risk factors.

Adolescent and young adults (AYA) with cancer have distinct psychosocial needs, with reproductive health being a chief concern. Reproductive health includes fertility, contraception, romantic relationships, body image, sexuality and disease prevention. Along with the unique needs of AYAs with cancer, health disparities exist among sexual and gender minority (SGM) AYAs, and there is a gap in clinician training. Our NCI-funded R25 Enriching Communication skills for Health professionals in Oncofertility (ECHO) provides reproductive health communication training to psychologists, social workers, nurses, and physician assistants who provide care for AYA people diagnosed with cancer. To refine our curriculum to address the unique needs of SGM AYAs with cancer, we conducted a survey of prior ECHO trainees to evaluate knowledge and comfort in obtaining sexual orientation and gender identity (SOGI) information from patients and providing reproductive health counseling. A 28-item electronic survey was distributed to 601 prior ECHO trainees. Quantitative items assessed: SOGI data collection at their institution; SGM AYA cancer-related health knowledge; adequacy of ECHO training for SGM AYAs; desire for additional training; comfort discussing reproductive health with SGMs; and confidence in knowledge of SGM health needs (pre- and post-survey). Response options ranged from 1=strongly agree to 5=strongly disagree, or ‘prefer not to answer. Total knowledge score was computed and ranged from 0=no correct responses to 7=all correct. Self-perceived comfort and confidence were assessed with regard to specific patient subgroups (i.e., gay/lesbian; bisexual/queer; and trans/nonbinary patients). Four open-ended items invited respondents to describe personal experiences, reservations, and suggestions for improving SGM AYA cancer care. Quantitative responses were summarized with descriptive statistics. Paired t-tests were used to analyze changes in confidence. Content analysis was applied to qualitative responses. Of the 346 who completed the survey (58% response rate), only 7.4% correctly answered all knowledge questions (M=3.76, SD=1.72). One-third thought ECHO training adequately addresses SGM needs, and the majority (89%) wanted additional training in SGM reproductive health. Confidence in knowledge of SGM health was neutral in all subgroups prior to survey completion (M=3.05, SD=1.02), but reduced significantly for bisexual/queer (ΔM=-0.21 t(307)=4.70, p<.001) and transgender/nonbinary health(ΔM=-0.12 t(307)=2.66, p=.008). Open-ended responses focused on experiences caring for SGM AYAs with cancer; training needs; and appreciation for the survey. Results demonstrate a need to refine ECHO curriculum to include SGM reproductive health concerns and strong desire for SGM content among trainees. We are developing a module to improve reproductive health communication for the care of SGM AYAs with cancer and survivors.