European Cancer Summit 2022 Submission for Survivorship and Quality of Life NetworkFertility Preservation and Quality of Life among Adolescent and Young Adult Cancer Patients from Across Europe

Compromised fertility in young people is one of the most life-altering late effect of cancer, affecting domains from sexuality and body image to self-esteem and quality of life (Logan and Anazodo 2019). While there exist evidence-based international guidelines for fertility preservation (FP) (Lambertini et al. 2020), there is no standardized way of implementing these guidelines within and between countries across Europe. We aimed to better understand young people’s awareness to FP and its relationship to QOL and mental health. In this online cross-sectional study, adolescent and young adult (AYA) cancer patients and survivors from the wider European region responded to questions related to fertility preservation, awareness, access, and mental health and quality of life. Responses were summarized descriptively and organized by country clusters for meaningful between-cluster healthcare comparisons (Ferreira et al. 2018). Comparisons were done using χ2 or nested linear models Project and analyses were pre-registered at: https://osf.io/t9h82/. Participants were 629 cancer patients and survivors, aged 15 to 39 (M = 24.7 years) at diagnosis, recruited from 47 counties (26 EU) between February and August 2022. Overall, only 53% of respondents were made aware of the available medical options for fertility preservation. Country cluster comparisons revealed significant differences: compared to others, cluster Easter Countries A1 showed that fewest people were informed about the possibility of infertility (χ2 (10, 629) = 17.21, p = 0.07). A multilevel linear model revealed that overall quality of life differed significantly between those who were aware of FP services within Southern and Eastern B country clusters2 (t = 2.03, p = 0.425 and t = 2.30, p = 0.022; See Fig.1A). Specifically, 27% said fertility-related concerns greatly impacted their level of anxiety and depression, and 17% reported great impact on their quality of life (see Fig.1B). Significant cancer-related fertility inequalities exist among AYA cancer patients and survivors between countries and healthcare systems within Europe. Accessible FP programs should become an integral part of cancer rehabilitation for AYAs and should actively include them in the development of any novel guidelines. AYAs’ mental health and quality of life may be compromised by fertility-related distress and should be monitored throughout the cancer continuum.