Impact of pediatric versus adult oncology home on outcomes for AYAs with cancer.

192 Background: Adolescent and young adults (AYA) face disparate oncologic outcomes and distinct biopsychosocial needs inconsistently met by current healthcare delivery models within pediatric or adult oncology medical homes. This study examined institutional patterns of oncology home and receipt of guideline recommended care. Methods: This is a retrospective cohort study using data abstracted from NC Cancer Registry and the Carolina Data Warehouse. Patients aged 15-25 years old at cancer diagnosis between 2014-2022 that received care at University of North Carolina Medical Center were included. We compared characteristics of patients cared for in a pediatric oncology home (at least one pediatric provider) versus an adult oncology home (all adult providers). We used Fisher’s Exact tests to compare rates of clinical trial consideration, fertility counseling, and palliative care across oncology homes. Log binomial models were used to compare outcomes across oncology home while adjusting for receipt of chemotherapy. Results: Care within a pediatric oncology home decreased with rising age (95% at 15 years to 17% at 20 years), then plateaued at ages 20-25 years (range 14%-29%). Cancer types with the highest proportion of patients treated within a pediatric oncology home were lymphoma (55%), leukemia (53%), and sarcoma (51%). AYA Cancer Program involvement was higher for those treated within a pediatric oncology home than an adult oncology home (59% vs 25%, respectively). There were differences in receipt of chemotherapy, clinical trial consideration, fertility counseling, and palliative care between oncology homes (Table). After adjusting for receipt of chemotherapy, patients with a pediatric oncology home were more likely to receive fertility counseling (RR: 3.31 95% CI (2.09, 5.23) p =<.0001). Conclusions: We observed differences in care experienced by AYAs between pediatric and adult oncology homes, including higher rates of chemotherapy, fertility counseling, and clinical trial consideration. To better evaluate the process leading to oncology home recommendations, we plan to further explore the biopsychosocial considerations of the AYA Cancer Program through interviews and surveys. Impact of pediatric versus adult oncology home on outcomes for AYAs with cancer. Pediatric Oncology Home Adult Oncology Home p-value n (%) n (%) Receipt of chemotherapy 199 (73%) 184 (39%) <.0001 Clinical trial consideration 149 (55%) 178 (38%) <.0001 Fertility preservation consult 64 (23%) 24 (5%) <.0001 Palliative care consult 36 (13%) 24 (5%) 0.0002