Identifying fertility concerns and needs among adolescent and young adult males with melanoma receiving immunotherapy: A qualitative analysis.

356 Background: The risk of infertility is a cause of distress among adolescent and young adult (AYA) cancer patients (pts). While this concern is appreciated, there is a paucity of data on the impact of immunotherapy on male fertility. Immunotherapy is often the initial treatment for pts with melanoma, the third most common cancer in AYAs. This study aims to explore fertility concerns in male AYAs with melanoma who have received immunotherapy through semi-structured interviews focused on knowledge of treatment effects and the experience of fertility discussions or fertility preservation. Methods: Single-center electronic database search for male pts ages 18-39 with metastatic and locally advanced melanoma treated with anti-PD-1/PD-L1/CTLA-4 therapies between 2013 and 2024. Semi-structured interviews with a random cohort of 10 pts were conducted. Authors deductively coded interviews for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns as well as emergent, inductive themes (Table 1). Results: 38 pts (median age 34) were identified overall. Among the interview cohort, 9/10 pts recalled a fertility discussion, and 3 pts completed fertility preservation. 6 pts had children prior to treatment while 3 pts had children post-treatment. No pts used banked sperm. Emergent themes included: challenges in accepting the uncertainty of future family planning, feelings of accelerated timelines, and concerns about reliable information. Some pts struggled to appreciate the consequences of current decisions on future outcomes. Others felt that their treatment course compelled them to consider family planning before peers. Pts noted difficulty managing information from many sources, including parents and partners, medical providers, and internet/social media. Conclusions: AYA males with melanoma receiving immunotherapy recall discussions about fertility, although with various levels of engagement with fertility specialists or fertility preservation. Themes identified in this study suggest that collaboration between medical oncologists, fertility specialists, and supportive personnel with an appreciation of the unique challenges facing AYAs (social workers, financial counselors, psychologists), is needed to prepare discussion outlines and educational materials specific to this population. Code book with definitions. Code Definitions Reproductive Concerns Acceptance of potential infertility Disclosing fertility status with partners Costs of fertility preservation Information Needs Information from medical providers Information from other patients Internet/social media resources Knowledge of Effects Treatment factors affecting fertility Reproductive technology and fertility preservation Alternative parenting options (adoption, child-free living, surrogacy)