PROJECT SUMMARY/ABSTRACT Improving cancer survival trends among adolescent and young adults (AYAs) present an urgent need to address their unique survivorship concerns and strive toward NCI's scientific priority to “ensure that cancer survivors have the highest possible quality of life.” This fellowship will address the fertility challenges faced by females with cancer and provide me with training and expertise to become an emerging cancer outcomes researcher. Current gaps in cancer outcomes research related to assisted reproductive technology (ART)— and specifically ART for fertility preservation—may contribute to lack of patient and provider knowledge and low utilization rates, particularly among marginalized groups. Key evidence gaps include: (1) the extent to which disparities exist in use of fertility preservation; (2) the impact of fertility preservation on time to cancer treatment; and (3) reproductive success after ART, accounting for fertility preservation prior to cancer treatment. Study aims will address these gaps by utilizing innovative and generalizable population-based data linkages between the North Carolina (NC) Central Cancer Registry, the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System, and NC birth certificates. This linkage captures AYA (aged 15-39 years) females diagnosed with cancer in NC during 2004-2015 who utilized ART (with or without fertility preservation prior to cancer treatment) through 2016 (n=370 estimated women). To examine disparities in fertility preservation utilization (Aim 1), sociodemographic factors will be compared between AYA females with cancer who underwent fertility preservation prior to cancer treatment and AYA females with cancer who did not, accounting for clinical cancer characteristics. To examine the effect of fertility preservation on cancer treatment delay (Aim 2), time to initiation of gonadotoxic cancer treatment will be compared between AYA females with cancer who initiated ART for fertility preservation prior to cancer treatment and AYA females with cancer who did not, accounting for clinical cancer characteristics. Lastly, pregnancy and birth rates will be compared between AYA females with cancer who initiated ART for fertility preservation prior to cancer treatment and AYA females with cancer who initiated ART after treatment (Aim 3). Study results can enhance the evidence-base available to health care providers and patients to guide fertility-related decisions after cancer. The fellowship training will take place in a supportive, resource-rich environment and will provide me with clinical- and research-focused perspectives related to ART; active involvement with community-engaged research; expertise in multilevel data analysis; diverse opportunities to disseminate my research; reinforcement of ethical research conduct; and will promote my development as an emerging cancer outcomes researcher. This fellowship will be an invaluable contribution to my caree...