Project Summary Young Adult (YA) survivors of childhood cancer (ages 18-39), have unique medical and psychosocial needs that may differ from older survivors, with reproductive health being a paramount concern. Reproductive health for YA survivors extends beyond infertility and fertility preservation to include other interrelated components: contraception for pregnancy and sexually transmitted infection prevention; HPV vaccine; and assessment of sexual health and functioning and the promotion of quality of life. NCCN (1.2021) survivorship guidelines recommend addressing late effect related to: ovarian function; estradiol levels; treatment for vasomotor symptoms and vaginal dryness; androgen depravation symptoms; sexual function; HPV vaccine recommendation; sexual health and function; and fertility related concerns. However, the extent to which these issues are addressed and documented is not well understood at NYU Perlmutter Cancer Center (PCC) and gauging our rates will allow us to develop future interventions for improvement. Coupled with individual factors that may hinder survivorship reproductive health counseling are institutional/practice level barriers that impede the timely offer of counsel, service or referrals for care. Several studies have concluded that lack of dedicated models of care to address reproductive health within the institution, clinician lack of time or training, and absence of a policy requiring such discussions all negatively impact quality reproductive care for AYA. Additionally, the examination of organizational factors such as policies and pathways may shed light on barriers and facilitators. PCC, is uniquely qualified to conduct this study. Our EPIC data review identified over 1300 patients currently receiving care at PCC diagnosed prior to age 18 and now aged 18-40. Thus, we have a large database of YA cancer survivors to identify documentation of reproductive health issues as per NCCN guidelines. The goals of this study are to conduct a retrospective chart review of YA survivors to identify documentation of counsel or referral for reproductive health concerns (sexual health/sexual dysfunction; HPV vaccine recommendation; contraception; and fertility related concerns) and examine if presence or absence of documentation is associated with patients’ pediatric cancer diagnosis, stage, treatment and status, parity, gender/identity, sexual orientation or payor status and examine if these patient characteristics, alone or in combination, are associated with the odds of documentation of attending to reproductive health issues. Additionally, we will conduct a policy and pathway analysis to identify if any PCC policies and or pathways support or address reproductive health using the Livestrong Recommended Practices for AYA. An outstanding team of experts in YA reproductive health, pediatric & YA cancer and survivorship, medical records, policy analysis and behavioral statistics will conduct this study and results will have si...