Julia Stal Receives National Cancer Institute Predoctoral to Postdoctoral Fellow Transition Award (F99/K00)

Julia Stal is the recipient of the prestigious National Cancer Institute (NCI) Predoctoral to Postdoctoral Fellow Transition Award (F99/K00). Stal was awarded $477,546 to study the multi-level influences of patient-, provider-, system- and policy-level factors to understand fertility experiences among adolescent and young adult cancer patients. This funding is given to outstanding PhD candidates to complete their dissertation research training (F99 phase) and transition to a cancer-focused postdoctoral research position (K00 phase). Stal is a fifth-year PhD candidate in the Health Behavior Research program in the Department of Population and Public Health Sciences at the Keck School of Medicine of USC. She is one of approximately 20 recipients nationwide to receive this grant.

“Julia is only the second student at USC to receive this highly competitive grant which supports outstanding PhD candidates nationally,” shares Kimberly Miller, PhD, MPH, associate professor of population and public health sciences and Stal’s primary mentor. “The funding from NCI will allow her to seamlessly transition to the postdoctoral institution of her choice and help her become an exceptional independent cancer researcher.” 

Curative cancer treatment frequently causes infertility and fertility-related distress for patients. Unfortunately, many patients are not informed that their cancer treatment may impact their fertility. “Historically, fertility discussions occur at very low rates and are delivered at disproportionately lower rates to racial and ethnic minorities,” she assesses. “Likely in light of this, patients continue to endorse fertility as a prevalent unmet need, representing an area in which they desire more information and resources pertaining to their reproductive health and family planning.” Therefore, the ‘fertility experiences’ Stal is investigating through her dissertation research refer to patient-provider discussions surrounding fertility, obtaining fertility preservation, patient reproductive concerns, and impact to their future family planning.

Her first two dissertation studies are cancer registry derived population-based studies exploring sociodemographic predictors and healthcare factors on the fertility experiences of ethnically diverse adolescent and young adult cancer patients. This cancer registry data will help to address the lack of racial and ethnic diversity in existing oncofertility research by including a diverse population of nearly 1,500 patients, involving those who are under-resourced and not currently in-care. Her third study is a qualitative study interviewing oncologists to gain an understanding of the barriers and facilitators to providing guideline-concordant fertility discussions for adolescent young adult cancer patients. “While guidelines exist for these discussions, research is lacking regarding their implementation, and we are unsure how they hinder or support patient care,” she advises. “Oncologists should initiate fertility discussions as early as possible, ideally at the time of diagnosis, and should provide comprehensive and actionable information to patients in their reproductive years, however, we lack a detailed understanding as to why providers are or are not adherent to guidelines.”

After graduation, Stal will embark on the post-doctoral portion of her grant where she will study implementation science, intervention research, and health policy. Her research will focus on system- and policy-level factors that impact optimal oncofertility care for pediatric, adolescent, and young adult patients, particularly through insurer adherence to legislative mandates and barriers to coverage for fertility preservation.

By collectively investigating oncofertility across the cancer care continuum through her dissertation and postdoctoral research, Stal hopes her research will inform the delivery of equitable, guideline-concordant care and future intervention development to improve care and long-term reproductive health outcomes for young patients. “I want all patients—regardless of their sociodemographic or economic background—to maintain agency in their health care, make informed decisions, and have the ability to act on available resources. Advocating for young patients and facilitating the delivery of quality care are passion areas for me, and I hope my work will contribute to improvements in cancer survivorship, quality of life, and well-being for this population,” she concludes.