About

Dr. Anne C. Kirchhoff is a researcher involved in pediatric and adolescent cancer studies, with a focus on survivorship, health disparities, and access to healthcare. She is a professor at the University of Utah and serves as the co-medical director of the HIAYA Cancer Care Program. Her work includes collaboration on studies related to pediatric and AYA cancer, emphasizing health equity, community-based research approaches, and the impact of sociocultural factors on healthcare access. Dr. Kirchhoff's research aims to improve health outcomes for cancer survivors and to address barriers faced by children, young adults, and families affected by cancer.

Research topics

• Medicine
• Internal medicine
• Family medicine
• Gerontology
• Psychiatry
• Nursing
• Pediatrics
• Virology
• Psychology
• Psychotherapist
• Emergency medicine
• Immunology
• Demography

Selected publications

• Associations between Ambient Air Pollution and Cardiovascular and Respiratory Healthcare Visits in Adolescent and Young Adult Cancer Survivors

  Cancer Epidemiology Biomarkers & Prevention · 2026-02-06

  articleOpen accessSenior author

  BACKGROUND: Cancer therapies have well documented adverse effects on cardiovascular and respiratory health, which could increase cancer survivors' susceptibility to poor air quality. We describe the risk of cardiovascular and respiratory healthcare visits following acute air pollution exposures among adolescent and young adult (AYA) cancer survivors. METHODS: We identified all Utah AYAs diagnosed at 15 to 39 years of age with thyroid, melanoma, lymphoma, breast, or testicular cancer from 1998 to 2016 (N = 8,016). AYAs were linked by residential location to daily particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) for 2000 to 2016. Case cross-over models in a distributed lag nonlinear model framework estimated odds ratios (OR) and 95% confidence intervals (95% CI) for cardiovascular and respiratory healthcare visits (inpatient admissions and emergency department/urgent care visits) with exposure over the 6 days preceding an event, adjusting for temperature and relative humidity. RESULTS: A total of 3,143 AYAs (39%) experienced ≥1 respiratory/cardiovascular event. O3 was associated with cardiovascular events (ORlag4 = 1.08; 95% CI, 1.02-1.14, and ORlag5 = 1.05; 95% CI, 1.01-1.09), and NO2 was associated with respiratory events (ORlag1 = 1.05; 95% CI, 1.01-1.10). Breast cancer survivors showed an elevated risk for cardiovascular and respiratory visits; melanoma, lymphoma, and testis survivors displayed an increased risk for cardiovascular visits. CONCLUSIONS: O3 was linked with an elevated risk of cardiovascular events, whereas respiratory events were associated with NO2. Associations between air pollutants and healthcare visits varied by primary diagnosis site, indicating that susceptibility to air pollution could differ due to cancer-specific treatment factors. IMPACT: AYAs face an increased risk for cardiovascular and respiratory events with exposure to ambient air pollution and may benefit from interventions to reduce exposures.

  PublisherOA PDFDOI

• Association of Health Insurance Literacy on Financial Toxicity Among Adolescent and Young Adult Cancer Patients

  Journal of Adolescent and Young Adult Oncology · 2026-03-30

  articleSenior author

  We explored how sociodemographics and health insurance literacy (HIL) are associated with financial toxicity (FT) among adolescent and young adult (AYA) cancer patients using linear regression. Participants ( N = 86; ages: 18–39) diagnosed with cancer in the past year completed baseline surveys of an intervention trial assessing HIL (range: 4–36, lower scores = worse literacy) and the COmprehensive Score for financial Toxicity (COST; range: 0–44, lower scores = higher toxicity). Policyholders had higher FT (β = −5.24, p = 0.02). Among AYAs aged 26–39, each one-point HIL increase correlated with a 0.55 increase in COST score ( p = 0.05). Improving HIL could address FT among AYAs aged 26–39, suggesting a potential target for intervention.

  PublisherDOI

• Identifying the Core Functions of a Health Insurance Literacy Program for Adolescent and Young Adult Cancer Survivors

  Journal of Adolescent and Young Adult Oncology · 2026-02-27 · 1 citations

  article

  CHAT is a virtual navigation program designed to improve adolescent and young adult cancer survivors (AYAs) health insurance literacy. CHAT is feasible, acceptable, and preliminarily efficacious. We used state-of-the-science methods to identify CHAT's core functions (i.e., effectiveness-driving features). We conducted 7 semistructured interviews with CHAT developers (e.g., health services researchers, psychologists) and implementers (e.g., AYA patient navigator). We used interview data to develop a preliminary list of core functions. We then used a member-checking exercise with interview participants and other CHAT team members to develop consensus on a final list of core functions and underlying theory of change.

  PublisherDOI

• Test-Retest Reliability and Mode Effects on Single-Item and Multi-Item Measures in a Survey of Adolescent and Young Adults with Cancer

  Journal of Adolescent and Young Adult Oncology · 2026-01-12

  article

  Purpose: This project examined test-retest reliability and survey mode administration across single-item and multi-item measures among adolescent and young adult (AYA) cancer survivors. Methods: Forty-six AYAs randomly assigned to survey mode (phone, online, and paper) completed the survey and were invited to complete the survey again 1 week later. Results: Mode effects were found on 6% of single-items and 25% of multi-item scores. Reliability was low for 52% of single-items and 8% of multi-item scores. Conclusion: Multi-item measures should generally be used over single-item measures due to better reliability, but single-item measures may be preferable when mode effects are large.

  PublisherDOI

• Neurocognitive impairment and financial hardship in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

  JNCI Journal of the National Cancer Institute · 2026-01-28

  articleOpen access

  More than 60% of adult survivors of childhood cancer report medical financial hardship due to the cumulative costs of cancer-directed therapy and related chronic health conditions. Whether neurocognitive impairment as a late effect is associated with increased financial hardship is unknown. In a large national cohort of 3023 adult survivors of childhood cancer, we observed a dose-dependent relationship between neurocognitive impairment and financial hardship outcomes. Individuals with 4 impaired neurocognitive domains had over 3-fold increased odds of debt collection (OR = 3.12, 95% CI = 1.91-5.09) and bankruptcy (OR = 3.77, 95% CI = 2.01-7.07) compared to individuals with no impaired neurocognitive domains. After adjusting for education, employment, and household income, the independent association between neurocognitive impairment and financial hardship outcomes persisted suggesting that other mechanisms may be at play. Neurocognitive impairment is an important risk factor for medical financial hardship in this patient population and should be considered for targeted screening and intervention.

  PublisherDOI

• Caring for Children in Relation to Financial Hardship, Advance Care Planning, and Genetic Testing Among Adolescent and Young Adults with Cancer

  UNC Libraries · 2026-04-18

  articleOpen access

  <strong><em>Purpose:</em></strong> When a cancer diagnosis coincides with caring for children, it may influence the financial impacts of cancer and decisions to pursue advance care planning (ACP) or genetic testing. We examined associations between caring for children and financial hardship, ACP, and genetic testing among female adolescent and young adult (AYA) cancer survivors in North Carolina and California. <strong><em>Methods:</em></strong> Participants were diagnosed at ages 15-39 years with breast, melanoma, gynecologic, lymphoma, or thyroid cancer during 2004-2016. We estimated adjusted prevalence differences (aPDs) and ratios (aPRs) for each outcome by child caring status using marginal structural binomial regression models. <strong><em>Results:</em></strong> Among 1595 women ages 19-54 years at survey (median&thinsp;=&thinsp;7 years since diagnosis), 819 (51.3%) reported that they were caring for children at diagnosis. Women caring for children had a higher prevalence of material financial hardship (e.g., medical debt; 30% vs. 21.9%; aPD&thinsp;=&thinsp;9%, 95% confidence interval [CI]: 3 to 14; aPR&thinsp;=&thinsp;1.39, 95% CI: 1.12 to 1.72) but similar levels of psychological financial hardship compared to noncaregivers. Women caring for children were more likely to complete ACPs (42.2% vs. 30.7%; aPD&thinsp;=&thinsp;9%, 95% CI: 3 to 16; aPR&thinsp;=&thinsp;1.30, 95% CI: 1.08 to 1.57). Among the 723 survivors of breast, endometrial, and ovarian cancer, the prevalence of genetic testing was higher among women caring for children (89%) than noncaregivers (81%); this difference was not statistically significant. <strong><em>Conclusion:</em></strong> Women caring for children at diagnosis may be at elevated risk for adverse financial outcomes and may benefit from additional financial navigation support. Childcare responsibilities may further complicate health decision-making for AYAs diagnosed with cancer.

  PublisherDOI

• Abstract 5219: Systemic therapy and cardiovascular disease in adolescent and young adult breast cancer survivors

  Cancer Research · 2026-04-03

  article

  Abstract Breast cancer (BC) is the most common cancer among female adolescents and young adults (AYAs; 15-39 years). While advances in treatment have improved survival, cardiovascular disease (CVD) can result from systemic therapies, and CVD is a leading cause of death in AYA cancer survivors. AYAs with BC face nearly a four-fold increased risk of CVD compared to their peers without cancer. However, data on the effects of systemic treatment on CVD in this population remains limited. We estimated risk of CVD in AYAs diagnosed with invasive BC (2006-2020), who survived ≥2 years, and were diagnosed and treated in the Kaiser Permanente (KP) Northern and Southern California. Patients were categorized by receipt of anthracycline-, alkylating-, HER2-, platinum-, and taxane-based therapies within 2 years of diagnosis. We examined the cumulative incidence of CVD starting 2 years post-diagnosis and used Cox proportional hazards regression to determine factors associated with CVD. Among 3,071 AYAs, 35.1% were non-Hispanic (NH) White, 31.6% were Hispanic, 18.3% were NH Asian, and 8.2% were NH Black. Most received systemic therapy (90.6%), including anthracycline- and alkylator without HER2-targeted therapy (41.9%) and HER2-targeted therapy without anthracycline (20.9%). Fewer AYAs received a taxane and alkylator (13.0%) or anthracycline with alkylator and taxane along with a HER2-targeting agent (6.4%). Mean follow-up after cancer diagnosis was 7.2 years (range: 2.0-17.5). The 10-year cumulative incidence of CVD was highest among AYAs who received anthracycline/alkylator/taxane/HER2-targeting therapy (19.6%), intermediate for those with anthracycline/alkylator without HER2-targeting therapy (13.0%) and those who received HER2-targeted therapy without anthracycline (14.6%), and lowest for those who received taxane/alkylator (7.3%). In the multivariable model adjusted for demographic factors and radiation, compared to taxane/alkylator, anthracycline/alkylator/taxane/HER2-targeting therapy (hazard ratio (HR)=2.63, 95% confidence interval (CI) 1.56-4.43); anthracycline/alkylator without HER2-targeting therapy (HR=1.75, CI 1.13-2.71); and HER2-targeting therapy without anthracycline (HR=2.13, CI 1.11-4.09) were associated with an increased risk of CVD. CVD risk was similar for taxane/alkylator and no systemic therapy. Other factors associated with higher risk of CVD included NH Black race/ethnicity (HR=1.90, CI 1.32-2.73 vs. NH White) and public health insurance (HR=1.67, CI 1.00-2.78 vs private). This study identifies AYA BC survivors at higher risk of CVD based on treatment regimens received, with highest risks found for those receiving anthracycline/alkylator/taxane/HER2 treatment combinations. In addition, AYAs of Black race/ethnicity and those with public health insurance experienced more CVD, underscoring the need for targeted interventions to mitigate these disparities. Citation Format: Theresa H. M. Keegan, Candice A. Sauder, Ann M. Brunson, Renata Abrahao, Anne C. Kirchhoff, Eric Haupt, Mallory Casperson, Ted Wun, Chun R. Chao, Andrew B. Smitherman, Hazel B. Nichols, Jessica Chubak, Erin E. Hahn, Lawrence H. Kushi, Kathryn J. Ruddy. Systemic therapy and cardiovascular disease in adolescent and young adult breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5219.

  PublisherDOI

• Identifying clustering in patterns of late effects among survivors of adolescent and young adult Hodgkin lymphoma

  JNCI Cancer Spectrum · 2025-09-27

  articleOpen accessSenior author

  BACKGROUND: We examined late effects clustering among adolescent and young adult (AYA; age 15-39 years at diagnosis) Hodgkin lymphoma (HL) survivors and identified characteristics associated with each cluster. METHODS: We included AYAs with HL in 2006-2018 from the California and Utah Cancer Registries linked to statewide hospitalization, emergency department, and ambulatory surgery visit data. We identified severe late effects >2 years after cancer diagnosis in 9 late effects categories. Latent class analysis (LCA) was used to identify late effects clusters. Multinomial logistic regression models estimated adjusted associations of demographic and treatment characteristics with LCA late effect group. RESULTS: We identified 4635 AYA HL survivors with median follow-up of 8.2 years and 4 late effects groups: 77.1% had a low probability of any late effect (Low Morbidity), 12.8% had high probability of Thyroid disorders, 8.0% had high probability of Cardiovascular Disease (CVD), and 2.1% had high probability of Multiple Conditions (CVD, diabetes/pancreatic, thyroid, and renal diseases). Publicly insured AYAs were more likely than those with private insurance to be in the CVD (OR = 1.53, 95% CI = 1.18 to 1.98) and Multiple Conditions (OR = 2.17, 95% CI = 1.29 to 3.66) than the Low Morbidity group. AYAs with radiation were more likely to be in the Multiple Conditions (OR = 2.31, 95% CI = 1.41 to 3.78) and Thyroid (OR = 2.81, 95% CI = 2.20 to 3.58) groups. Hematopoietic cell transplantation was associated with Multiple Conditions (OR = 9.50, 95% CI = 5.82 to 15.50), CVD (OR = 3.82, 95% CI = 2.96 to 4.93), and Thyroid (OR = 2.86, 95% CI = 2.12 to 3.85) groups. CONCLUSIONS: While most AYA HL survivors were in the Low Morbidity group, those with public insurance or intense treatment may be at higher risk for multiple conditions.

  PublisherDOI

• Accuracy and inclusiveness of health insurance information in generative artificial intelligence.

  Journal of Clinical Oncology · 2025-05-28

  articleSenior author

  e13723 Background: GenerativeAI (genAI) has the potential to revolutionize how cancer patients seek information. As more cancer survivors look to genAI for guidance on health insurance topics, it is critical to evaluate the accuracy and inclusiveness of genAI generated responses to questions about health insurance. Methods: Prompts were constructed based on the content of an NCI-funded health insurance literacy patient navigation intervention (CHAT-S). In CHAT-S, participants meet with a navigator over four 30-minute sessions to cover information on health insurance terms/processes, specifics of their health insurance, healthcare laws, information about appeals, tips for budgeting, and financial resources. Topics from these sessions were converted into 13 unique AI prompts (e.g., what is preauthorization, how do I file an appeal, etc.). Each prompt was put into Microsoft Copilot. A codebook was applied to the genAI responses to systematically evaluate accuracy and inclusiveness on a scale of 0-2 (0 = no meaningful difference, 1 = appropriate slight difference, 2 = meaningful difference). To assess accuracy, genAI content was compared against the CHAT-S intervention content and evaluated for incorrect information, lack of assertive language, and missing context. To assess inclusiveness, content was evaluated for dehumanizing language and Flesch reading ease. Results: Across all 13 genAI responses, context was consistently lacking across all genAI responses (Mean: 2, Standard Deviation: 0). While every response included appropriate information, there was important information included in the booklet that was absent in the genAI response. For example, when defining a deductible, genAI did not include that it resets annually. Overall, the main content presented in CHAT-S and the genAI responses were consistent with each other (1.2, 0.44) When content differed, it was in specificity. For example, the booklet provided names and contact information for financial resources, whereas genAI linked to resource databases where a survivor could find additional resources independently. Assertiveness was appropriate across all genAI responses (1.2, 0.44). The language used by genAI was inclusive in sentiment; however, not in reading level. The average Flesch reading ease across responses was more challenging than recommended for health educational materials (Mean 11 th grade; recommended 6 th grade). Notably, genAI responses did not produce any inaccurate information. Conclusions: GenAI has potential to guide and inform cancer survivors on health insurance topics. In this explorative study, genAI responses included helpful steps to guide patients in understanding and using their health insurance. While we used broad prompts about insurance, future studies should evaluate the ability of genAI to generate tailored recommendations based on individuals’ specific scenarios.

  PublisherDOI

• Incidence of chronic medical conditions among survivors of adolescent and young adult cancer compared to a population without cancer

  Cancer · 2025-10-10 · 1 citations

  articleOpen access

  BACKGROUND: Few studies have assessed the burden of chronic medical conditions in adolescent and young adult (AYA) cancer survivors. This study estimated the risk of these conditions among AYA survivors compared to a matched cohort without cancer. METHODS: This retrospective cohort study included 2-year survivors (n = 14,917) of 11 common AYA (15-39 years) cancers diagnosed at the integrated health care organizations of Kaiser Permanente (KP) Southern and Northern California during 2006-2020. A comparison cohort (n = 149,164) without cancer (matched 10:1 by age, sex, calendar year, and KP site) was included. Cumulative incidence (CMI) accounting for death as a competing risk was calculated. Poisson regression estimated the incidence rate ratio (IRR) of each condition in cancer survivors versus the matched cohort, adjusting for age, sex, and race/ethnicity. RESULTS: The 5-year CMI was highest for thyroid (17.4%), respiratory (6.6%), cardiovascular (5.0%), and liver (4.8%) diseases. At 10 years, the CMI of any condition was 39% in survivors versus 26% in the matched cohort. Survivors had a 2-fold increased risk of being diagnosed with any medical condition (IRR, 2.0; 95% confidence interval [CI], 1.9-2.0) as well as two or more conditions (IRR, 2.3; 95% CI, 2.2-2.5). Risk was highest among survivors of hematologic cancers and those diagnosed with distant stage disease. Elevated risks were observed within all sociodemographic groups of this insured population. CONCLUSION: AYAs with cancer had a higher risk of chronic medical conditions compared to those without cancer. Long-term surveillance, risk mitigation through lifestyle modifications and effective disease management are crucial to reduce premature mortality.

  PublisherOA PDFDOI

Recent grants

• Health and socioeconomic outcomes for adolescent and young adult cancer survivors

  NIH · $147k · 2013–2015

Frequent coauthors

• Echo L. Warner

  University of Utah

  256 shared

• Wendy M. Leisenring

  213 shared

• Gregory T. Armstrong

  St. Jude Children's Research Hospital

  191 shared

• Leslie L. Robison

  172 shared

• Elyse R. Park

  167 shared

• Mark Fluchel

  120 shared

• Austin R. Waters

  University of Utah

  114 shared

• Karen Kuhlthau

  Walsh University

  105 shared

Labs

• Kirchhoff GroupPI

  Not provided