Background: Adolescent and young adults (AYAs, aged 13-39) with cancer face barriers to care and stagnant survival outcomes. The University of North Carolina (UNC) at Chapel Hill's AYA Cancer Program, established in 2015, aims to address these challenges. The program operates through both consultations and targeted outreach based on patient risk-stratification, offering services such as fertility counseling, enhanced access to clinical trial enrollment, a dedicated sarcoma palliative care collaborative, survivorship clinic, and psychosocial support. AYA program providers work with patients to create tailored care plans that meet AYAs' psychosocial and medical needs. To better understand the reach and impact of this novel care delivery approach, we performed a retrospective cohort study over the 8-year period of program development. Methods: Using linked electronic health record (EHR) and State Cancer Registry data, we performed a retrospective cohort study of AYA patients at UNC from 2014-2022, comparing sociodemographic and clinical criteria between those with and without AYA Cancer Program contact. Our analysis included outcomes of care utilization, complications, and supportive care measures. Using SMR propensity weighting with multivariable log binomial modeling, we evaluated associations between outcomes and AYA program contact. Factors such as age at diagnosis, race, sex, insurance status, cancer site, metastatic disease, and receipt of systemic therapy were considered in the weighting scheme. Results: Of 4,016 AYAs receiving cancer care at UNC, 670 had contact with our program. Program-engaged patients were younger at diagnosis, more likely to be Black, and had higher rates of metastatic disease or hematologic malignancies. In weighted model analyses, program patients were more likely to receive guideline recommended care, including enrollment in a clinical trial, receipt of fertility counseling and palliative care, and documented advanced care planning. Over time, our program's reach expanded from 6% to more than 25% of the total AYA population. Conclusions: Our findings indicate that AYAs contacted by our program through a consult-based, targeted outreach model represent a distinct population with higher clinical needs. Despite this complexity, they were more likely to receive guideline-recommended care, including clinical trial enrollment, fertility counseling, and palliative care.