Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer

Abstract

Background This study seeks to examine the relationship between socio-demographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer. Methods 1041 women diagnosed with cancer between age 18 and 40 responded to our retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin’s disease (HD), Non-Hodgkin Lymphoma (NHL), breast cancer, and gastrointestinal cancer (GI). 918 women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student’s t-test, linear regression, and multivariate logistic regression were used where appropriate to determine the relationship between socio-demographic characteristics and the odds of utilizing fertility preservation services. Results 61% of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor’s degree (OR 0.7, 95%CI 0.5 – 0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age greater than 35 years old (OR 0.1, 95% CI 0.0 – 1.4) or previous children (OR 0.3, 95% CI 0.1 – 1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed. Conclusion Socio-demographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the last decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer.

Outcome of Patients with Pregnancy during or after Breast Cancer: A Review of the Recent Literature

“…More patients with bca inquire about fertility-related issues and whether a subsequent pregnancy might alter their risk of disease recurrence after adjuvant treatment 7 . Approximately 50% of women with a history of bca might wish for a subsequent pregnancy 8 , but only 4%-7% manage to become pregnant 9 . Potential explanations are damaged fertility and fear on the part of both the patient and her physician of a negative impact of pregnancy on the evolution of bca.…”

Gravidez após o Cancro da Mama: Estado da Arte

“…Estima-se que entre 40% a 50% das mulheres pré--menopausicas com antecedentes de cancro da mama desejam engravidar após o tratamento. 9 No entanto, menos de 10% destas mulheres efetivamente vai engravidar, sendo que alguns estudos têm evidenciado que a percentagem de mulheres com menos de 45 anos que concebe após o final do tratamento parece variar entre 3,6% -5%. 2,10,11 A profunda e bem estabelecida heterogeneidade genética e molecular do cancro da mama coloca questões acrescidas a esta problemática, nomeadamente quando considerada a expressão dos recetores hormonais e o subtipo biológico do tumor, com implicações significativas não só no prognóstico, mas também nas opções terapêuticas e na fertilidade destas mulheres.…”

Adolescent and Young Adult Cancer: Principles of Care

“…The fertility concerns of aya cancer patients while on therapy and after therapy discontinuation have been documented to be one of the major causes for their anxiety [7][8][9][10][11] . Chemotherapy and radiotherapy can be gonadotoxic, resulting in impaired fertility [12][13][14] .…”