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

Authors

  • Joseph M. Letourneau MD,

    1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
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  • James F. Smith MD, MS,

    1. Department of Urology, University of California at San Francisco School of Medicine, San Francisco, California
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  • Erin E. Ebbel BA,

    1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
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  • Amaranta Craig BA,

    1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
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  • Patricia P. Katz PhD,

    1. Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, California
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  • Marcelle I. Cedars MD,

    1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
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  • Mitchell P. Rosen MD, HCLD

    Corresponding author
    1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco School of Medicine, San Francisco, California
    • HCLD, 1635 Divisadero, Suite 601, San Francisco, CA 94115

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    • Fax: (415) 353-7744


Abstract

BACKGROUND:

This study seeks to examine the relation between sociodemographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer.

METHODS:

A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Nine hundred eighteen women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student t test, linear regression, and multivariate logistic regression were used where appropriate to determine the relation between sociodemographic characteristics and the odds of using fertility preservation services.

RESULTS:

Sixty-one percent 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 (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age older than 35 years (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.

CONCLUSIONS:

Sociodemographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the past decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer. Cancer 2012. © 2012 American Cancer Society.

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