Fertility Preservation for Cancer Patients: Demographic Disparities in Counseling and Financial Concerns Are Barriers to Utilization
ASRM23 October 2012
San Diego, CA - Several teams of researchers will present new survey data covering the use of fertility preservation for cancer patients at the Sixty-Eighth Annual Meeting of the American Society for Reproductive Medicine.
Researchers from the University of North Carolina at Chapel Hill and the University of California San Francisco will describe and quantify disparities in access to reproductive health information experienced by women with gynecological cancer.
They found that many cancer patients may not be receiving counseling about their treatment’s potential to affect their long-term reproductive health and that demographic disparities exist between those who receive counseling and those who do not.
The survey was mailed to 2300 women from the California Cancer Registry who had been diagnosed with a gynecologic cancer between 1993 and 2007 and aged18 to 40 at time of their diagnosis.
Preliminary results show that, of patients who received cancer treatment with the power to impact their fertility, only 50% were counseled by their oncology team about those risks, and only 3% underwent fertility preservation (FP).
Factors which influenced who got counseling and who did not include education level, whether or not the women had children, and insurance status.Taking into account the women’s parenting desires, women who had already had children at the time of their treatment were half as likely to be counseled about FP as those who were childless. Women who had a bachelor’s degree were twice as likely to be counseled as those without a degree and a trend suggests that women with private insurance are three times more likely to receive counseling than the uninsured.
P-31 Sociodemographic Disparities Affect Access to Reproductive Health Counseling Among Reproductive Age Women Undergoing Gynecologic Cancer Treatment
Letourneau et al.
Another survey-based investigation to be presented at ASRM found that a lack of money is the biggest barrier preventing women with cancer who have received counseling on fertility preservation from following through with it. Women reporting to a reproductive health clinic for FP counseling were surveyed before and after their new patient consultations, again at the time they made their decisions about FP and then, six to eight months later. Of those surveyed at the third time point (decision-making), 90% identified cost and lack of insurance coverage as their reasons for not undergoing fertility preservation.
P-35 It Comes Down to Money: Why Women Decide not to Undergo Fertility Preservation
Niemasik et al.
A multicenter survey provides a context for the range of fertility preservation services used by cancer patients and their availability, costs and utilization rates. With 48 clinics responding, researchers found that sperm and embryo cryopreservation were generally offered, but only 10% of the clinics performed in vitro maturation of eggs (under experimental protocol). Average costs were as follows: oocyte cryopreservation, $6608; embryo cryopreservation, $8285; sperm cryopreservation, $244; and sperm storage, $381 annually.
Responding providers reported that financial constraints and patients’ feelings of being overwhelmed were the most common reasons they did not proceed with FP. Only half of the providers were aware of ICD V codes for fertility preservation. ("V codes" are used for supplementary classification of factors influencing health status in submissions to third party payors.)
The survey also determined that men are underserved: Only 30% of the clinics answering the survey offered consultation to male patients.
P-39 Trends in Oncofertility Services and Costs Across the Nation: Have We Overcome the Financial Barriers to Access?
Kondapalli et al.
“Young cancer patients whose treatment endangers their fertility can benefit from fertility preservation procedures, but many are not getting the opportunity to learn about or use them. It is important that we increase awareness among oncologists concerning what reproductive specialists can do for their patients. And we need to expand our own awareness of the financial and other pressures cancer patients face and how we can help address them,” said Linda Giudice, MD, PhD, President-elect of the American Society for Reproductive Medicine.