Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer

A population-based study

Margarett Shnorhavorian, Linda C. Harlan, Ashley Wilder Smith, Theresa H Keegan, Charles F. Lynch, Pinki K. Prasad, Rosemary D Cress, Xiao Cheng Wu, Ann S. Hamilton, Helen M. Parsons, Gretchen Keel, Sarah E. Charlesworth, Stephen M. Schwartz

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

BACKGROUND The fertility of adolescent and young adult (AYA) patients with cancer can be threatened by treatments, but to the authors' knowledge little is known regarding the extent to which providers discuss this with patients or recommend fertility preservation, or the patient and physician characteristics associated with these interactions. METHODS Questionnaires from 459 AYA patients with cancer who were diagnosed between 2007 and 2008 and recruited through 7 US population-based cancer registries were analyzed using sex-specific multivariable models. The authors assessed characteristics associated with not discussing therapy effects on fertility or fertility preservation options, and not making fertility preservation arrangements. RESULTS Males without a medical oncologist were more likely not to be told that therapy might affect fertility than those with a medical oncologist (male odds ratio [OR], 2.28; 95% confidence interval [95% CI], 1.03-5.00). Individuals without insurance (male OR, 2.91 [95% CI, 1.41-5.91] and female OR, 5.46 [95% CI, 1.59-18.72]); those raising children aged <18 years; and, among males only, those who received treatment posing no or a low fertility risk (OR, 3.39; 95% CI, 1.60-7.16) were more likely not to discuss fertility preservation with providers. Finally, among males, those without a college degree (OR, 1.98; 95% CI, 1.00-3.97), lacking private insurance (OR, 2.97; 95% CI, 1.16-7.63), and raising children aged <18 years (OR, 3.53; 95% CI, 1.63-7.65) were more likely to not make fertility preservation arrangements; too few females had made fertility preservation arrangements for similar analyses to be performed. CONCLUSIONS Discussion and action surrounding fertility preservation for AYA patients with cancer are associated with medical factors, patient socioeconomic data, and child-rearing status. These results highlight the need for insurance coverage for fertility preservation and increased awareness of fertility preservation options.

Original languageEnglish (US)
Pages (from-to)3499-3506
Number of pages8
JournalCancer
Volume121
Issue number19
DOIs
StatePublished - Oct 1 2015

Fingerprint

Fertility Preservation
Counseling
Young Adult
Odds Ratio
Confidence Intervals
Population
Neoplasms
Fertility
Insurance
Child Rearing
Insurance Coverage
Therapeutics
Registries
Physicians

Keywords

  • adolescent and young adult
  • disparities
  • fertility
  • late effects
  • treatment

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Shnorhavorian, M., Harlan, L. C., Smith, A. W., Keegan, T. H., Lynch, C. F., Prasad, P. K., ... Schwartz, S. M. (2015). Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: A population-based study. Cancer, 121(19), 3499-3506. https://doi.org/10.1002/cncr.29328

Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer : A population-based study. / Shnorhavorian, Margarett; Harlan, Linda C.; Smith, Ashley Wilder; Keegan, Theresa H; Lynch, Charles F.; Prasad, Pinki K.; Cress, Rosemary D; Wu, Xiao Cheng; Hamilton, Ann S.; Parsons, Helen M.; Keel, Gretchen; Charlesworth, Sarah E.; Schwartz, Stephen M.

In: Cancer, Vol. 121, No. 19, 01.10.2015, p. 3499-3506.

Research output: Contribution to journalArticle

Shnorhavorian, M, Harlan, LC, Smith, AW, Keegan, TH, Lynch, CF, Prasad, PK, Cress, RD, Wu, XC, Hamilton, AS, Parsons, HM, Keel, G, Charlesworth, SE & Schwartz, SM 2015, 'Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: A population-based study', Cancer, vol. 121, no. 19, pp. 3499-3506. https://doi.org/10.1002/cncr.29328
Shnorhavorian, Margarett ; Harlan, Linda C. ; Smith, Ashley Wilder ; Keegan, Theresa H ; Lynch, Charles F. ; Prasad, Pinki K. ; Cress, Rosemary D ; Wu, Xiao Cheng ; Hamilton, Ann S. ; Parsons, Helen M. ; Keel, Gretchen ; Charlesworth, Sarah E. ; Schwartz, Stephen M. / Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer : A population-based study. In: Cancer. 2015 ; Vol. 121, No. 19. pp. 3499-3506.
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abstract = "BACKGROUND The fertility of adolescent and young adult (AYA) patients with cancer can be threatened by treatments, but to the authors' knowledge little is known regarding the extent to which providers discuss this with patients or recommend fertility preservation, or the patient and physician characteristics associated with these interactions. METHODS Questionnaires from 459 AYA patients with cancer who were diagnosed between 2007 and 2008 and recruited through 7 US population-based cancer registries were analyzed using sex-specific multivariable models. The authors assessed characteristics associated with not discussing therapy effects on fertility or fertility preservation options, and not making fertility preservation arrangements. RESULTS Males without a medical oncologist were more likely not to be told that therapy might affect fertility than those with a medical oncologist (male odds ratio [OR], 2.28; 95{\%} confidence interval [95{\%} CI], 1.03-5.00). Individuals without insurance (male OR, 2.91 [95{\%} CI, 1.41-5.91] and female OR, 5.46 [95{\%} CI, 1.59-18.72]); those raising children aged <18 years; and, among males only, those who received treatment posing no or a low fertility risk (OR, 3.39; 95{\%} CI, 1.60-7.16) were more likely not to discuss fertility preservation with providers. Finally, among males, those without a college degree (OR, 1.98; 95{\%} CI, 1.00-3.97), lacking private insurance (OR, 2.97; 95{\%} CI, 1.16-7.63), and raising children aged <18 years (OR, 3.53; 95{\%} CI, 1.63-7.65) were more likely to not make fertility preservation arrangements; too few females had made fertility preservation arrangements for similar analyses to be performed. CONCLUSIONS Discussion and action surrounding fertility preservation for AYA patients with cancer are associated with medical factors, patient socioeconomic data, and child-rearing status. These results highlight the need for insurance coverage for fertility preservation and increased awareness of fertility preservation options.",
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AU - Keegan, Theresa H

AU - Lynch, Charles F.

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AU - Wu, Xiao Cheng

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