Disparities in counseling female cancer patients for fertility preservation: adding insult to injury?

Abstract

ObjectiveTo explore disparities in counseling of adult female cancer patients for fertility preservation.DesignRetrospective study of female patients with a diagnosis of breast, gynecologic, or hematologic cancer from 2009-2013 at an academic medical center.Materials and MethodsElectronic medical record data for demographics, counseling for fertility preservation, and cancer diagnosis and treatment was obtained for 587 female patients with breast, gynecologic, or hematologic cancer. Retrospective analysis of 353 patients (19-42y; x- = 35.0, SD = 5.31) with available chemotherapeutic treatment data was performed.Results262/353 (74%) women were exposed to a gonadotoxic chemotherapeutic agent; 181 women were diagnosed with breast cancer, 53 with a hematologic (i.e., leukemia/lymphoma) cancer, and 28 with a gynecologic cancer. 161/262 (62%) chemotherapy exposed women had documented counseling for fertility preservation; 77 (29%) women were not counseled, and counseling was not documented in 24 (9%) charts. Younger women were more likely to be counseled than older women; the average age of those counseled was (x- =34.0, SD =5.6yrs), not counseled (x- = 35.0, SD =4.7yrs), and not appropriate for counseling (x- =35.5, SD =4.4 yrs) (p <. 05). Racial differences in counseling were also found (p <. 05) with 86% of Hispanic women, 65% of Asian women, 62% of white women, and 53% of black women with documented counseling. Divorced women were less likely to be counseled than women of any other marital status (p <. 05). Women with gynecological or hematological cancer or who had a lower cancer stage were more likely to be counseled that those with other cancers or higher stages (p <. 05). Logistic regression resulted in no unique variance contribution in a model including age, marital status, race, cancer diagnosis, and stage.ConclusionIn the current study, demographic and diagnostic disparities were evident in the counseling of cancer patients for fertility preservation. Patients who are not offered fertility preservation prior to cancer treatment have previously been found to experience significant regret and poorer quality of life. In addition to emotional harm, disparate counseling for fertility preservation could result in an unnecessary decreased ability for some women to fulfill their future reproductive desires. Equality in the counseling of female cancer patients for fertility preservation is imperative in order to reduce the risk of emotional harm and future infertility. ObjectiveTo explore disparities in counseling of adult female cancer patients for fertility preservation. To explore disparities in counseling of adult female cancer patients for fertility preservation. DesignRetrospective study of female patients with a diagnosis of breast, gynecologic, or hematologic cancer from 2009-2013 at an academic medical center. Retrospective study of female patients with a diagnosis of breast, gynecologic, or hematologic cancer from 2009-2013 at an academic medical center. Materials and MethodsElectronic medical record data for demographics, counseling for fertility preservation, and cancer diagnosis and treatment was obtained for 587 female patients with breast, gynecologic, or hematologic cancer. Retrospective analysis of 353 patients (19-42y; x- = 35.0, SD = 5.31) with available chemotherapeutic treatment data was performed. Electronic medical record data for demographics, counseling for fertility preservation, and cancer diagnosis and treatment was obtained for 587 female patients with breast, gynecologic, or hematologic cancer. Retrospective analysis of 353 patients (19-42y; x- = 35.0, SD = 5.31) with available chemotherapeutic treatment data was performed. Results262/353 (74%) women were exposed to a gonadotoxic chemotherapeutic agent; 181 women were diagnosed with breast cancer, 53 with a hematologic (i.e., leukemia/lymphoma) cancer, and 28 with a gynecologic cancer. 161/262 (62%) chemotherapy exposed women had documented counseling for fertility preservation; 77 (29%) women were not counseled, and counseling was not documented in 24 (9%) charts. Younger women were more likely to be counseled than older women; the average age of those counseled was (x- =34.0, SD =5.6yrs), not counseled (x- = 35.0, SD =4.7yrs), and not appropriate for counseling (x- =35.5, SD =4.4 yrs) (p <. 05). Racial differences in counseling were also found (p <. 05) with 86% of Hispanic women, 65% of Asian women, 62% of white women, and 53% of black women with documented counseling. Divorced women were less likely to be counseled than women of any other marital status (p <. 05). Women with gynecological or hematological cancer or who had a lower cancer stage were more likely to be counseled that those with other cancers or higher stages (p <. 05). Logistic regression resulted in no unique variance contribution in a model including age, marital status, race, cancer diagnosis, and stage. 262/353 (74%) women were exposed to a gonadotoxic chemotherapeutic agent; 181 women were diagnosed with breast cancer, 53 with a hematologic (i.e., leukemia/lymphoma) cancer, and 28 with a gynecologic cancer. 161/262 (62%) chemotherapy exposed women had documented counseling for fertility preservation; 77 (29%) women were not counseled, and counseling was not documented in 24 (9%) charts. Younger women were more likely to be counseled than older women; the average age of those counseled was (x- =34.0, SD =5.6yrs), not counseled (x- = 35.0, SD =4.7yrs), and not appropriate for counseling (x- =35.5, SD =4.4 yrs) (p <. 05). Racial differences in counseling were also found (p <. 05) with 86% of Hispanic women, 65% of Asian women, 62% of white women, and 53% of black women with documented counseling. Divorced women were less likely to be counseled than women of any other marital status (p <. 05). Women with gynecological or hematological cancer or who had a lower cancer stage were more likely to be counseled that those with other cancers or higher stages (p <. 05). Logistic regression resulted in no unique variance contribution in a model including age, marital status, race, cancer diagnosis, and stage. ConclusionIn the current study, demographic and diagnostic disparities were evident in the counseling of cancer patients for fertility preservation. Patients who are not offered fertility preservation prior to cancer treatment have previously been found to experience significant regret and poorer quality of life. In addition to emotional harm, disparate counseling for fertility preservation could result in an unnecessary decreased ability for some women to fulfill their future reproductive desires. Equality in the counseling of female cancer patients for fertility preservation is imperative in order to reduce the risk of emotional harm and future infertility. In the current study, demographic and diagnostic disparities were evident in the counseling of cancer patients for fertility preservation. Patients who are not offered fertility preservation prior to cancer treatment have previously been found to experience significant regret and poorer quality of life. In addition to emotional harm, disparate counseling for fertility preservation could result in an unnecessary decreased ability for some women to fulfill their future reproductive desires. Equality in the counseling of female cancer patients for fertility preservation is imperative in order to reduce the risk of emotional harm and future infertility.