Utilization of Fertility Preservation Services By Patients Aged 18-40 Prior to Hematopoietic Cell Transplantation

Abstract

Introduction Survivors of hematopoietic cell transplantation (HCT) often face infertility later in life due to preparative conditioning regimens that are harmful to reproductive function. Current American Society of Clinical Oncology (ASCO) clinical guidelines on fertility preservation (FP) recommend that all patients who are at risk for infertility due to medical treatment should be referred to a fertility specialist for counseling following diagnosis and preferably prior to the start of treatment. Despite HCT physicians' awareness of standard-of-care services for preserving fertility and the psychosocial sequelae resulting from patients losing their fertility, anecdotal evidence indicates that few patients actually receive FP services. National utilization of FP services prior to HCT is currently unknown. Objective The goal of this retrospective descriptive analysis is to understand commercially insured and covered FP utilization among HCT recipients and describe patterns of engagement in FP services prior to HCT. Methods FAIR Health's national claims database was used to identify HCT recipients and the subgroup of patients who received FP services prior to HCT. Secondary analysis of the FP subgroup included the creation of patient-specific clinical journey timelines that included dates of services associated with diagnosis and procedure codes relevant to HCT and FP (Figure 1). Results There were 411 patients aged 18-40 who received HCT. Only 7.1% (N=29) of the HCT cohort had claims for FP services after diagnosis and prior to receiving HCT. Utilization of FP was most common in younger HCT patients, with 69% (N=20) of the FP subgroup being under age 26. The median time between FP services and HCT was 102 days and patients undergoing autologous HCT had longer intervals between FP services and HCT than allogeneic HCT patients (Figure 2). Conclusion Despite ASCO guidelines addressing the importance of FP options for cancer patients, results from this administrative claims analysis confirm that utilization of FP services by HCT patients is low. The longitudinally-linked claims allowed for detailed analysis of the FP subgroup which helped inform when patients receive FP services relative to their HCT as well as which FP services are utilized. Analysis of the FP subgroup also showed that the timing between diagnosis, FP services, and HCT may depend on the type of transplant. However, more research is needed to understand the barriers to FP prior to HCT so that targeted tools can be used to increase utilization and improve quality of life for HCT survivors. Future FP service cost and utilization research with an expanded population would be informative for policy-makers, payers, providers and patients. More work is needed to address the difficulty in quantifying FP service utilization that is not processed through commercial payers and as such not included in administrative claims data.