Views of reproductive-aged female cancer patients on oncofertility care (507)

Abstract

<b>Objectives:</b> It is reported that about half of women with cancer are unaware of how their cancer treatments can impact their fertility. We aimed to assess a diverse group of reproductive-age female cancer survivors being treated at a safety-net hospital in the Deep South regarding their preferences and experiences surrounding fertility preservation in the setting of their cancer treatment. <b>Methods:</b> After IRB approval, a 20-item survey was administered to women of <40 years of age with a cancer diagnosis treated in a clinic at a cancer center in a safety-net hospital in the Deep South. Wilcoxon rank-sum tests and Fisher's exact tests were used to compare demographic and clinical factors between the discussion groups. <b>Results:</b> Fifty-four patients were interviewed with a mean age of 34.28 years (SD: 4.95). Over half (<i>n</i>=29, 53.7%) reported considering the impact of their cancer treatment on their fertility. Over a third (<i>n</i>=19, 35.2%) and almost half (<i>n</i>=25, 46.3%) reported thinking about taking steps towards fertility preservation and being aware of fertility preservation methods, respectively, prior to their cancer treatment. Over half (<i>n</i>=30, 55.6%) discussed oncofertility care with a provider. About a fifth (<i>n</i>=12, 22.2%) were recommended to see a fertility specialist. Of those who did not have this recommendation, a third (<i>n</i>=13, 31.0%) reported that they would have preferred to have one. Half (<i>n</i>=12, 50.0%) of patients who were not counseled about oncofertility by any provider also noted that they would have wanted such a discussion. With regards to choosing cancer treatments, almost all of the patients reported minimizing the stress of their cancer treatment (<i>n</i>=48, 98.0%) and minimizing chances of death (<i>n</i>=52, 98.1%) as important factors. Other important factors included avoiding menopause (<i>n</i>=32, 59.3%), retaining their female organs (<i>n</i>=33, 66.0%), and being able to have biological children in the future (<i>n</i>=27, 54.0%). Patients reported the factors that made it more likely for them to pursue fertility preserving methods included their cancer prognosis (<i>n</i>=27, 55.1%), a desire to focus on cancer treatment (<i>n</i>=33, 68.8%), and a desire to survive their cancer (<i>n</i>=41, 77.4%). Factors that did not influence such a decision, either positively or negatively, included their personal/religious beliefs (<i>n</i>=25, 49%) and their families' wishes (<i>n</i>=24, 47.1%). Compared to patients who received education about fertility preservation methods prior to cancer treatment, those who did not were more likely to report their current financial status as a barrier to pursuing fertility preserving methods (7.4% vs 33.3%, p-value 0.043). No ethical or racial differences were noted between patients related to fertility preservation counseling at the time of their cancer diagnosis. Given the hypothetical scenario that their cancer was incurable, patients noted there would be a 37.8% (SD: 43.29) chance they would want to preserve their fertility, a 17.9% (SD: 31.42) chance they would want to become pregnant, and 22.3% (SD: 34.52) chance they would want to successfully become pregnant and deliver a baby over initiating cancer treatment. <b>Conclusions:</b> Almost half (44.4%) of women did not discuss oncofer- tility with their providers. There is a demonstrated interest amongst reproductive-age female cancer survivors to be counseled on fertility preservation. Many patients wish to explore these options even if their cancers are terminal. Providers should make a more concerted effort to provide appropriate counseling and referrals for oncofertil- ity care.