title: Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer.
abstract: BACKGROUND
  This study seeks to examine the relation between sociodemographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer.
  
  
  METHODS
  A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Nine hundred eighteen women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student t test, linear regression, and multivariate logistic regression were used where appropriate to determine the relation between sociodemographic characteristics and the odds of using fertility preservation services.
  
  
  RESULTS
  Sixty-one percent of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor's degree (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age older than 35 years (OR, 0.1; 95% CI, 0.0-1.4) or previous children (OR, 0.3; 95% CI, 0.1-1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed.
  
  
  CONCLUSIONS
  Sociodemographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the past decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Letourneau
authors.forename: James F
authors.initials: JF
authors.lastname: Smith
authors.forename: Erin E
authors.initials: EE
authors.lastname: Ebbel
authors.forename: Amaranta
authors.initials: A
authors.lastname: Craig
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.forename: Mitchell P
authors.initials: MP
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery; D003625:Data Collection; D005260:Female; D005298:Fertility / Q000187:drug effects / Q000528:radiation effects; D059247:Fertility Preservation / Q000706:statistics & numerical data*; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery; D054625:Healthcare Disparities; D006689:Hodgkin Disease / Q000188:drug therapy / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery; D009369:Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery; D044469:Racial Groups; D060728:Reproductive Health; D012189:Retrospective Studies; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D055815:Young Adult