title: Trends of socioeconomic disparities in referral patterns for fertility preservation consultation.
abstract: BACKGROUND
  While oncologists are aware that cancer treatments may impact fertility, referral rates for fertility preservation consultation (FPC) remain poor. The goal of this study was to identify predictors associated with FPC referral.
  
  
  METHODS
  This is a retrospective, cohort study of women aged 18-42 years diagnosed with a new breast, gynecologic, hematologic or gastrointestinal cancer at our institution between January 2008 and May 2010. Exclusion criteria included history of permanent sterilization, documentation of no desire for future children, stage IV disease, short interval (<4 days) between diagnosis and treatment and treatment that posed no threat to fertility. Demographic, socioeconomic and cancer variables were evaluated with respect to FPC. Logistic regression was used to determine the odds of referral for FPC based on specified predictors.
  
  
  RESULTS
  One hundred and ninety-nine patients were eligible for FPC and of those, 41 received FPC (20.6%). Women with breast cancer were 10 times more likely to receive FPC compared with other cancer diagnoses [odds ratio (OR) 10.1; 95% confidence interval (CI) 3.8-26.8]. The odds of FPC referral were approximately two times higher for Caucasian women (OR 2.4; 95% CI 0.9-6.2), three times higher for age <35 years (OR 3.3; 95% CI 1.4-7.7) and four times higher in nulliparous women (OR 4.6; 95% CI 1.9-11.3). There was no association between BMI, income, distance to our institution, being in a relationship and referral for FPC.
  
  
  CONCLUSIONS
  Overall referral rates for FPC are low, and there appear to be significant discrepancies in referral based on ethnicity, age, parity and cancer type. This highlights a need for further provider education and awareness across all oncologic disciplines.
authors.affiliation: Department of OB/GYN, University of North Carolina at Chapel Hill, 101 Manning Drive, Old Clinic Building, Campus Box 7570, Chapel Hill, NC 27514, USA. linnea.goodman@gmail.com
authors.forename: Linnea R
authors.initials: LR
authors.lastname: Goodman
authors.forename: Ursula
authors.initials: U
authors.lastname: Balthazar
authors.forename: Jayeon
authors.initials: J
authors.lastname: Kim
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Mersereau
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D059247:Fertility Preservation / Q000191:economics* / Q000379:methods*; D006801:Humans; D007246:Infertility / Q000517:prevention & control; D008495:Medical Oncology / Q000379:methods; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D016017:Odds Ratio; D012017:Referral and Consultation; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D055815:Young Adult