title: Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: A population-based study.
abstract: BACKGROUND
  The fertility of adolescent and young adult (AYA) patients with cancer can be threatened by treatments, but to the authors' knowledge little is known regarding the extent to which providers discuss this with patients or recommend fertility preservation, or the patient and physician characteristics associated with these interactions.
  
  
  METHODS
  Questionnaires from 459 AYA patients with cancer who were diagnosed between 2007 and 2008 and recruited through 7 US population-based cancer registries were analyzed using sex-specific multivariable models. The authors assessed characteristics associated with not discussing therapy effects on fertility or fertility preservation options, and not making fertility preservation arrangements.
  
  
  RESULTS
  Males without a medical oncologist were more likely not to be told that therapy might affect fertility than those with a medical oncologist (male odds ratio [OR], 2.28; 95% confidence interval [95% CI], 1.03-5.00). Individuals without insurance (male OR, 2.91 [95% CI, 1.41-5.91] and female OR, 5.46 [95% CI, 1.59-18.72]); those raising children aged <18 years; and, among males only, those who received treatment posing no or a low fertility risk (OR, 3.39; 95% CI, 1.60-7.16) were more likely not to discuss fertility preservation with providers. Finally, among males, those without a college degree (OR, 1.98; 95% CI, 1.00-3.97), lacking private insurance (OR, 2.97; 95% CI, 1.16-7.63), and raising children aged <18 years (OR, 3.53; 95% CI, 1.63-7.65) were more likely to not make fertility preservation arrangements; too few females had made fertility preservation arrangements for similar analyses to be performed.
  
  
  CONCLUSIONS
  Discussion and action surrounding fertility preservation for AYA patients with cancer are associated with medical factors, patient socioeconomic data, and child-rearing status. These results highlight the need for insurance coverage for fertility preservation and increased awareness of fertility preservation options.
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.affiliation: Applied Research Program, National Cancer Institute, Bethesda, Maryland.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.affiliation: Applied Research Program, National Cancer Institute, Bethesda, Maryland.
authors.forename: Ashley Wilder
authors.initials: AW
authors.lastname: Smith
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.|Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Department of Epidemiology, University of Iowa, Iowa City, Iowa.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Pinki K
authors.initials: PK
authors.lastname: Prasad
authors.affiliation: Department of Public Health Sciences, School of Medicine, University of California, Davis, California.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
authors.affiliation: Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, The University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.affiliation: Information Management Services Inc, Silver Spring, Maryland.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Keel
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Charlesworth
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.|Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: adolescent and young adult; disparities; fertility; late effects; treatment