Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Oncol. 2023 Oct 1;9(10):1364-1370. doi: 10.1001/jamaoncol.2023.2780.
Fertility preservation (FP), including oocyte and embryo cryopreservation prior to gonadotoxic therapy, is an urgent and essential component of comprehensive cancer care. Geographic proximity to a center offering FP is a critical component of ensuring equitable access for people with cancer desiring future fertility.
To characterize the distribution of centers offering FP services in the US, quantify the number of self-identified reproductive-age female individuals living outside of geographically accessible areas, and investigate the association between geographic access and state FP mandates.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis calculated 2-hour travel time isochrone maps for each center based on latitude and longitude coordinates. Population-based geospatial analysis in the US was used in this study. Fertility clinics identified through the 2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Report were defined as oncofertility centers by meeting 4 criteria: (1) offered oocyte and embryo cryopreservation, (2) performed at least 1 FP cycle in 2018, (3) served people without partners, and (4) had an accredited laboratory. County-level data were obtained from the 2020 US Census, with the primary at-risk population identified as reproductive-age female individuals aged 15 years to 44 years. The analysis was performed from 2021 to 2022.
Location outside of 2-hour travel time isochrone of an oncofertility center.
Oncofertility centers were compared with centers not meeting criteria and were classified by US region, state FP mandate status, number of assisted reproductive technology cycles performed, and number of FP cycles performed. The number and percentage of at-risk patients, defined as those living outside of accessible service areas by state, were identified.
Among 456 Centers for Disease Control and Prevention-reporting fertility clinics, 86 (18.9%) did not meet the criteria as an oncofertility center. A total of 3.63 million (5.70%) reproductive-age female individuals lack geographic access to an oncofertility center. States with FP mandates have the highest rates of eligible female patients with geographic access (98.54%), while states without active or pending legislation have the lowest rates (79.57%). The greatest disparities in geographic access to care are most concentrated in the Mountain West and West North Central regions.
Patients face numerous barriers to comprehensive cancer care, including a lack of geographic access to centers capable of offering FP services. This cross-sectional study identified disparities in geographic access and potential opportunities for strategic expansion.
在性腺毒性治疗前进行卵子和胚胎冷冻保存（FP）是综合癌症护理的重要组成部分。接近提供 FP 服务的中心对于希望保留未来生育能力的癌症患者获得公平的机会至关重要。
描述美国提供 FP 服务的中心的分布情况，量化居住在地理可达区域外的自我认定的育龄女性人数，并研究地理可达性与州 FP 授权之间的关联。
设计、设置和参与者：本横断面分析根据纬度和经度坐标为每个中心计算了 2 小时旅行时间等时线图。本研究使用了美国基于人群的地理空间分析。通过满足以下 4 个标准，将 2018 年疾病控制与预防中心生育诊所成功率报告中确定的生育诊所定义为肿瘤生育中心：（1）提供卵子和胚胎冷冻保存，（2）在 2018 年进行至少 1 个 FP 周期，（3）为没有伴侣的人服务，（4）拥有认证实验室。从 2020 年美国人口普查中获得县一级数据，主要高危人群为 15 至 44 岁的育龄女性。分析于 2021 年至 2022 年进行。
处于肿瘤生育中心 2 小时旅行时间等时线之外的位置。
将肿瘤生育中心与不符合标准的中心进行比较，并按美国地区、州 FP 授权状况、辅助生殖技术周期数和 FP 周期数进行分类。确定了根据州定义的处于可达服务区域之外的高危患者的数量和百分比。
在报告的 456 个疾病控制与预防中心生育诊所中，有 86 个（18.9%）不符合肿瘤生育中心的标准。共有 363 万（5.70%）名育龄女性无法获得肿瘤生育中心的地理服务。有 FP 授权的州有最高比例的符合条件的有地理服务机会的女性患者（98.54%），而没有现行或待决立法的州比例最低（79.57%）。地理可达性方面的最大差距集中在山区西部和中西部北部地区。
患者在接受综合癌症护理方面面临诸多障碍，包括缺乏能够提供 FP 服务的中心的地理可达性。这项横断面研究确定了地理可达性方面的差异，并为战略扩张提供了潜在机会。
