Mobley Erin M, Wolfson Julie Anna, Levine Jennifer, Ji Lingyun, Ramakrishnan Subhash, Nightingale Chandylen L, Dressler Emily V, Kittel Carol, Freyer David R, Sugalski Aaron J, Prasad Pinki Kumari, Bhutada Jessica Sheth, Murphy Karly, Kyono Wade, Roth Michael E, Parsons Susan K, Beauchemin Melissa P
Department of Surgery, College of Medicine Jacksonville, University of Florida, Jacksonville, FL.
Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL.
JCO Oncol Pract. 2025 Jun 4:OP2401017. doi: 10.1200/OP-24-01017.
Given the impact of cancer treatment on fertility among adolescents and young adults (AYAs: 15-39 years), it is important to ensure AYAs access to fertility preservation (FP). However, the availability of FP services for AYAs treated in community settings is unknown. We examined FP access at National Cancer Institute Community Oncology Research Program (NCORP) practice groups.
The 2022 NCORP Landscape Assessment survey captured available resources and cancer care services including FP services at practice groups. We described FP services as accessible (on-site or off-site) versus not accessible by AYA-treating status (as previously defined). Univariable and multivariable analyses were used to evaluate associations between FP services and practice characteristics (NCORP classification [minority/underserved or community] and proportion of Medicaid or uninsured above/below the national average).
Among 271 practice groups responding to the survey, 100 were categorized as AYA-treating, of which 32% had neither male nor female FP services available. Sperm banking was available at 59 AYA-treating practices, among which 43 (73%) referred for sperm banking off-site. Although approximately half of AYA-treating practices reported accessible female FP services (embryo = 54%, oocyte = 55%, ovarian tissue = 40%), most of them referred patients off-site (embryo = 72%, oocyte = 80%, ovarian tissue = 83%). The odds of access to male FP were lower at minority/underserved practices (odds ratio, 0.34 [95% CI, 0.13 to 0.88]; = .026; ref = community); however, this same relationship was not seen for females.
Despite guidelines surrounding FP discussions before cancer therapy, and strong consensus regarding the importance of FP access, many AYA-treating practices in community settings lack access to FP services. Understanding how to leverage available services and broadly expand access is urgently needed to facilitate guideline-concordant, high-quality cancer care for AYAs.
鉴于癌症治疗对青少年及年轻成人（15 - 39岁）生育能力的影响，确保他们能够获得生育力保存（FP）服务非常重要。然而，在社区环境中接受治疗的青少年及年轻成人可获得的FP服务情况尚不清楚。我们调查了美国国立癌症研究所社区肿瘤学研究项目（NCORP）实践组的FP服务可及性。
2022年NCORP概况评估调查收集了实践组的可用资源和癌症护理服务，包括FP服务。我们根据是否可及（现场或非现场）以及是否为青少年及年轻成人治疗机构（如先前定义）来描述FP服务。采用单变量和多变量分析来评估FP服务与实践特征（NCORP分类[少数族裔/服务不足或社区]以及医疗补助或未参保比例高于/低于全国平均水平）之间的关联。
在回复调查的271个实践组中，100个被归类为为青少年及年轻成人治疗的机构，其中32%既没有男性也没有女性FP服务。59个为青少年及年轻成人治疗的机构提供精子冷冻服务，其中43个（占73%）将患者转诊至非现场进行精子冷冻。尽管约一半为青少年及年轻成人治疗的机构报告称女性FP服务可及（胚胎冷冻 = 54%，卵母细胞冷冻 = 55%，卵巢组织冷冻 = 40%），但大多数机构将患者转诊至非现场（胚胎冷冻 = 72%，卵母细胞冷冻 = 80%，卵巢组织冷冻 = 83%）。在少数族裔/服务不足的实践组中，获得男性FP服务的几率较低（优势比，0.34[95%可信区间，0.13至0.88]；P = 0.026；对照 = 社区）；然而，女性的情况并非如此。
尽管有癌症治疗前进行FP讨论的指南，且对于FP服务可及性的重要性有强烈共识，但社区环境中许多为青少年及年轻成人治疗的机构缺乏FP服务。迫切需要了解如何利用现有服务并广泛扩大可及性，以促进符合指南的高质量青少年及年轻成人癌症护理。
