Disparities in Fertility Counseling for Young Women with Cancer

In my last post, I reported on a study that spoke about women getting pregnant after being treated for estrogen-positive breast cancers.

Research for that post got me thinking about who is offered fertility counseling prior to cancer treatment. Since chemo and radiation can bring on early menopause, if a woman wants to become pregnant after treatment she needs to find out about egg or embryo preservation.

When it comes to fertility counseling, not all young women have equal access.  A recent report on a study, funded by the National Institutes of Health, identifies the racial, socioeconomic and demographic disparities in access to fertility preservation in young women.

The study was conducted by Joseph M. Letourneau, MD, of the University of California at San Francisco School of Medicine, and colleagues. The study entailed contacting 2,500 women diagnosed with cancer during the years from 1993 to 1997. Of this number, 1,041 responded. Respondents were between the ages of 18 to 40 at time of diagnosis, with a mean age of 31.5.

The women were asked whether or not they were offered counseling about the risk of cancer treatment to fertility prior to their treatment. Each woman was asked to respond as to whether or not she pursued fertility preservation services from a reproductive endocrinologist.

Researchers took ethnicity, gender, income, education, age at diagnosis, age at time of survey, marital status, sexual orientation, desire for children, and whether or not the patient already had given birth.

Letourneau and colleagues noted that overall rates of counseling and preservation had improved over time. Patients diagnosed in 1993 had been counseled in only 44% of cases, rising to 61% for cases diagnosed in 2007.

The researchers wrote in the journal Cancer that patients with a college degree were more likely than women from other backgrounds to receive fertility services before treatment.

Despite improved awareness over the last 10 years, female cancer patients of less educated, minority, or non-heterosexual backgrounds showed an unmet need for fertility preservation services.

There was a strong trend towards decreased use of services in Latina women who were 80% less like to preserve fertility than white women. Researchers reported that there was no fertility preservation recorded among black or non-heterosexual women.

The research authors offered possible explanations for the disparity in care:

• Women with bachelor’s degrees may have higher health literacy than patients without a degree and may be more likely to bring up the topic of fertility preservation.

• Lower incomes have been associated with poorer outcomes in treatment, which may reflect on a woman’s inability to acquire counseling or preservation services, especially since these services are not usually covered by health insurance.

• The low number of non-heterosexual respondents may have underpowered results, but noted that non-heterosexual females showed no difference in desire for future children and did not receive counseling services.

• Minority women may have faced language, cultural, or economic barriers.

Source:
Letourneau JM, et al “Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer” Cancer 2012; DOI: 10.1002/cncr.26649.