Socioeconomic status and fertility counseling in patients with early onset colorectal cancer.

e15654 Background: The incidence of early onset colorectal cancer (EOCRC) has increased over the past several decades, with a corresponding need to counsel younger patients about options for fertility counseling. The characteristics of patients at risk for going without fertility counseling are unknown. Methods: We conducted a single site retrospective review of all patients diagnosed with colorectal cancer between 2012 and 2019 who were men age 55 or younger or women age 50 or younger. Clinical data and documentation of fertility counseling were extracted from the electronic medical record by explicit chart review. Median household income (MHI) by zip code was gathered from census data and assigned to each patient based on home address. Results: 194 subjects were identified, of whom 69% had colon cancer and 31% had rectal cancer. 61% were male with average age 44 and 39% were female with average age 42. 55% were White, 11% were Black, 14% were Asian, and 10% were Hispanic. 13% had stage II disease, 44% had stage III disease and 40% had stage IV disease. 15.5% had documented fertility counseling, of whom 43% were male and 57% were female. In univariate analysis, age less than 40 years old, female sex, curative intent treatment, and home address in areas of higher MHI were associated with higher rates of fertility counseling. Race, tumor type, stage of disease, and year of diagnosis were not associated with differences in rates of fertility counseling. Conclusions: We found low overall rates of fertility counseling in patients with EOCRC, and consistent with prior analyses, lower counseling of men and those over age 40. We found that patients who live in areas of relative poverty were less likely to receive fertility counseling. Limited fertility counseling and high out-of-pocket costs of fertility preservation may combine to deny vulnerable patients an essential service. Given the increasing diagnosis of EOCRC, efforts are needed to increase the rates of fertility counseling both systemically and equitably. Table: see text