1640 Background: Sociodemographic variation in fertility outcomes after cancer is not well described. We constructed a novel longitudinal dataset to capture sociodemographic variation in 1) live births and 2) use of assisted reproductive technology (ART) among female cancer patients across the US from 2004-2022. Methods: We linked population-based cancer registry data (2004–2018 in 12 states; 2004–2011 in California) with live birth certificates (2004–2022) and the Society for Assisted Reproductive Technology (2004-2022) database, which captures ~90% of ART cycles nationally, to create a dataset integrating oncologic characteristics, obstetric outcomes, and ART use. Patients aged 15-45 at diagnosis of cancer were included. The primary outcome was 5-year cumulative live birth incidence (CLBI) using the Fine and Gray method to account for all-cause death as a competing event and log-rank tests to compare by age, race/ethnicity, insurance, cancer site, cancer stage, and receipt of systemic therapy. Secondary outcome was use of ART after cancer diagnosis, defined as >1 autologous oocyte/embryo cryopreservation or embryo transfer cycles. Patients were categorized by expected fertility detriment, defined as pelvic malignancy and/or receipt of chemotherapy, hormone therapy, or abdominal or pelvic radiation, and covariates compared descriptively. Person-years were accrued from diagnosis date to first post-diagnosis birth/use of ART, death, age 51 (oldest age a post-cancer birth was observed), or December 31, 2022, whichever occurred first. The study was approved by the institutional review board. Results: 286,198 female cancer patients were included with 15 live births per 1,000 person-years. 5-year CLBI was 6.14% 6.05, 6.24. Lower CLBI was observed in Hispanic (4.5% 4.31, 4.76) and non-Hispanic Black (NHB) (5.23% 4.98, 5.50) populations compared to non-Hispanic white (NHW) populations (6.75% 6.62, 6.88) (p<0.001). Patients with public insurance also had significantly decreased CLBI (4.68% 4.47, 4.90) than those with private insurance (6.08% 5.95, 6.20, p<0.001). NHB, Hispanic, and patients with public insurance comprise higher proportions of patients with expected fertility detriment versus those without detriment (12.6 vs 8.6%, 18.2 vs 13.1%, and 18.7 vs 13.3%, p<0.001) but lower proportion of patients that use ART versus those that do not (5.9 vs 11.4%, 7.6 vs 16.6%, and 4.1 vs 17.1%, p<0.001). Conclusions: National vital statistics data demonstrates high fertility rates among Hispanic and NHB populations; among cancer patients, however, these trends are flipped, with lower cumulative incidence of live births in these groups. Despite a higher burden of anticipated fertility detriment, NHB, Hispanic, and publicly insured patients were less likely to access fertility care, revealing stark inequities in survivorship care.
Beshar et al. (Wed,) studied this question.