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OBJECTIVE: Fertility preservation (FP) is an important aspect of care for reproductive-aged cancer patients since treatment can significantly impact fertility. Despite professional recommendations for early referral to FP, rates remain low. This study evaluates predictors of FP referrals by Oncologists to Reproductive Endocrinology and Infertility (REI) physicians among reproductive-aged cancer patients at a large academic institution. MATERIALS AND METHODS: This cross-sectional study evaluated patients ages 14-42 years seen by an Oncologist from 2022 to 2024 with a new diagnosis of cancer for whom planned treatment is either gonadotoxic or requires delayed pregnancy. Referral rates to REI physicians were assessed by patient demographics and cancer and Oncologist characteristics as potential predictors. Statistical analysis used chi-square tests, Fisher's exact tests, and multivariable logistic regression. RESULTS: Of 510 patients seen by an Oncologist for a newly diagnosed cancer, only 127 (22.5%) were referred for FP. Patients > 30 years were less likely to be referred than younger patients (aOR = 0.15, 95% CI = 0.05, 0.47, p = 0.001). Patients with breast cancer were most likely to be referred compared to other cancers. There was no difference in referral rates by physician gender. Physicians with 21-30 years of experience were more likely to refer than those with < 10 years (aOR = 2.89, 95% CI = 1.50, 5.62, p = 0.002). CONCLUSIONS: There was a low rate of FP referral and significant disparities based on patient demographics and clinical factors. Referral rates were higher among younger patients and breast cancer patients. Standardizing FP referrals across oncology specialties, consideration of electronic health record "soft stops" for referral and increasing patient and provider education are essential to improving referral rates.
Chey et al. (Fri,) studied this question.