Patterns of Patient-Reported Awareness About Early-Onset Cancer-Related Infertility Risk

PURPOSE Reproductive care—including discussions about cancer-related infertility risk—is part of the recommended standard of care for all patients with cancer. Despite rising cancer incidence among adults younger than 50 years (early-onset), the evaluation of patients' knowledge about cancer-related infertility risk is limited. We characterized factors associated with lack of awareness of potential cancer-related infertility risk as reported by patients with early-onset cancer. PATIENTS AND METHODS Using data from the Reproductive Health After Cancer Diagnosis and Treatment (REACT) Study, we identified individuals diagnosed with a first primary early-onset cancer between 2006 and 2021. Awareness of potential cancer-related infertility risk was determined using questionnaires. Logistic regression models were fitted to examine associations between a lack of awareness of cancer-related infertility risk and patient-level factors. RESULTS Among 636 patients, 28.9% (n = 184) reported never being told that their cancer treatments may affect their fertility. Patients who were aware of a potential cancer-related infertility risk had heard this information, on average, from two unique sources (mean = 2.2, std = 1.3)—with 90.1% of all sources derived from clinical interactions/settings. Patients who self-identified with a racial ethnic minority (REM) population—inclusive of African American/Black, American Indian, Asian, Hispanic/Spanish/Latino/a/x, Middle Eastern or North African, or multiple races—were nearly twice as likely to report an unawareness of infertility risk compared with patients who identified as non-Hispanic White after adjusting for diagnosis age and year, sex, insurance coverage, marital status, and pregnancy history (odds ratio, 1.70 [95% CI, 1.05 to 2.74]; P = .03). CONCLUSION Three in every 10 patients with early-onset cancer reported never having been told that cancer treatments may affect their fertility. Individual factors contributed to differences in patients' knowledge of potential cancer-related infertility risk. Further study is needed to address this care gap among patients and providers to deliver concordant, high-quality reproductive and oncology care to this growing population.