Patient- and system-level predictors of fertility preservation counseling among AYAs.

79 Background: Adolescents and young adults (AYAs) with cancer are at risk for treatment-related infertility. National guidelines recommend AYAs discuss reproductive risks and fertility preservation (FP) approaches before starting cancer-directed therapy. Our pragmatic intervention across pediatric and adult oncology included an informational email to the clinical team highlighting FP, followed by visit(s) by a dedicated AYA social worker (AYASW) for psychosocial and FP support; we previously reported increased rates of FP discussions and referrals using this intervention as part of an enhanced team-based framework at a Deep South comprehensive cancer center (Wolfson et al., JCO-OP 2023). However, patient- and system-level predictors of post-intervention FP counseling (FPc) were not examined. We address these knowledge gaps here. Methods: AYAs (15–39y) with new cancer diagnosis or relapse between 02/2019 and 03/2025 at the pediatric (all cancers) or adult (excluding thyroid, melanoma, breast, and gynecologic cancers) facility were eligible for the intervention if planned treatment included chemo/immunotherapy (or radiation alone in neuro-oncology). Clinical and FP data (documented FP counseling = FPc) were abstracted from medical records. Multivariable logistic regression modeled the odds of FPc by age, sex, race/ethnicity, insurance, cancer diagnosis, facility (pediatric/ adult), disease status, illness severity, and AYASW involvement (≥1visit). Results: Among 631 AYAs, 389 (62%) had FPc. Providers documenting FPc were mainly oncologists (74%), advanced practice providers (10%), or AYASWs (9%). Most AYAs with FPc had AYASW visits (91%). The odds of FPc were lower among older AYAs (29–39y: OR = 0.38, p = 0.02 ref = 15–20y), those publicly insured (OR = 0.50, p = 0.01), or at the pediatric facility (OR = 0.42, p = 0.05). Odds of FPc were higher among males (OR = 1.57, p = 0.02) and those with AYASW involvement (OR = 5.48, p < 0.001). Multivariable analyses stratified by facility (pediatric/adult) revealed lower odds of FPc in publicly insured patients in adult (but not pediatric) oncology (OR = 0.28, p < 0.001) and Black AYAs in pediatric (but not adult) oncology (OR = 0.25, p = 0.01). Multivariable analyses stratified by sex revealed lower odds of FPc in publicly insured males (OR = 0.38, p = 0.003) but not females. In all stratified analyses, those with AYASW visits had higher odds of FPc (OR range = 3.3–23.8, p < 0.001). Conclusions: In the context of this pragmatic intervention using an enhanced team-based framework, the majority of AYAs had FPc, but a third did not. Although most AYAs with documented FPc had an AYASW involved in their care, the majority of AYAs with FPc had that discussion with an oncologist. AYASW involvement plays a critical role in facilitating FPc. Additional work is necessary to understand the ways in which AYASW involvement (as part of the team-based framework and intervention) facilitates FPc.