Patient Location and Disparities in Access to Fertility Preservation for Women With Gynecologic or Breast Cancer

Authors

• Alexa Kanbergs
• Kirsten Jorgensen
• Nuria Agusti
• David Viveros-Carreño
• Chi-Fang Wu
• Roni Nitecki
• John A Harris
• Terri Woodard
• Ryan Ramphul
• Jose Alejandro Rauh-Hain

Language

English

Publication Date

6-1-2024

Journal

Gynecologic and Obstetric Pathology

DOI

10.1097/AOG.0000000000005570

PMID

38574368

PMCID

PMC11098692

PubMedCentral® Posted Date

6-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Objective: To assess the effect of geographic factors on fertility-sparing treatment or assisted reproductive technology (ART) utilization among women with gynecologic or breast cancers.

Methods: We conducted a cohort study of reproductive-aged patients (18-45 years) with early-stage cervical, endometrial, or ovarian cancer or stage I-III breast cancer diagnosed between January 2000 and December 2015 using linked data from the California Cancer Registry, the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. Generalized linear mixed models were used to evaluate associations between distance from fertility and gynecologic oncology clinics, as well as California Healthy Places Index score (a Census-level composite community health score), and ART or fertility-sparing treatment receipt.

Results: We identified 7,612 women with gynecologic cancer and 35,992 women with breast cancer. Among all patients, 257 (0.6%) underwent ART. Among patients with gynecologic cancer, 1,676 (22.0%) underwent fertility-sparing treatment. Stratified by quartiles, residents who lived at increasing distances from gynecologic oncology or fertility clinics had decreased odds of undergoing fertility-sparing treatment (gynecologic oncology clinics: Q2, odds ratio [OR] 0.76, 95% CI, 0.63-0.93, P =.007; Q4, OR 0.72, 95% CI, 0.56-0.94, P =.016) (fertility clinics: Q3, OR 0.79, 95% CI, 0.65-0.97, P =.025; Q4, OR 0.67, 95% CI, 0.52-0.88, P =.004), whereas this relationship was not observed among women who resided within other quartiles (gynecologic oncology clinics: Q3, OR 0.81 95% CI, 0.65-1.01, P =.07; fertility clinics: Q2, OR 0.87 95% CI, 0.73-1.05, P =.15). Individuals who lived in communities with the highest (51 st -100 th percentile) California Healthy Places Index scores had greater odds of undergoing fertility-sparing treatment (OR 1.29, 95% CI, 1.06-1.57, P =.01; OR 1.66, 95% CI, 1.35-2.04, P =.001, respectively). The relationship between California Healthy Places Index scores and ART was even more pronounced (Q2 OR 1.9, 95% CI, 0.99-3.64, P =.05; Q3 OR 2.86, 95% CI, 1.54-5.33, P < .001; Q4 OR 3.41, 95% CI, 1.83-6.35, P < .001).

Conclusion: Geographic disparities affect fertility-sparing treatment and ART rates among women with gynecologic or breast cancer. By acknowledging geographic factors, health care systems can ensure equitable access to fertility-preservation services.

Keywords

Humans, Female, Breast Neoplasms, Fertility Preservation, Adult, Health Services Accessibility, Healthcare Disparities, California, Middle Aged, Genital Neoplasms, Female, Young Adult, Adolescent, Cohort Studies, Reproductive Techniques, Assisted, Registries

Published Open-Access

yes

Recommended Citation

Kanbergs, Alexa; Jorgensen, Kirsten; Agusti, Nuria; et al., "Patient Location and Disparities in Access to Fertility Preservation for Women With Gynecologic or Breast Cancer" (2024). Faculty, Staff and Student Publications. 1496.
https://digitalcommons.library.tmc.edu/uthsph_docs/1496