Characterizing the use of fertility preservation among women with early-onset cancer in a nationwide electronic health record database.

Abstract

252 Background: Fertility preservation (FP) support, which aims to conserve fertility in people undergoing treatment that may impair reproductive function, can improve quality of life among women diagnosed with early-onset cancer. The American Society of Clinical Oncology recommends integrating FP support into the cancer care plan for all people diagnosed with early-onset cancer. Studies using data from one hospital or health system show receipt of FP support is low, but there is a need for a national, longitudinal assessment of FP support. Objectives: To identify patient characteristics associated with the use of FP support, to summarize longitudinal and geographic trends in the use of FP support, and to report on the types of FP support used. Methods: This study used Epic Cosmos and identified a study population that consisted of females residing in the U.S., aged 18-40 years old, who were diagnosed with an incident case of cancer between 2015-2025. FP support was defined as a visit for FP counseling or an FP procedure in the 12 months following cancer diagnosis. We conducted bivariate analyses to identify patient characteristics associated with receipt of FP support. We calculated and visualized FP visit rates by year, state, and region to summarize longitudinal and geographic trends. Results: Of the 183,078 females identified with an incident case of cancer, 3,464 (1.9%) used FP support. Those that used FP support tended to be younger, urban-residing, single or not married, privately insured, and diagnosed with blood or breast cancer as compared to those that did not use FP support. From 2015-2025, the number of patients with at least one FP visit per 1,000 patients (FP rate) increased from 5.9 to 37.7. In 2015, the FP rate was similar across all regions, varying from 4.4 to 8.1. In 2025, the FP rate was highest in the West and Midwest, at 56.4 and 41.5, respectively; the FP rate was lowest in the Northeast and South, at 35.6 and 28.2, respectively. The median time from incident cancer diagnosis to the first FP visit was 25 days. Among patients who used FP support, 72.3% had at least one FP counseling visit and 42.1% had at least one FP procedure visit. Conclusions: Use of FP support among women diagnosed with early-onset cancer is increasing nationally, but remains low, with rates that align with prior literature. The next steps are to conduct a difference-in-differences analysis to determine whether state-level mandates that require insurance plans to cover FP are effective at increasing use of FP support.