PD34-01 EVALUATION OF FERTILITY PRESERVATION PRACTICES AMONG ONCOLOGISTS: REVIEW OF ASCO’S QUALITY ONCOLOGY PRACTICE INITIATIVE STANDARDS FOR CANCER CARE

Abstract

INTRODUCTION AND OBJECTIVES: The ASCO Quality Oncology Practice Initiative is an oncologist-led practice-based quality assessment program to promote excellence in cancer care. A total of 994 practices submit data on over 32,000 patients. We utilized their dataset to identify the proportion and predictors of discussing fertility risks and fertility preservation prior to initiating cancer therapy among patients of reproductive age. METHOD(S): Reproductive age was defined as 18-40 and 18-50 for females and males, respectively. We assessed whether fertility risks and fertility preservation options were discussed prior to chemotherapy with patients of reproductive age. We also assessed whether a referral to a specialist was made. Multivariable linear regression was performed to identify predictors of fertility preservation counselling controlling for practice type (academic vs. private), geographic location (region and state) and state legislature mandating insurance coverage for fertility preservation. RESULT(S): A total of 136,746 charts were reviewed with a total of 27,052 patients identified as being of reproductive age. Overall, 41.8% of patient of reproductive age had a discussion regarding the risk of infertility associated with chemotherapy while 27.7% of patients had fertility preservation options discussed or were referred to a specialist. On multivariable linear regression being seen at an academic institution was associated with more frequent discussion of fertility risk (48.0% vs 40.4%, p = 0.04) and more frequent discussion of fertility preservation options (34.0% vs 25.5%, p = 0.004) when compared with private practices. States in which laws mandate coverage of fertility preservation were associated with significantly higher rates of discussion (48.6% vs 39.6%, p = 0.0003) and more frequent discussion of fertility preservation (32.9% vs 25.1%, p=0.0003). There has been no increase in either discussion of risk or fertility preservation from 2015 to 2018. State and region were not significantly associated with differences in discussions. CONCLUSION(S): Despite institution of guidelines mandating fertility preservation, less than half of providers appear to discuss risks and options. Providers in academic institutions and providers in states that mandate fertility preservation appear to discuss options more frequently as compared to providers in private practices and states that lack coverage. Further research is necessary to increase fertility preservation awareness aimed at both patients and providers.