Banking on Fertility Preservation: Financial Concern for Adolescent and Young Adult Cancer Patients Considering Oncofertility Services

Levin, Nina Jackson; Tan, Chiu Yi; Stelmak, Daria; Iannarino, Nicholas T.; Zhang, Anao; Ellman, Erin; Herrel, Lindsey A.; Walling, Emily; Moravek, Molly B.; Chugh, Rashmi; Haymart, Megan R.; Zebrack, Brad

doi:10.1089/jayao.2022.0055

Cited by 12 publications

(5 citation statements)

References 49 publications

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“…The financial impact of FP must also be considered. 16 As of this writing, 16 states have mandated insurance coverage for iatrogenic infertility, but the level of coverage is variable (Alliance for Fertility Preservation 17 ), and even when mandated, health insurance plans cover services to varying degrees. Engaging in FP is associated with a 50% increased risk of experiencing financial hardship among female AYA survivors, with more than twice as many women who used FP describing debt exceeding $25,000 US dollars compared with those who did not.…”

Section: Financial Challengesmentioning

confidence: 99%

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Fertility Preservation in Adolescents and Young Adults With Cancer: A Case-Based Review

Burns,

Loren

2024

JCO

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Adolescent and young adult (AYA) oncology patients are unique in many aspects of their care; fertility preservation (FP) is one of the most complex to address. In addition to the newly diagnosed AYA patient, there are growing numbers of AYA survivors of childhood cancer who present with concerns about their fertility. Emerging independence, emotional and intellectual growth, and development of an adult mindset are hallmarks of the AYA population; these transitions heighten the intrinsic medical, social, and financial challenges of a cancer diagnosis. FP is extraordinarily important in AYA oncology and can be addressed in many ways: experimental options as well as standard of care, with key differences on the basis of pubertal development, cancer diagnosis, and urgency of cancer-directed therapy. Options exist both at diagnosis and throughout the survivorship journey. It is imperative that oncologists recognize the challenges in this age group, as well as opportunities to pursue FP. The field has evolved significantly in the past 25 years and will continue to evolve as we incorporate more immune-based and targeted therapies into our treatment regimens. This case-based review will explore opportunities to preserve fertility in this unique patient population.

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Section: Financial Challengesmentioning

confidence: 99%

“…16 hardship among female AYA survivors, with more than twice as many women who used FP describing debt exceeding $25,000 US dollars compared with those who did not. 16 Philanthropic organizations may help cover costs (Table 3), and additional local resources may also be available. 4 c Gonadotropin-releasing hormone agonist.…”

Section: Financial Challengesmentioning

confidence: 99%

Fertility Preservation in Adolescents and Young Adults With Cancer: A Case-Based Review

Burns,

Loren

2024

JCO

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“…In the third year, 11 patients elected further REI evaluations, sperm banking, and testicular tissue freezing [35]. Jackson Levin et al highlighted the major financial concerns and economic distress experienced by adolescent and young adult cancer patients pursuing FP, with many patients relying on parental health insurance that may or may not cover FP services [36]. Beyond expanding FP coverage, the establishment and improvement of financial aid and counseling services are crucial in reducing financial toxicity and advancing more equitable access to FP services [36].…”

Section: Utilization Based On Demographic Characteristicsmentioning

confidence: 99%

“…Jackson Levin et al highlighted the major financial concerns and economic distress experienced by adolescent and young adult cancer patients pursuing FP, with many patients relying on parental health insurance that may or may not cover FP services [36]. Beyond expanding FP coverage, the establishment and improvement of financial aid and counseling services are crucial in reducing financial toxicity and advancing more equitable access to FP services [36]. Patient navigators, including nurses, can be helpful in guiding patients through the complexities of insurance coverage, as well as assistance from philanthropic or financial organizations [37].…”

Section: Utilization Based On Demographic Characteristicsmentioning

confidence: 99%

The Status of Fertility Preservation (FP) Insurance Mandates and Their Impact on Utilization and Access to Care

Sauerbrun-Cutler,

Rollo,

Gadson

et al. 2024

JCM

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Fertility preservation (FP) is the use of a specific medical intervention to protect the fertility of individuals whose disease or disease treatment may lead to infertility. These medical interventions include the cryopreservation of oocytes, embryos, ovarian tissue, sperm, and testicular tissue; oocyte and embryo cryopreservation are the most widely used interventions in the United States. Although guidelines recommend FP prior to undergoing gonadotoxic treatments, cost barriers are high. For example, the average cost of an oocyte cryopreservation cycle in the United States exceeds $10,000. High cost and lack of insurance coverage are two of the most cited reasons explaining the low Reproductive Endocrinology and Infertility (REI) referral rates and limited FP utilization. Broadening insurance mandates for FP prior to gonadotoxic treatments could improve utilization and provide cancer survivors with improved quality of life post treatment.

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“…Costs were mentioned as a barrier for FP referral or FP procedures [30,52,67,69]. The costs that need to be considered are not just the financial burden of cancer (i.e., not being able to work) and the cost of medical treatment, but also the anticipated future costs of IVF using stored biological material [38,39,41]. In studies of Latif et al and Yee et al about sperm cryopreservation, costs seemed to be less of a barrier to undergoing FP treatment [32,64].…”

Section: Costs Of Fertility Preservation Treatmentmentioning

confidence: 99%

Patient-Reported Outcomes (PROs) and Patient Experiences in Fertility Preservation: A Systematic Review of the Literature on Adolescents and Young Adults (AYAs) with Cancer

Klijn,

ter Kuile,

Lashley

2023

Cancers

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With better survival rates for patients diagnosed with cancer, more attention has been focused on future risks, like fertility decline due to gonadotoxic treatment. In this regard, the emphasis during counselling regarding possible preservation options is often on the treatment itself, meaning that the medical and emotional needs of patients regarding counselling, treatment, and future fertility are often overlooked. This review focuses on patient-reported outcomes (PROs) and patient experiences regarding fertility preservation (FP)—among adolescents and young adults (AYAs) with cancer. A systematic review of the literature, with a systematic search of online databases, was performed, resulting in 61 selected articles. A quality assessment was performed by a mixed methods appraisal tool (MMAT). Based on this search, three important topics emerged: initiating discussion about the risk of fertility decline, acknowledging the importance of future fertility, and recognizing the need for more verbal and written patient-specific information. In addition, patients value follow-up care and the opportunity to rediscuss FP and their concerns about future fertility and use of stored material. A clear FP healthcare pathway can prevent delays in receiving a referral to a fertility specialist to discuss FP options and initiating FP treatment. This patient-centered approach will optimize FP experiences and help to establish a process to achieve long-term follow up after FP treatment.

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Banking on Fertility Preservation: Financial Concern for Adolescent and Young Adult Cancer Patients Considering Oncofertility Services

Cited by 12 publications

References 49 publications

Fertility Preservation in Adolescents and Young Adults With Cancer: A Case-Based Review

Fertility Preservation in Adolescents and Young Adults With Cancer: A Case-Based Review

The Status of Fertility Preservation (FP) Insurance Mandates and Their Impact on Utilization and Access to Care

Patient-Reported Outcomes (PROs) and Patient Experiences in Fertility Preservation: A Systematic Review of the Literature on Adolescents and Young Adults (AYAs) with Cancer

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