Fertility counseling, preservation, and time to treatment in adolescents and young adults diagnosed with lymphoma.

Abstract

250 Background: Fertility counseling and preservation is an inconsistently implemented services for adolescents and young adults (AYA) with cancer. Providers and patients often express concerns about delaying treatment initiation, with limited data on how fertility preservation impacts time to chemotherapy in patients with lymphoma. We quantified fertility-related care and its association with time to chemotherapy in AYAs with lymphoma. Methods: We included AYAs aged 15–39 years at diagnosis with diffuse large B cell lymphoma (DLBCL) and Hodgkin lymphoma (HL) at Kaiser Permanente (KP) Southern and Northern California (2013-2022) in the Valuing Opinions and Insight from Cancer Experiences (VOICE) study. Eligible patients had not achieved their desired family size and initiated chemotherapy <1 year from diagnosis. Fertility-related characteristics were patient-reported on the VOICE survey in 2023-2024; clinical factors and treatment dates were collected from KP’s electronic medical records. Using descriptive statistics and linear regression (with log transformation), we compared days to chemotherapy initiation among those who reported (1) no fertility counseling from a reproductive specialist, (2) counseling from a specialist but no fertility preservation, and (3) use of fertility preservation (cryopreservation of sperm, oocytes, ovarian tissue, or embryos). Results: Among 67 DLBCL and 167 HL respondents, mean age at diagnosis was 27 years; 53% were females; and 38% were of non-Hispanic white race/ethnicity. A total of 85% reported fertility discussions with the healthcare team. Overall, 50% did not receive fertility counseling from a specialist or fertility preservation; 16% received fertility specialist counseling but did not cryopreserve; and 33% received fertility preservation. These proportions were 48%, 4% and 49% in males; and 53%, 27% and 20% in females. The mean time to chemotherapy initiation was 27, 42, and 33 days, respectively for the three groups; 30, 24, and 27 days for males; and 25, 44, and 45 days for females. The proportion of patients receiving chemotherapy >60 days after diagnosis was 3%, 16%, and 13%, respectively overall; 4%, 0% and 8% for males; and 3%, 18% and 24% for females. In the regression model, time to chemotherapy was statistically significantly longer in AYAs who received fertility counseling from a specialist but did not cryopreserve and in those who received cryopreservation (vs no specialist counseling) in females, but not in males. Conclusions: Half of all patients did not receive fertility counseling from a specialist. Time to chemotherapy was longer in females who used a fertility service; nearly a quarter of those who cryopreserved had > 60 days delay in treatment initiation. Our findings point to potential gaps in fertility care in AYA oncology.