Evaluating longitudinal concordance in the perceived importance of fertility maintenance between premenopausal women with cancer and their providers: ECOG-ACRIN E1Q11.

Abstract

473 Background: Misaligned perceptions between patients with cancer and their providers regarding the importance of fertility may impact oncofertility care delivery and experiences, yet empirically measured concordance remains an important gap. We evaluated concordance in the perceived importance of fertility maintenance between premenopausal women with cancer and their providers. Methods: Data were derived from Engendering Reproductive Health within Oncologic Survivorship (EROS), a cluster randomized trial (NCT01806129) with 17 NCI Community Oncology Research Program (NCORP) sites, evaluating an intervention to improve goal-concordant reproductive health care. Eligible women were age 15-55 years, premenopausal, and newly diagnosed with cancer. Patients reported how important fertility maintenance is to them; their providers reported how important they perceive fertility maintenance to be for their patient. Responses ranged from 1 (not important) to 10 (extremely important) and were collected at baseline, 3, 6, 12, and 24-months from baseline. Differences between patient and provider scores were compared at each timepoint using t-tests. A linear mixed-effects model with a random intercept was used to examine differences in scores over time. Results: Participants were 420 women with cancer (median age 41 years; 68% White, 21% Black or African American; 17% Hispanic; 60% privately insured; 82% breast cancer; 70% with local/regional disease; 64% completed childbearing at baseline) and their providers (88% medical doctor, 8% nurse practitioner or physician assistant, 2% nurse, 2% other). Both patients and providers, on average, rated the importance of fertility maintenance as highest at baseline (mean score [SD]; patients: 4.3 [3.8]; providers: 5.1 [3.5]) and lowest 24-months from baseline (patients: 3.3 [3.5]; providers: 4.3 [3.4]). At all time points, providers, on average, rated fertility maintenance as significantly more important than patients (provider - patient differences in scores ranged from 0.8-1.1; all t-tests p <.05). A linear mixed-effects model confirmed that the difference between patient and provider scores was present at baseline and remained consistent over time (estimate=.008, 95% CI: -.01-.03; p =.37). Across all time points, exact agreement between patients and providers ranged from 30-39%, agreement within 1 point ranged from 44-53%, and agreement within 2 points ranged from 54-63%. Conclusions: Providers consistently rating fertility maintenance as more important than patients suggests a need for greater understanding of patients’ reproductive goals and shared decision-making. The decline in scores over time about the importance of fertility maintenance may reflect increased age and changing survivorship priorities, highlighting the value of reassessing goals longitudinally.