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A Geospatial Analysis of Disparities in Access to Oncofertility Services.

Publication ,  Journal Article
Peipert, BJ; Potapragada, NR; Lantos, PM; Harris, BS; Reinecke, J; Goldman, KN
Published in: JAMA Oncol
October 1, 2023

IMPORTANCE: Fertility preservation (FP), including oocyte and embryo cryopreservation prior to gonadotoxic therapy, is an urgent and essential component of comprehensive cancer care. Geographic proximity to a center offering FP is a critical component of ensuring equitable access for people with cancer desiring future fertility. OBJECTIVE: To characterize the distribution of centers offering FP services in the US, quantify the number of self-identified reproductive-age female individuals living outside of geographically accessible areas, and investigate the association between geographic access and state FP mandates. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis calculated 2-hour travel time isochrone maps for each center based on latitude and longitude coordinates. Population-based geospatial analysis in the US was used in this study. Fertility clinics identified through the 2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Report were defined as oncofertility centers by meeting 4 criteria: (1) offered oocyte and embryo cryopreservation, (2) performed at least 1 FP cycle in 2018, (3) served people without partners, and (4) had an accredited laboratory. County-level data were obtained from the 2020 US Census, with the primary at-risk population identified as reproductive-age female individuals aged 15 years to 44 years. The analysis was performed from 2021 to 2022. EXPOSURES: Location outside of 2-hour travel time isochrone of an oncofertility center. MAIN OUTCOMES AND MEASURES: Oncofertility centers were compared with centers not meeting criteria and were classified by US region, state FP mandate status, number of assisted reproductive technology cycles performed, and number of FP cycles performed. The number and percentage of at-risk patients, defined as those living outside of accessible service areas by state, were identified. RESULTS: Among 456 Centers for Disease Control and Prevention-reporting fertility clinics, 86 (18.9%) did not meet the criteria as an oncofertility center. A total of 3.63 million (5.70%) reproductive-age female individuals lack geographic access to an oncofertility center. States with FP mandates have the highest rates of eligible female patients with geographic access (98.54%), while states without active or pending legislation have the lowest rates (79.57%). The greatest disparities in geographic access to care are most concentrated in the Mountain West and West North Central regions. CONCLUSIONS AND RELEVANCE: Patients face numerous barriers to comprehensive cancer care, including a lack of geographic access to centers capable of offering FP services. This cross-sectional study identified disparities in geographic access and potential opportunities for strategic expansion.

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Published In

JAMA Oncol

DOI

EISSN

2374-2445

Publication Date

October 1, 2023

Volume

9

Issue

10

Start / End Page

1364 / 1370

Location

United States

Related Subject Headings

  • 3211 Oncology and carcinogenesis
  • 1117 Public Health and Health Services
  • 1112 Oncology and Carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
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Peipert, B. J., Potapragada, N. R., Lantos, P. M., Harris, B. S., Reinecke, J., & Goldman, K. N. (2023). A Geospatial Analysis of Disparities in Access to Oncofertility Services. JAMA Oncol, 9(10), 1364–1370. https://doi.org/10.1001/jamaoncol.2023.2780
Peipert, Benjamin J., Nivedita R. Potapragada, Paul M. Lantos, Benjamin S. Harris, Joyce Reinecke, and Kara N. Goldman. “A Geospatial Analysis of Disparities in Access to Oncofertility Services.JAMA Oncol 9, no. 10 (October 1, 2023): 1364–70. https://doi.org/10.1001/jamaoncol.2023.2780.
Peipert BJ, Potapragada NR, Lantos PM, Harris BS, Reinecke J, Goldman KN. A Geospatial Analysis of Disparities in Access to Oncofertility Services. JAMA Oncol. 2023 Oct 1;9(10):1364–70.
Peipert, Benjamin J., et al. “A Geospatial Analysis of Disparities in Access to Oncofertility Services.JAMA Oncol, vol. 9, no. 10, Oct. 2023, pp. 1364–70. Pubmed, doi:10.1001/jamaoncol.2023.2780.
Peipert BJ, Potapragada NR, Lantos PM, Harris BS, Reinecke J, Goldman KN. A Geospatial Analysis of Disparities in Access to Oncofertility Services. JAMA Oncol. 2023 Oct 1;9(10):1364–1370.

Published In

JAMA Oncol

DOI

EISSN

2374-2445

Publication Date

October 1, 2023

Volume

9

Issue

10

Start / End Page

1364 / 1370

Location

United States

Related Subject Headings

  • 3211 Oncology and carcinogenesis
  • 1117 Public Health and Health Services
  • 1112 Oncology and Carcinogenesis