Health equity in fertility specialty care among cancer survivors

1项目概要 2对于许多生育年龄的癌症幸存者来说，获得安全有效的生育保护方法是必要的。 这是建立家庭必不可少但往往难以捉摸的途径。随着越来越多的妇女推迟生育， 4%的女性在癌症诊断时没有达到理想的家庭规模，生育问题 5、越来越重要。虽然生育治疗的适当性因临床和患者而异 6个因素，癌症幸存者更有可能在年轻时需要辅助生殖技术（ART） 7，可能有较低的机会怀孕。使用抗逆转录病毒疗法实现生育目标的方法对于 8名癌症幸存者在两种不同的环境中，无论是在癌症诊断时还是在完成 9癌症治疗对于许多幸存者来说，个人因素（例如，种族/民族、保险状况）， 10邻域（例如，家庭收入、教育、ART诊所的地理位置）以及政策水平 11获得这些方法的实质性障碍。因此，随着癌症幸存者的生育选择变得 12更常见和成功，一个潜在的新领域的医疗保健差距已经出现。此外，不平等 13生育保护和癌症治疗后使用抗逆转录病毒疗法的保险范围进一步扩大了 14医疗服务不足的幸存者的差异。大多数接受抗逆转录病毒疗法的女性都是自掏腰包， 15治疗，使这种选择对那些财力有限的人来说过于昂贵。整体 16我们研究的目的是回答两个不同的问题：1。不平等的来源和程度是什么？ 17生育力保存，接受ART治疗，癌症幸存者的活产？2.改善获得 18种抗逆转录病毒疗法缓解了这些差异？我们将评估个人- 19级、社区级（在人口普查区测量的社会决定因素）和政策级（国家保险 影响获得和使用抗逆转录病毒疗法和活产的因素。具体而言，我们的目标是：1）调查 21个与生育率保持相关的个人，社区和政策层面的因素; 2）调查 22个与癌症治疗结束后使用ART相关的个人、社区和政策层面因素 23治疗;和3）量化个人，邻里，政策层面的因素对活产率的贡献 癌症后的活产率是否会在医疗服务不足的人群中降低， 25部分由ART使用介导。建立家庭是一项基本人权，确保平等享有 为所有人群提供肿瘤生育服务是解决生殖年龄癌症的癌症护理差异的关键 27名幸存者癌症治疗对医疗服务不足的癌症患者生育能力的有害影响 28名幸存者已成为医疗保健差距扩大的一个重要领域。研究结果应该揭示 29.在获得抗逆转录病毒疗法方面存在差距的机制，决策者可以利用这些机制来改善 30为弱势群体提供抗逆转录病毒疗法。

1 Project Summary 2 For many reproductive-age cancer survivors, access to safe and effective methods for fertility preservation is 3 an essential but often elusive path to creating a family. As more women delay childbirth, and greater numbers 4 of women are not reaching their desired family size at the time of cancer diagnosis, fertility concerns have 5 become increasingly relevant. Although the appropriateness of fertility treatment varies by clinical and patient 6 factors, cancer survivors are more likely to require assisted reproductive technologies (ARTs) at a younger age 7 and may have lower chances of conceiving. Methods to achieve fertility goals using ARTs are important to 8 cancer survivors in two distinct settings, either at cancer diagnosis for fertility preservation or after completing 9 cancer treatment. For many survivors, factors at the individual (e.g., race/ethnicity, insurance status), 10 neighborhood (e.g., household income, education, geographic access to ART clinics), and policy levels create 11 substantial barriers to accessing these methods. Therefore, as fertility options for cancer survivors become 12 more common and successful, a potential new area for health care disparity has emerged. In addition, unequal 13 insurance coverage for fertility preservation and the use of ARTs after cancer treatment further magnifies the 14 disparities for medically underserved survivors. Most women who receive ARTs pay out-of-pocket for their 15 treatment, making this option prohibitively expensive for those with limited financial resources. The overall 16 objective of our study is to answer two distinct questions: 1. What are the sources and extent of disparities in 17 fertility preservation, access to ARTs, and live births among cancer survivors? 2. Does improving access to 18 ARTs mitigate these disparities? We will evaluate how dimensions of social disparities arising from individual- 19 level, neighborhood-level (social determinants measured at census tract), and policy-level (state insurance 20 mandates) factors affect access to and use of ARTs and live births. Specifically, we aim to 1) investigate 21 individual-, neighborhood-, and policy-level factors associated with fertility preservation; 2) investigate 22 individual-, neighborhood-, and policy-level factors associated with ART use after completion of cancer 23 treatment; and 3) quantify the contribution of individual-, neighborhood-, policy-level factors to live birth rates 24 after cancer, and whether live birth rates after cancer will be lower in medically underserved populations and 25 partially mediated by ART use. Creation of a family is a basic human right, and ensuring equitable access to 26 oncofertility services for all populations is key to addressing cancer care disparities for reproductive-age cancer 27 survivors. The deleterious effects of cancer treatments on fertility among medically underserved cancer 28 survivors has emerged as an important area of widening disparity in health care. Study findings should reveal 29 the mechanisms underlying disparities in access to ARTs and could be used by policymakers to improve 30 access to ARTs for vulnerable populations.