Health equity in fertility specialty care among cancer survivors

癌症幸存者生育专科护理的健康公平

• 批准号: 10561780
• 负责人: Jose Alejandro Rauh-Hain
• 金额: $ 76.33万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-28 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10561780
• 关键词: Address; Affect; Age; Alaska Native; American; American Indians; American Medical Association; American Society of Clinical Oncology; Area; Asian; Assisted Reproductive Technology; Biological; Birth; Birth Rate; Black race; California; Cancer Survivor; Caring; Censuses; Childbirth; Clinic; Clinical; Colorado; Connecticut; Data; Data Linkages; Desired Family Sizes; Diagnosis; Dimensions; Disparity; Education; Ensure; Equity; Ethnic Origin; Face; Family; Fertility; Financial Support; Future; Geographic Locations; Geography; Goals; Hispanic; Household; Human Rights; Improve Access; Income; Individual; Infertility; Insurance; Insurance Carriers; Insurance Coverage; Iowa; K-Series Research Career Programs; Kentucky; Live Birth; Louisiana; Malignant Neoplasms; Maryland; Massachusetts; Measures; Mediating; Medical; Methods; Michigan; Minority Women; National Institute on Minority Health and Health Disparities; Neighborhoods; New Jersey; New Mexico; North Carolina; Outcome; Patients; Policies; Policy Maker; Population; Poverty; Privatization; Quality of life; Race; Records; Reporting; Reproductive Health; Reproductive Medicine; Research; Resources; Services; Societies; Source; Specialist; Survivors; System; Time; Uninsured; United States; Utah; Virginia; Vulnerable Populations; Woman; Work; access disparities; cancer care; cancer diagnosis; cancer therapy; cost; disparity reduction; ethnic minority; fertility preservation; health care disparity; health disparity; health equity; improved; infertility treatment; involuntary childlessness; medical specialties; medically underserved; medically underserved population; neoplasm registry; novel; oncofertility; population based; psychologic; racial minority; reproductive; rural area; social determinants; social disparities; success; young woman

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.

1 项目概要 2 对于许多育龄癌症幸存者来说，获得安全有效的生育力保存方法是很重要的 3 创建家庭的基本但往往难以捉摸的途径。随着越来越多的女性推迟生育，数量也越来越多 4 名女性在癌症诊断时尚未达到理想的家庭规模，生育问题引起关注 5 变得越来越重要。尽管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、受孕机会可能较低。使用 ART 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，要么是在癌症诊断时进行生育力保留，要么是在完成癌症诊断后 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 社区（例如家庭收入、教育、前往 ART 诊所的地理位置）和政策水平创造了 11 获取这些方法的重大障碍。 Therefore, as fertility options for cancer survivors become 12 更常见和成功，一个潜在的医疗保健不平等新领域已经出现。另外，不平等 13 保留生育能力的保险和癌症治疗后使用 ART 进一步放大了 医疗服务不足的幸存者存在 14 种差异。大多数接受 ART 的女性都会自掏腰包 15 治疗，对于那些财力有限的人来说，这种选择过于昂贵。整体 16 我们研究的目的是回答两个不同的问题： 1. 差异的来源和程度是什么？ 17 癌症幸存者的生育能力保留、ART 治疗和活产率如何？ 2. 是否改善了访问 18 ART 可以缓解这些差异吗？我们将评估个人所产生的社会差异的维度 19 层面、社区层面（在人口普查区测量的社会决定因素）和政策层面（国家保险） 20 条规定）因素影响着抗逆转录病毒治疗的获取和使用以及活产。具体来说，我们的目标是 1）调查 21 与保留生育能力相关的个人、社区和政策层面的因素； 2）调查 与癌症治愈后使用 ART 相关的 22 个个人、社区和政策层面的因素 23 治疗； and 3) quantify the contribution of individual-, neighborhood-, policy-level factors to live birth rates 癌症后 24 岁，以及医疗服务不足的人群中癌症后的活产率是否会降低以及 25 部分由 ART 使用介导。建立家庭是一项基本人权，并确保公平地享有 26 为所有人群提供肿瘤生育服务是解决育龄癌症癌症护理差异的关键 27名幸存者。 The deleterious effects of cancer treatments on fertility among medically underserved cancer 28 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 the mechanisms underlying disparities in access to ARTs and could be used by policymakers to improve 30 弱势群体获得抗逆转录病毒治疗的机会。