Health equity in fertility specialty care among cancer survivors

1个项目摘要 2对于许多处于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 3.组建家庭的必经之路，但往往难以捉摸。随着越来越多的女性推迟分娩，越来越多的女性 4%的女性在被诊断为癌症时没有达到理想的家庭规模，生育方面的担忧 5变得越来越重要。虽然不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更年轻的时候需要辅助生殖技术(ART) 7岁，受孕几率可能较低。使用抗逆转录病毒疗法实现生育目标的方法对 8名癌症幸存者在两个不同的环境中，要么是在被诊断为保留生育能力的癌症诊断时，要么是在 9癌症治疗。对于许多幸存者来说，个人因素(如种族/族裔、保险状况)、 10个社区(例如，家庭收入、教育程度、前往ART诊所的地理位置)和政策级别 11获取这些方法的巨大障碍。因此，随着癌症幸存者的生育选择变得 12更普遍和更成功的是，出现了一个潜在的卫生保健差距的新领域。此外，不平等 13保留生育能力和癌症治疗后使用抗逆转录病毒药物的保险范围进一步扩大 14医疗服务不足的幸存者之间的差距。大多数接受艺术教育的女性都会自掏腰包为她们的 15治疗，使这一选择对那些财政资源有限的人来说昂贵得令人望而却步。整体而言 16我们研究的目的是回答两个不同的问题：1.性别差异的来源和程度是什么 17在癌症幸存者中保留生育能力、获得抗逆转录病毒治疗和活产的机会？2.改善获得 18艺术能缓解这些差距吗？我们将评估社会差距的各个维度是如何从个人- 19.一级、邻里一级(在人口普查区域衡量的社会决定因素)和政策一级(国家保险 20)影响获得和使用艺术和活产的因素。具体地说，我们的目标是1)调查 21个人、邻居和政策层面的与保持生育能力有关的因素；2)调查 与癌症完成后使用抗癌药物有关的22个个人、社区和政策层面的因素 23治疗；以及3)量化个人、社区、政策层面的因素对活出生率的贡献 24癌症后，以及在医疗服务不足的人群中，癌症后的活出生率是否会更低 25部分受抗逆转录病毒药物使用的影响。创建家庭是一项基本人权，并确保公平获得 26为所有人群提供肿瘤生育服务是解决育龄期癌症治疗差距的关键 27名幸存者。癌症治疗对缺乏医疗服务的癌症患者生育力的有害影响 28名幸存者已成为医疗保健差距扩大的重要领域。研究结果应该揭示 29获得艺术的机会方面存在差异的机制，政策制定者可以利用这些机制来改进 30弱势群体获得艺术的机会。

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.