A new Columbia University School of Nursing systematic review published by Algave et al in the journal Cancer reveals access to fertility preservation care remains limited and unequal for girls and young women with cancer.
Each year, more than 85,000 adolescents and young adults (AYAs)—individuals aged 15 to 39 years—are diagnosed with cancer in the United States. Following diagnosis, AYAs face an increased risk of long-term treatment-related effects, including cardiotoxicity, ototoxicity, and infertility. Among these, infertility is frequently reported as the most distressing concern by girls and young women with cancer. ASCO published guidelines on fertility preservation in 2006, which emphasize fertility preservation as essential to cancer care. Despite this, female patients are offered fertility preservation care at less than half the rate of male patients because available interventions are often costly, invasive, and time sensitive.
The review of existing literature from 2006 to 2025 revealed inconsistent implementation of these guidelines, resulting in inequities across gender, race, geography, and socioeconomic status. Out of 10,151 publications that were initially identified through a standard search, the Columbia Nursing research team found 25 that focused on access to fertility preservation care among girls and young women with cancer. Notably, most of these studies documented barriers to fertility preservation care, but few found evidence of interventions addressing them.
“Rates of [fertility preservation] discussions with health-care providers ranged from 9% to 75%, consultations with fertility specialists ranged from 0.9% to 57%, and [fertility preservation] completion ranged from 0.56% to 70.3%. Facilitators of access included younger age, private insurance, nulliparity, higher socioeconomic status, certain cancer types, and more recent diagnosis year,” the authors reported.
“This review also highlights the multidimensional nature of disparities in fertility preservation care delivery and access. Consistent with prior literature, racial and ethnic minority patients were significantly less likely to receive counseling, referrals, or complete fertility preservation. Similar inequities have been documented across other domains of survivorship care, suggesting that barriers to fertility preservation reflect broader structural inequities within oncology systems.”
These inequities underscore the need for routine integration of fertility preservation into oncology care and for interventions that address structural and geographic barriers, the authors concluded.
DISCLOSURE: This work was supported by the Reducing Health Disparities through Informatics (RHeaDI) Pre and Postdoctoral Training Program T32 Grant. For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
