Access to fertility preservation services among commercially insured adults with early-onset colorectal cancer.

Abstract

38 Background: Despite the increasing number of adults diagnosed with, treated for, and surviving colorectal cancer (CRC) within their child-bearing years, reproductive health counseling and CRC-related infertility treatment remain an unmet clinical care need. We documented the current use of fertility preservation (FP) services among commercially-insured adults diagnosed with early-onset CRC in the United States. Methods: We analyzed patient-level healthcare claims data for reproductive-age males and females (18-42 years) diagnosed with CRC between 2016-2022 in the national MarketScan Commercial Encounters Database. Incident CRC was identified using international classification of disease (ICD)-O-3 diagnosis codes (1 inpatient claim with diagnosis codes or 2 outpatient claims with diagnosis codes incurred 42 days apart). Current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) standardized billing codes were used to capture CRC treatment(s) and FP services—inclusive of consultation services, laboratory testing, ultrasound monitoring, in vitro fertilization (IVF) procedures, FP medications and pre-implantation genetic testing. Primary outcomes were the use of and time to FP services after CRC diagnosis. Multivariable Poisson regressions were used to estimate relative risks (RRs) and 95% confidence intervals (CI) for documented use of FP services. Results: Among 1,966 early-onset CRC patients (male: 49.2%, mean age: 36.9 years) with at least 1 year of pre- and post-CRC diagnosis follow-up, 8.2% (n=161) had any documented use of FP services after diagnosis. A total of 3.6% (n=71) of patients had a fertility consultation, 2.8% (n=55) had laboratory testing, 2.1% (n=42) had ultrasound monitoring, 3.6% (n=70) had IVF laboratory procedures, 1.9% (n=37) had fertility medications and 0.1% (n<10) had pre-implantation genetic testing. Receipt of fertility counseling was lower among patients diagnosed with colon (RR 0.58, 95% CI 0.35-0.96, P=0.03) relative to rectal cancer, and among male (RR 0.27, 95% CI 0.15-0.47, P<0.001) relative to female patients in models adjusted for CRC diagnosis age and year, health plan type, area of residence, Census region, and CRC treatment. Specific to patients who underwent CRC treatment and had a fertility consultation (n=67), only 31.1% (n=21) received fertility consultation prior to initiation of CRC treatment. The median time from CRC treatment to fertility consultation was 92 days (range: 3-2,027). Conclusions: Fewer than one in every 10 commercially-insured patients with early-onset CRC in the United States had any documented use of FP services as reimbursed through their commercial insurance plan. Further investigation into the potential barriers for FP services among reproductive-age CRC patients is needed to facilitate delivery of concordant reproductive healthcare to this growing population.