Awareness of gestational surrogacy among female patients treated for cancer: A national survey.

Abstract

12103 Background: ASCO and other international guidelines recommend fertility counseling at diagnosis for all reproductive-aged cancer patients. Yet, how commonly gestational surrogacy (GS) is presented as an option remains unclear. To date, there is very little data to inform the question. Our primary objective was to determine the proportion of cancer survivors aware of GS as an option for parenthood. For the purposes of this study, we defined a gestational surrogate as one who carries a pregnancy using an embryo from the intended parents or a donor embryo, and as such, has no genetic link to the fetus. Methods: We developed a national survey that covered fertility preservation options, with specific questions regarding GS. Survey validation and usability testing were conducted with 17 cancer survivors, providing input on the final instrument. Following IRB approval, the survey was disseminated online via REDCap in partnership with multiple cancer advocacy organizations between April and November 2024. All respondents had the ability to select multiple responses as appropriate. Frequencies, proportions, and 95% confidence intervals (CI) were calculated using SAS 9.4 (SAS Institute, Cary, NC). Results: 519 female participants completed the survey. By cancer type: 60.7% breast, 14.3% hematologic, 8.1% cervical/uterine, 4.4% ovarian, 3.7% GI, and 8.9% other. Mean age (SD) was 31.1 (6.6) at diagnosis and 36.8 (7.4) at survey response; 30% had children at diagnosis. Overall, 75.9% expressed a desire for children post-cancer at the time of their diagnosis. Among respondents, 302 (58.2%; 95% CI 54.0-62.4) reported that they were aware of GS at diagnosis. Among those aware of GS, a similar proportion learned about it through oncologists (32.1%; 95% CI 26.9-37.4) or REI specialists (31.1%; 95% CI 25.9-36.4). However, the majority learned about GS through non-clinical resources (73.2%; 95% CI 68.2-78.2), including internet/social media (46.0%; 95% CI 40.5-51.7). Of those aware, GS was actively considered by 134 (44.5%) participants, of which 20 (14.9%) pursued GS and 16 (11.9%) have had a child using GS. Of those who did not actively consider GS but who were aware, common barriers included cost (45.3%), not ready to build a family (41.4%), preference to carry the pregnancy (29.9%), and using/planning other methods (20.5%). Conclusions: GS is a common route to parenthood in the US and internationally. While almost 60% of participants were aware of GS as an option, the primary source of information was through non-clinical resources. These data indicate GS should be routinely included in fertility counseling at diagnosis, especially in cases where cancer treatment compromises the patient’s ability to carry a pregnancy. Education is needed to ensure oncologists are equipped to provide access to accurate, patient-centered oncofertility care, including REI referral.