Cancer
Sources of financial support accessed by AYA cancer survivors using fertility cryopreservation strategies Taylor Ellington* Taylor Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington Ellington University of North Carolina at Chapel Hill
Clinical guidelines recommend fertility counseling for adolescent and young adults (AYAs) undergoing gonadotoxic cancer treatments. Fertility preservation strategies such as sperm, oocyte, or embryo cryopreservation are expensive and often not covered by insurance, potentially leading to financial hardship. We assessed the relation between use of cryopreservation strategies at cancer diagnosis and accessing external financial support among 3,410 survey respondents in the VOICE Study. Participants were diagnosed with 10 common AYA cancers at ages 15-39 years in California and North Carolina during 2013-2022 and surveyed in 2023-24. External financial support was measured with 9 items including savings, family, community, government, employer, student loans, crowdfunding or donations, hospitals, and other sources. Multivariable Poisson regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) for accessing any external financial support according to use of cryopreservation and adjusted for the following characteristics at cancer diagnosis: age, sex assigned at birth, diagnosis year, income, employment, children, partner status, and cancer stage. Overall, 13% (N=458) of survivors used cryopreservation; 65% reported accessing ≥1 source of external financial support, with 44% accessing ≥2 sources. In multivariable models, survivors who used cryopreservation at diagnosis had a 20% higher prevalence of accessing external financial support (PR 1.2; 95% CI 1.1, 1.4) compared to those who did not. The association between cryopreservation and external financial support was similar by sex (males: PR 1.2; 95% CI 1.0, 1.4; females: PR 1.3; 95% CI 1.1, 1.5). Our analyses highlight the high proportion of AYA cancer survivors who access external sources of financial support to meet their cancer-related costs. Ongoing efforts focused on financial navigation may help facilitate fertility preservation for AYAs with cancer.