Purpose: Given the impact of cancer treatment on fertility among adolescents and young adults (AYAs: 15-39 years), it is important to ensure AYAs access to fertility preservation (FP). However, the availability of FP services for AYAs treated in community settings is unknown. We examined FP access at National Cancer Institute Community Oncology Research Program (NCORP) practice groups.

Methods: The 2022 NCORP Landscape Assessment survey captured available resources and cancer care services including FP services at practice groups. We described FP services as accessible (on-site or off-site) versus not accessible by AYA-treating status (as previously defined). Univariable and multivariable analyses were used to evaluate associations between FP services and practice characteristics (NCORP classification [minority/underserved or community] and proportion of Medicaid or uninsured above/below the national average).

Results: Among 271 practice groups responding to the survey, 100 were categorized as AYA-treating, of which 32% had neither male nor female FP services available. Sperm banking was available at 59 AYA-treating practices, among which 43 (73%) referred for sperm banking off-site. Although approximately half of AYA-treating practices reported accessible female FP services (embryo = 54%, oocyte = 55%, ovarian tissue = 40%), most of them referred patients off-site (embryo = 72%, oocyte = 80%, ovarian tissue = 83%). The odds of access to male FP were lower at minority/underserved practices (odds ratio, 0.34 [95% CI, 0.13 to 0.88]; P = .026; ref = community); however, this same relationship was not seen for females.

Conclusion: Despite guidelines surrounding FP discussions before cancer therapy, and strong consensus regarding the importance of FP access, many AYA-treating practices in community settings lack access to FP services. Understanding how to leverage available services and broadly expand access is urgently needed to facilitate guideline-concordant, high-quality cancer care for AYAs.

目的： 鉴于癌症治疗对青少年和年轻成人（AYA，15-39岁）生育能力的影响，确保AYA能够获得生育力保存（FP）非常重要。然而，在社区环境中接受治疗的AYA可获得的FP服务情况尚不清楚。我们调查了国家癌症研究所社区肿瘤学研究计划（NCORP）实践小组中的FP访问权限。

方法： 2022年NCORP景观评估调查记录了各实践小组可用资源和癌症护理服务，包括FP服务。我们根据是否治疗AYA患者（如先前定义），将FP服务描述为可获得的（现场或非现场）与不可获得的，并使用单变量和多变量分析来评估FP服务与实践特征（NCORP分类[少数群体/未得到充分服务或社区]以及医疗补助或无保险比例高于/低于全国平均水平）之间的关联。

结果： 在回应调查的271个实践中，有100个被归类为治疗AYA患者。其中32%没有提供男性或女性FP服务。59家治疗AYA患者的实践中有精子银行服务，其中43家（73%）将患者转介到外部进行精子冷冻保存。尽管大约一半的治疗AYA患者的实践报告了可获得的女性FP服务（胚胎=54%，卵子=55%，卵巢组织=40%），但大多数将其患者转介到其他地方（胚胎=72%，卵子=80%，卵巢组织=83%）。少数群体/未得到充分服务实践中男性FP访问权限的概率较低（比值比，0.34 [95% CI, 0.13 to 0.88]; P = .026; ref = 社区），然而这种关系在女性中没有观察到。

结论： 尽管有关于癌症治疗前进行FP讨论的指南，以及关于FP访问权限重要性的强烈共识，在社区环境中治疗AYA患者的许多实践中仍然缺乏可获得的FP服务。为了促进符合指南的高质量癌症护理，迫切需要了解如何利用现有的服务并广泛扩大访问权限。