ASH 2024: Inequitable Patterns in Fertility Counseling Reported by Patients with NHL

Late effects from non-Hodgkin lymphoma (NHL) treatment can lead to decreased fertility, which may be of particular concern for adolescents and young adults. Utilization of fertility counseling is often challenging, though, due to time and cost restraints. Investigators therefore sought to understand the frequency and predictors of fertility counseling and preservation in patients with NHL using data from the Lymphoma Epidemiology of Outcomes (LEO) cohort study, which included patients who were newly diagnosed with NHL from 2015 to 2020 at 8 academic medical centers in the United States.

To understand trends in fertility counseling and preservation, a questionnaire was administered to the LEO cohort at 3 years of follow-up. The questionnaire contained one question on whether their healthcare providers discussed the impact of lymphoma treatment on fertility and one on whether providers discussed the process of fertility preservation.

Survey results from 77 patients ages 18 to 50 years were included in the analysis, of which 46% were female and 53% were male. The median age at diagnosis was 40 years, and 47% of participants were in the 18- to 39-year age range. Approximately 6% of female and 12.2% of male patients underwent fertility preservation after lymphoma diagnosis.

Compared with male patients, female patients were nearly twice as likely to receive fertility counseling at the time of diagnosis; 72% of females and 59% of males recalled having these discussions. Younger patients (18 to 39 years) were more than 10-times as likely as older patients (40 to 50 years) to have received fertility counseling. When accounting for confounding factors, younger age and use of alkylating therapy were found to be significant predictors of whether fertility counseling was performed.

The researchers concluded that their results emphasize the importance of ensuring fertility counseling for all patients of childbearing age so that all patients have the opportunity to address family-planning concerns prior to treatment.

This study also included contributions from Foundation SAB members Thomas M. Habermann, MD of Mayo Clinic, Rochester; Jonathan W. Friedberg, MD of Wilmot Cancer Institute; Peter Martin, MD, of Weill Cornell Medicine; Christopher R. Flowers, MD, MS of The University of Texas MD Anderson Cancer Center; James Cerhan, MD, PhD of Mayo Clinic, Rochester; and former Foundation SAB member Brian K. Link, MD of University of Iowa; Izidore S. Lossos, MD of Sylvester Comprehensive Cancer Center; Brad Kahl, MD of Washington University; and former Foundation grantees Carla Casulo, MD of Wilmot Cancer Institute; Matthew J. Maurer, DSc of Mayo Clinic, Rochester; Jonathon B. Cohen, MD, MS of Winship Cancer Institute; Dai Chihara, MD, PhD of National Institute of Health; Allison C. Rosenthal, DO of Mayo Clinic, Phoenix.