Inclusion of gestational surrogacy in oncologist-led fertility counseling at cancer diagnosis: A national survey.

Abstract

12104 Background: ASCO guidelines recommend that oncologists discuss infertility risks and fertility preservation early with reproductive-aged cancer patients. However, little is known about how often gestational surrogacy (GS) is presented as a parenthood option, or the factors influencing these conversations. GS is defined as someone who carries a pregnancy using an embryo from the intended parents or donor, with no genetic link to the fetus. We sought to assess the frequency and predictors of oncologist-provided GS counseling among a national cohort of female cancer survivors diagnosed at a reproductive age. Methods: We developed a REDCap survey on GS counseling experiences and demographic/cancer-related information, incorporating feedback from 17 survivors. The final survey was distributed nationally via multiple cancer advocacy organizations (April–November 2024). Fisher’s exact tests, T-tests, and multiple logistic regression identified predictors of GS counseling, with p < 0.05 considered significant. Results: 519 female cancer survivors 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 at diagnosis was 31.1 (SD 6.6). 82.1% of patients recalled their doctor discussing the impact of cancer treatment on fertility. Only 18.7% received GS counseling from their oncologist. Patients with cervical/uterine (35.7%) and ovarian (30.4%) cancer were significantly more likely to receive GS counseling from their oncologist compared to breast (19.1%), hematologic (13.5%), GI (5.3%), and other cancers (8.7%) (p = 0.007). Patients who were younger age at diagnosis (mean 30.0 vs. 31.4 years, p = 0.05), had a younger current age (mean 34.2 vs. 37.4, p < 0.001), fewer years since diagnosis (21.3% < 5 years vs. 20.6% 6-10 years vs. 6.0% > 10 years since diagnosis, p = 0.003), and were childless at diagnosis (21.3% vs. 12.9% with children, p = 0.03) were significantly more likely to receive counseling. GS counseling did not vary by patient race, sexual orientation, relationship status, geographic location, income, or education. Logistic regression showed older current age (aOR 0.90; 95% CI 0.95-0.95) and having children at diagnosis (aOR = 0.56; 95% CI 0.31-0.98) predicted lower odds, while gynecologic cancer increased odds of GS counseling (aOR = 2.21; 95% CI 1.06-4.49). Conclusions: Fewer than 1 in 5 survivors received GS counseling from their oncologist, with younger, childless patients with gynecologic cancers more likely to be counseled. These findings highlight potential biases in counseling practices and underscore the need for systematic, equitable fertility discussions at diagnosis, before gonadotoxic treatment.