Oncofertility practice patterns in NCCN cancer centers after the overturn of <i>Roe v. Wade</i> .

Abstract

1536 Background: The Supreme Court decision of Dobbs v. Jackson to overturn Roe v. Wade gave states authority to regulate reproductive health. This has led to concerns about access to assisted reproductive technologies used in oncofertility. The impact of this legal climate on oncofertility practices remains unknown. This study aims to understand how academic cancer centers across the United States have experienced changes in oncofertility care in a post- Roe world. Methods: In collaboration with the National Comprehensive Cancer Network (NCCN) Best Practices Committee, a survey was developed to evaluate changes in oncofertility access and utilization in the 2 years since the Dobbs decision. In July 2024, the survey was sent to NCCN Member Institutions, which represent 23 states with varied post- Roe protections for reproductive care. The survey responses were de-identified for analysis. Questions were both multiple choice and free response. Results: The survey was sent to 33 NCCN Member Institutions and yielded 24 responses (72.7%). A majority (83.3%) indicated that reproductive care was a moderate-high priority for their cancer center. Most (62.5%) reported an increase in the number of cancer patients receiving fertility preservation. According to the Center for Reproductive Rights, 13 institutions are in states that have restricted reproductive rights since the Dobbs decision. However, only 4 (16.7%) survey respondents reported that reproductive health laws had become more restrictive. The remaining reported that laws had not changed, were less restrictive, or abstained (83.3%). All 4 respondents who indicated more restrictive laws reported moderate-high priority placed on reproductive care and half reported an increase in cancer patients receiving fertility care. In the states that reported no or neutral change (n=14, 58.3%) or less restrictive laws (n=5, 20.8%), most (68.4%) reported an increase in patients receiving fertility care. One respondent who indicated more restrictive laws reported a decrease in resources for fertility care. Many centers have prioritized oncofertility by developing oncofertility programs, assigning fertility navigators, and creating electronic health record-assisted referral alerts and clinical pathways. Conclusions: Large academic NCCN Member Institutions, most in states with no change or less restrictive reproductive laws since the Dobbs decision, reported an increase in number of patients who accessed fertility care. Additional studies will clarify whether this reflects underlying trends or increased fertility care due to a fear of limited future access. Only a minority of the institutions in restrictive states responded to the survey and most who did reported similar or improved access to oncofertility care. The lack of response from restrictive states needs to be examined further as it may reflect concerns about oncofertility care in the new political landscape.