Leveraging patient-reported and health record data to monitor oncofertility care among adults with cancer: A proof-of-concept study.

Abstract

608 Background: Electronic patient-reported outcomes (ePROs) may provide a scalable approach for identifying adults with cancer experiencing fertility-related concerns and for monitoring subsequent fertility-related care, though the feasibility of using informatics data for this purpose has seldom been explored. We evaluated whether ePROs could be used to identify adults with cancer experiencing fertility concerns and linked these data with the electronic health records (EHR) to characterize subsequent fertility-related care. Methods: We conducted a retrospective cohort study of adults with cancer age 18+ referred to psychosocial oncology at a large academic medical center who completed a language-concordant self-report survey via EHR patient portal or tablet provided in clinic including assessment of fertility concerns. We identified those who reported fertility concerns and linked ePRO data with sociodemographic, clinical, encounter, and billing data from the EHR. As a proof-of-concept for informatics-based care monitoring, we characterized subsequent encounters for fertility preservation counseling and fertility preservation. Results: Among 87 adults with cancer reporting fertility concerns, the median age was 33 years (range: 21-77), 69% (n=60) were female, 89% (n=77) White, 9% (n=8) Hispanic, 53% (n=46) partnered, and most had breast (34%, n=30), gastrointestinal (16%; n=14), or hematologic (16%, n=14) malignancies. Following report of fertility concerns, 42% (n=25) of females had fertility preservation counseling documented; no males in this sample had fertility preservation counseling documented. Younger age, female sex, and single marital status were associated with counseling ( p <0.05); no significant differences were observed by race, ethnicity, or education. Among males, 15% (n=4) had sperm cryopreservation documented; among females, 0% had oocyte cryopreservation and 5% (n=3) had embryo cryopreservation documented. Conclusions: Our proof-of-concept study demonstrates the feasibility of leveraging ePROs linked with EHR data to identify adults with cancer experiencing fertility concerns and characterize subsequent oncofertility care. Findings suggest informatics-based approaches can provide a scalable strategy to monitor oncofertility care delivery, identify gaps in fertility-related care following reported concerns, and inform interventions to improve fertility counseling, referral, and navigation for adults with cancer.