Critical appraisal:Goodman LR, Balthazar U, Kim J, Mersereau JE 2012

Critical Appraisal

Article being appraised

Goodman LR, Balthazar U, Kim J, Mersereau JE. Trends of socioeconomic disparities in referral patterns for fertility preservation consultation. Hum Reprod 2012 Jul;27(7):2076-81 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22552688.

Applicable clinical question

What proportion of cancer patients are referred to fertility specialists? Which patients are more likely to be referred to fertility specialists?

Key Facts

Study Design

cohort study

Study aims:

To investigate trends of FPC referral patterns by evaluating demographic, socioeconomic and cancer-specific predictive factors associated with FPC.

FPC - fertility preservation consultation

Number of Patients:

199

cohort study of women aged 18–42 years diagnosed with a new breast, gynecologic, hematologic or gastrointestinal cancer at our institution between January 2008 and May 2010. Exclusion criteria included history of permanent sterilization, documentation of no desire for future children, stage IV disease, short interval (,4 days) between diagnosis and treatment and treatment that posed no threat to fertility. Demographic, socioeconomic and cancer variables were evaluated with respect to FPC. Logistic regression was used to determine the odds of referral for FPC based on specified predictors.

Reported outcome(s):

Overall referral rates for FPC are low
There appear to be significant discrepancies in referral based on ethnicity, age, parity and cancer type.

Results of outcome(s):

One hundred and ninety-nine patients were eligible for FPC and of those, 41 received FPC (20.6%). Women with breast cancer were 10 times more likely to receive FPC compared with other cancer diagnoses [odds ratio (OR) 10.1; 95% confidence interval (CI) 3.8– 26.8]. The odds of FPC referral were approximately two times higher for Caucasian women (OR 2.4; 95% CI 0.9–6.2), three times higher for age ,35 years (OR 3.3; 95% CI 1.4–7.7) and four times higher in nulliparous women (OR 4.6; 95% CI 1.9–11.3). There was no association between BMI, income, distance to our institution, being in a relationship and referral for FPC.

Includes an economic evaluation

no