Travel Time to Fertility Specialty Care Among Reproductive-Age Cancer Survivors

Purpose: Adolescent and young adult (AYA) women facing gonadotoxic cancer treatments are recommended to consider fertility preservation. However, fertility clinics are scarce in number and location. We describe geographic access to fertility clinics in a statewide cancer population. Methods: This cross-sectional study included 5,632 AYA women from the North Carolina Central Cancer Registry diagnosed with lymphoma, breast, or gynecological cancers who received gonadotoxic treatment during 2004-2015. Geographic access was defined as travel time from patient residence to the nearest fertility clinic at diagnosis. Multivariable logistic regression was used to calculate prevalence odds ratios (POR) and 95% confidence intervals (CIs) for the association between travel time and individual and contextual factors (neighborhood socioeconomic status and rurality). Results: Mean travel time was 51 ± 42 minutes, and 42% of AYAs lived <30 minutes from a clinic. Black non-Hispanic women, those living in advantaged neighborhoods, metropolitan areas, and privately insured had shorter average travel times. Black non-Hispanic women were more likely to live <30 minutes from a clinic than their white non-Hispanic counterparts (POR = 3.3; 95% CI: 2.8-3.8). Publicly insured (vs privately) AYAs and those living in the most (vs least) deprived neighborhoods were 40% less likely to live within a 30-minute drive (POR for both = 0.6; 95% CI: 0.5-0.7). Compared to metropolitan areas, micropolitan (small city) residents were less likely to live <30 minutes from a clinic. Conclusion: The burden of travel time to fertility clinics showed important differences by race and ethnicity, neighborhood SES, insurance, and rurality. The results emphasize the need for tailored and multifaceted strategies to improve access.