Counseling and use of surrogacy among cancer survivors (CUSACS)

International guidelines recommend fertility counseling at diagnosis for all women with cancer of child-bearing potential, yet whether gestational surrogacy (GS) is included in such counseling is not clear, nor is whether and what proportion of survivors are aware of GS. We assessed the counseling and use of GS, and predictors of oncologist-provided GS counseling among female cancer survivors.

A survey on fertility and GS counseling was distributed via national advocacy organizations (April-November 2024). Descriptive statistics and logistic regression evaluated predictors of GS counseling.

A total of 519 participants were included. Median age at diagnosis was 32. Most participants had breast (61.5%) or hematologic (14.5%) cancers; 58.2% of participants learned about GS at diagnosis, most often from non-clinical sources (73.2%), including internet/social media (46.0%). Among those aware of GS at diagnosis (n = 302), 134 (44.5%) considered it. Of these, 20 (14.9%) pursued GS, and 16 (80%) ultimately had a child using GS. Commonly cited barriers included cost (45.3%), not ready to build a family (41.4%), and preference to carry the pregnancy (29.9%). While 82.1% remembered receiving counseling on fertility risk, 18.7% recalled GS being included in the conversation. Younger patients without children and those with gynecologic cancers were more likely to receive oncologist-led GS counseling.

Fewer than one in five survivors recalled GS counseling from their oncologist at diagnosis, with most learning from non-clinical sources. Predictors of oncologist-led GS counseling included younger current age, having no children, and gynecologic cancers.

These findings highlight the need for improved family-building counseling at cancer diagnosis, including GS.