(P 06) ONCOFERTILITY AND PREGNANCY IN ADOLESCENT AND YOUNG ADULT CANCERS: PHYSICIANS' KNOWLEDGE AND PREFERENCES IN A LARGE LOW-MIDDLE- INCOME COUNTRY

Objective: Adolescent and young adult(AYA) cancers have prognostically improved with advanced oncology care and demand sustainable, precision care inclusive of fertility preservation(FP), including in low-middle income countries(LMIC).

Methods: An online survey link with 17 questions was circulated among oncologists on social media platforms and conference venues to assess the knowledge and seek suggestions to optimize referral pathways for FP.

Results: The median age of the 179 respondents was 37 (IQR:10,29-74) years, with a predominance of medical oncologists (68.7%), working in academic centers (39%) having median experience of 4(IQR 4,1-42)years; 23(12.8%) had dedicated AYA cancer units.
Though a quarter (19-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8-11%) refer>90% of these for FP, with significantly higher (p < 0.05) discussions and referrals in males and by more experienced oncologists (p < 0.05).
Forty-six (25.6%) were not well-versed with the international guidelines for FP. Most (122,68.1%) oncologists knew about the referral path for semen cryopreservation;however, only 46% were knowledgeable about additional complex procedures(testicular/ovarian cryopreservation, testicular sperm extraction). One-hundred and ten(61.5%) of oncologists never/or rarely altered the systemic treatment for FP.
Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices and outcomes are education, easy enhancement, and affordable access to FP facilities.
Seventy-four(41.3%) respondents knew about international guidelines for pregnancy with or after cancer; however, only half of them (20%) often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and oncologic and pregnancy outcomes among survivors.

Conclusion: There is uncertainty among oncologists regarding the guidelines, FP practices, referral pathways, and post-treatment pregnancies. A multi-pronged approach with focused AYA clinics with experts, improving awareness, and provision of easily accessible oncofertility facilities is the need of the hour including in LMIC.