The use of an electronic medical record (EMR) best practice advisory (BPA) to facilitate oncofertility referrals and fertility preservation: Updated analysis.

284 Background: The incidence of young adult (YA) and early onset cancer has increased significantly over the past two decades, necessitating an increase in access to fertility education and preservation for this patient population. Up to 75% of young cancer survivors are concerned about their future fertility, yet as low as 28% of YA patients report receiving information on fertility risk associated with chemotherapy. We sought to find a widely applicable method to improve fertility discussions and preservation. Methods: At Fox Chase Cancer Center (FCCC), we implemented a BPA through our EMR (Epic) in July 2024. The alert was triggered for any patient under the age of 50, when a provider placed an order for a new chemotherapy or immunotherapy agent. Patients were excluded if they underwent surgical procedures that would lend themselves to be unable to reproduce. The alert would prompt the provider to send a referral to the FCCC Oncofertility team or provide a reason that precluded referral. Data was collected through an Epic inquiry collecting data. We compared the total number of oncofertility referrals, as well as patient referrals appropriate for fertility preservation within the first 10 months (7/1/24 to 5/1/25) of BPA implementation, to the past 12 years at our center. Results were stratified by age, gender, and cancer type. Results: From 2011 to 2023, a median of 13 referrals were made per year, with 33% of these patients undergoing fertility preservation. After implementation of the BPA, the BPA was triggered for 423 individual patients, with 108 referrals made (25.53%), representing a 730% increase in the number of total referrals over 10 months. 56% of referrals were female, 44% were male. Referrals ranged from 19 to 50 years old, with a median age of 39. The most common referred cancer type was breast (n = 35), followed by hematologic (n = 27) and gastrointestinal cancers (n =15), respectively. Of the patients not referred, the most common reasons were: on active treatment (n =139), followed by patient refused (n =90), and medically inappropriate (n =68). 20 referrals were deemed appropriate for fertility preservation. Conclusions: The implementation of an EMR BPA resulted in a significant increase in referrals to the FCCC Oncofertility program and fertility preservation. This intervention can serve as a model for other institutions to improve provider discussion of the risks of oncologic treatment on fertility, advance patient awareness of preservation options and ultimately increase rates of fertility preservation in YA and early onset patients with cancer. Future directions include promoting fertility discussions as early as possible after initial diagnosis, increasing awareness of the implications of cancer directed therapy on fertility, improving provider education, and increasing access and funding to fertility preservation.