Female Cancer Survivors Need Better Info, Support for Family Planning
NEW YORK (Reuters Health) - Young female cancer survivors face daunting decisions about whether to undergo fertility-preservation procedures, and they need better information and support, researchers say.
"When a young woman is diagnosed with cancer, a whirlwind of tests, doctor visits, and procedures follows. The focus tends to be on the cancer diagnosis, staging, and treatment plan," said Dr. Julie Nangia, an assistant professor of medicine at Baylor College of Medicine in Houston, Texas, who was not involved in the study.
Difficult family-planning decisions, which need to be made quickly, often take a back seat to the cancer treatment, and "not all physicians adequately address this with their patients - a point clearly demonstrated in this study - which can lead to fertility-planning decisional conflict," Dr. Nangia told Reuters Health by email.
Dr. Sibil Tschudin of the University of Basel, Switzerland, and her colleagues asked current and former female cancer patients, who had cancer types or treatments that might affect their ability to have children, questions about cancer, fertility, fertility preservation, and decisional conflict. The participants were between 18 and 45 years old.
Through a number of cancer and fertility websites, the researchers recruited 155 women, with an average age at diagnosis of 31 years (74% were under 35; 53% had a university degree). More than three-quarters were living in a relationship and 70% had not yet given birth. Breast cancer was the most common cancer diagnosed (44.0%).
The women answered the Cancer and Fertility Survey (CFS) - an online questionnaire that was developed specifically for the study in English, French and German - an average of 4.5 years after diagnosis.
The researchers found considerable decisional conflict among the women, especially with regard to missing information and support. The mean decisional conflict was 50.13 on a modified Decisional Conflict Scale from 0 to 100; 62.7% of the participants showed high decisional conflict (>37.5 points).
Those who had discussed the risks of infertility with health professionals, who had had a fertility-preservation procedure, or who had attended university, had lower overall decisional conflict, the researchers report in BMJ Sexual & Reproductive Health, online November 17.
Discussing the issues with partners and physicians and getting information from leaflets and websites were helpful. A longer time interval since the cancer diagnosis was associated with higher decisional conflict.
"I would encourage all healthcare providers to have these discussions with their patients prior to initiation of cancer therapy so patients have less anxiety and stress and can make informed decisions about family planning for the future," Dr. Nangia advised. "Options include an urgent consult with a fertility specialist to see if they want eggs/embryos harvested versus ovarian suppression."
Three experts who also were not involved in the survey echoed the need for more awareness of these issues among physicians.
Dr. Halle Moore, a breast oncologist at Cleveland Clinic, in Ohio, told Reuters Health by email, “The most important take-away from this study is that more informed patients were more likely to be content with their decision making; those who are providing care for young cancer patients being treated with curative intent need to provide these individuals with access to the necessary information to aid their decision making during what is generally a stressful time during which numerous decisions are being made."
"Fertility preservation almost becomes a beacon of hope in these women’s lives," said Dr. Zaraq Khan, an assistant professor of obstetrics and gynecology at Mayo Clinic in Rochester, Minnesota.
"Widening the readership of this report to oncologists and reproductive endocrinologists will be of paramount importance," Dr. Khan advised. "The field of fertility preservation is in its early years, and not many studies have quantified these associations. This lack of data and gap in the knowledge makes studies like these very critical. Studies like these not only become landmark papers in the medical literature, they continue to help us understand the intricacies associated with the field of fertility preservation and help healthcare providers cater to the best interests of these women."
Dr. Terri Woodard, an assistant professor of gynecologic oncology and reproductive medicine at The University of Texas MD Anderson Cancer Center in Houston, said, "In spite of the ASCO guidelines on fertility preservation in cancer patients, many women still do not have meaningful discussions about fertility risk and options for fertility preservation prior to initiating cancer treatment. The number of cancer survivors continues to increase; as a result of this and more awareness of the field of oncofertility, these issues are becoming increasingly important and visible."
"One thing that is concerning is the reluctance of some clinicians to have these discussions with patients they perceive as unable to afford fertility-preservation treatments," Dr. Woodard noted. "While the discussion may be uncomfortable, it is still necessary. All patients deserve it as standard of care. Once these conversations happen on a routine basis, who knows? Maybe they will result in a patient-driven impetus that has the power to change policy regarding mandatory insurance coverage for fertility preservation."
Dr. Tschudin was unable to respond to requests for comment.
BMJ Sex Reprod Health 2017.