PROBLEMS WITH ACCESS OF CANCER PATIENTS TO FERTILITY CLINIC

Up to half of cancer patients of reproductive age do not receive adequate information about the impact of treatment on their fertility, decreasing their options for family planning and support, a new study suggests.

“When we look at studies of regret after cancer treatment one area that is always mentioned is reproductive regrets. Women come back and say they never got the chance to discuss their fertility and now it is gone,” Dr. Donald Dizon, clinical co-director of gynecologic oncology at the Massachusetts General Hospital Cancer Center, told Reuters Health.

“My hope is that this study reinforces the importance of bringing up fertility to all patients of reproductive age regardless of prognosis,” said Dizon, who wasn’t involved in the research, which was published online August 24 in Psycho-Oncology.

For the new analysis, Dr. Shanna Logan at Kids Cancer Center, Sydney Children’s Hospital in Australia and colleagues examined data from 23 previous studies conducted in seven countries from 2007 to 2016.

Across the studies, the likelihood that health care providers and patients discussed fertility issues depended on the provider’s specialty, the patient’s gender and age, and the provider’s attitude and knowledge of fertility preservation techniques.

In one study included in the review, 93% of clinicians said they routinely discuss fertility issues with their patients, but medical records showed that only 74% actually did so.

In another study, clinical nurse specialists discussed with patients the possibility that treatment could adversely affect fertility 68% of the time, while only 40% of surgeons reported being involved in such discussions.

Fewer than half of clinicians said they referred patients to a reproductive specialist when patients had fertility concerns. One study found that only 61% of clinicians were aware of an established referral pathway to a fertility clinic.

Cancer and cancer treatment either temporarily or permanently affects the fertility potential of 50% to 75% of cancer survivors. The American Society of Clinical Oncology (ASCO) recommends that healthcare providers discuss as early as possible the risk of infertility and fertility preservation options with all post-pubescent patients who will undergo cancer treatment.

Logan told Reuters Health by email that young female patients reported greater barriers to receiving appropriate oncofertility support than male patients.

Sperm banking is more often easily available than female preservation techniques, she noted.

“At times patients report that clinicians felt embarrassed having these conversations or did not place great importance on the topic of fertility,” Logan said.

She emphasized that patients want both verbal and written information related to their age and tumor type.

Logan believes oncofertility support is not uniform because clinicians don’t all have the same up-to-date information about resources available.

Dizon agrees. In a telephone interview, he said oncologists don’t get trained in reproductive methods so they’re not the ones to explain them.

“I wish I could say I was shocked that oncofertility support is not offered routinely, but I’m not,” Dizon added.

Oncologists who aren’t comfortable with these discussions should refer patients to other experts, he said. But outside large medical centers, he noted, these services may not be widely available.

Dr. Pasquale Patrizio, director of the Yale Fertility Center and Fertility Preservation Program in New Haven, Connecticut, told Reuters Health by phone, “We are making good progress in having patients be referred to a reproductive endocrinologist in a timely manner, but we still have a lot of work to do.”

Fertility preservation must not compromise the patient’s chance for a cure, Patrizio said. He only needs 10 days to plan a fertility preservation strategy like collecting or retrieving eggs. When a patient needs to begin treatment immediately, ovarian tissue can be cryopreserved in 48 hours.

Logan said, “Providing oncofertility care at the time of diagnosis and through till survivorship is integral in reducing later psychological distress and lowered quality of life seen in cancer survivors with impaired fertility.”