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Advising Cancer Patients to Preserve their Fertility
ASRM, 17 October 2007
Washington, DC- Determining the need for information on fertility preservation and the extent to which that need is being fulfilled is a subject of international interest at the 63rd Annual Meeting of the American Society for Reproductive Medicine. Two groups, one Canadian and one at Duke, surveyed physicians who care for female cancer patients of childbearing age to determine the extent of their knowledge when it comes to fertility preservation and what options they offer their patients. A French group surveyed cancer patients to find out if their desire for information had been met.
The objective of the Canadian survey was to gauge the adequacy and accessibility of fertility services to this patient population. A survey was mailed to all Canadian oncologists identified as those who might see female cancer patients at risk for infertility. Thirty-five percent (395) of those surveyed responded. The authors found that many oncologists were not aware of certain options for fertility preservation, such as ovarian tissue cryopreservation. While 82% of the oncologists surveyed felt it was their responsibility to refer patients for consultation on fertility preservation, only 39% of them routinely discuss the possibility with patients and only 7% of clinics have protocols for referring female cancer patients for these procedures.�
A group at Duke University Medical Center surveyed oncologists at that institution and found that only 15% of the respondents regularly refer their patients for fertility preservation and 44% never refer patients to reproductive specialists. The majority, 61%, usually discuss cancer treatment’s impact on fertility. When the oncologist chooses not to discuss fertility it is most often because of the patient’s poor prognosis. Almost all oncologists surveyed are aware of the possibilities of embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation and all agreed that oncologists have a responsibility to inform patients that treatments may permanently impair fertility.�
To obtain patients’ perspectives on whether they were getting sufficient information about fertility and sexuality after cancer treatment, French researchers surveyed 169 women who had survived breast cancer diagnosed between 1990 and 2000 when they were younger than 42. The survey received a high response rate, 71.6%, indicating that the women were very interested in these issues. Thirty-eight percent of the women expressed a desire for more information about how breast cancer would affect their fertility. Sixty-five percent of childless women wanted more information. Only 18% of all survey respondents and 28% of childless respondents reported discussing fertility and future pregnancy with their doctors. The women also wanted more information about sexuality after cancer treatment.�
David Adamson, MD, President-Elect of the American Society for Reproductive Medicine, noted, “Our field has made a great deal of progress in freezing eggs and ovarian tissue in the last two decades and it is encouraging to see that oncologists recognize the need to inform cancer patients of the ways treatment will affect their fertility and the options they have to preserve fertility. However, women with cancer are not getting all the information they want on these topics. Reproductive specialists and oncologists both must make greater efforts to increase awareness.”
P-703, Glass, A survey of fertility preservation practices by Canadian oncologists for female cancer patients.
P-690, Forman et al, A survey of oncologists regarding treatment-related infertility preservation in female cancer patients.
P-689, Barriere et al, Quality of information given to young breast cancer patients about fertility and sexuality after treatment.
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