For adolescents and young adults undergoing cancer therapy, the effect their treatment may have on future fertility can be one of many concerns. While there are fertility preservation options available for these patients, a new study suggests awareness of this fact may be low – particularly for women.
Dr. Margarett Shnorhavorian, of the University of Washington and Seattle Children’s Hospital, WA, and colleagues report their findings in Cancer – a journal of the American Cancer Society.
Some cancer treatments can negatively impact fertility for patients of reproductive age. For example, a man’s fertility may be compromised if they undergo testicular radiotherapy; the treatment may harm sperm quality or quantity.
Some cancer therapies may only impact a patient’s fertility short term, while other treatments – such as surgical removal of the womb, for example – can cause infertility.
There are fertility preservation options available for patients. For example, embryo cryopreservation – where eggs are harvested from the ovaries, fertilized via in vitro fertilization (IVF), frozen and stored – may be an option for women. Gonadal shielding – where testicles are protected from radiation exposure – may be an option for men.
Guidelines from the American Society of Clinical Oncology (ASCO) recommend oncologists talk to reproductive-age cancer patients about their risk of infertility and refer them for consultations regarding fertility preservation.
“Despite these guidelines, referrals are inconsistently made, even at large multidisciplinary institutions, and many reproductive-age patients still initiate treatment without discussion of, or opportunity for, fertility preservation,” note the study authors.
Dr. Shnorhavorian and colleagues set out to determine how often fertility discussions and arrangements for fertility preservation take place between health care providers and cancer patients, and what patient factors may influence this.
For the study, 459 adolescents and young adults who were diagnosed with cancer in 2007-08 were recruited via seven US population-based cancer registries.
All patients were required to complete questionnaires, disclosing whether their health care provider had told them how cancer treatment may impact fertility, whether they had been counseled about fertility preservation options and whether arrangements had been made for fertility preservation.
Information on demographic characteristics of patients – such as age, sex, race/ethnicity, education, insurance status and responsibility for raising children aged under the age of 18 – were gathered from the Surveillance, Epidemiology and End Results (SEER) program and the AYA HOPE survey.
The results revealed that more than 70% of patients said their health care provider informed them about the fertility risks of cancer treatment.
However, the team found that male patients were more than twice as likely as female patients to have had discussions about fertility preservation and were four to five times more likely to have made arrangements for fertility preservation.
The findings also revealed that a patient’s socioeconomic status, child-rearing status and medical factors may influence the occurrence of fertility discussions with their health care provider.
For example, male and female patients who were raising children, those without medical insurance and individuals undergoing cancer treatment with low risk to fertility were less likely to have engaged in discussions about fertility preservation.
Male patients without private medical insurance, those without a college degree and those who were raising children were also less likely to have made arrangements for fertility preservation.
Commenting on the team’s findings, Dr. Shnorhavorian says:
“The access and health-related reasons for not making arrangements for fertility preservation reported by participants in this study further highlight the need for decreased cost, improved insurance coverage, and partnerships between cancer health care providers and fertility experts to develop strategies that increase awareness of fertility preservation options and decrease delays in cancer therapy as fertility preservation for adolescent and young adult cancer patients improves.”
Earlier this month, Medical News Today reported on another study in Cancer suggesting infertile cancer survivors wishing to adopt need more support.