Abstract
High survival rates in adolescent cancer patients have shifted the medical focus to the long-term outcomes of cancer treatments. Surgery, chemotherapy, and radiation increase the risk of infertility and infertility-related distress in adolescent cancer patients and survivors. The aims of this narrative review were to (1) describe the psychosocial impacts of cancer-related infertility in adolescents, (2) identify multilevel barriers to fertility preservation (FP) conversations and referrals, and (3) conclude with evidence-based clinical solutions for improving the oncofertility support available to Canadian adolescents. The results of this review revealed that FP decisions occur within the patient, parent, and health care provider (HCP) triad, and are influenced by factors such as parent attitudes, patient maturity, and HCP knowledge. Decision tools and HCP education can promote the occurrence of developmentally appropriate fertility discussions. At the systems level, cost and resource barriers prevent patients from receiving sufficient fertility information and referrals. Clinical models of care (MOCs) can define interdisciplinary roles and referral pathways to improve the integration of oncofertility services into adolescent cancer care. The continued integration of oncofertility care will ensure that all Canadian adolescents receive the exemplary medical and psychological support necessary to make empowered decisions about their own fertility.
Highlights
Oncofertility is an emerging discipline that is increasingly recognized as an essential component of adolescent cancer care [1]
These recommendations are outlined in the national guidelines, many adolescents do not receive sufficient oncofertility support in Canada
This review has identified multilevel barriers and corresponding solutions to oncofertility access for adolescent cancer patients
Summary
Oncofertility is an emerging discipline that is increasingly recognized as an essential component of adolescent cancer care [1]. The National Cancer Institute defines adolescence as patients 15–19 years of age [2]. Recent Canadian research [5–7] has shown that the majority of cancer patients do not receive the recommended standard of oncofertility care—a result of a combination of parent, patient, and health care system barriers to developmentally appropriate fertility care. The aims of this narrative review are to (1) describe the psychosocial impacts of cancer-related infertility in adolescents, (2) identify multilevel barriers to FP conversations and referrals, and (3) conclude with evidence-based clinical solutions for improving the oncofertility support available to Canadian adolescents
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