Abstract
Simple SummaryThe following review addresses the effects of cancer and cancer treatments on fertility and reproductive health, and reviews standard and novel fertility preservation options. This article presents a needs assessment focusing on disparities in access to care for the pediatric, adolescent, and young adult (AYA) population to include cost, provider bias, inequitable referral patterns to reproductive specialists, and a lack of knowledge within the medical community regarding assisted reproductive technologies and reproductive health care in survivorship. The information presented in this article is targeted to oncologists, gynecologists, pediatric subspecialists, and primary care providers who care for this population and introduces areas for further research to address gaps in care and improve access for this population.Advancements in cancer screening and implementation of targeted treatments have significantly improved survival rates to 85% for pediatric and AYA survivors. Greater than 75% of survivors will live to experience the long-term adverse outcomes of cancer therapies, termed late effects (LE), that disrupt quality of life (QoL). Infertility and poor reproductive outcomes are significant disruptors of QoL in survivorship, affecting 12–88% of survivors who receive at-risk therapies. To mitigate risk, fertility preservation (FP) counseling is recommended as standard of care prior to gonadotoxic therapy. However, disparities in FP counseling, implementation of FP interventions, and screening for gynecologic late effects in survivorship persist. Barriers to care include a lack of provider and patient knowledge of the safety and breadth of current FP options, misconceptions about the duration of time required to implement FP therapies, cost, and health care team bias. Developing strategies to address barriers and implement established guidelines are necessary to ensure equity and improve quality of care across populations.
Highlights
Almost one million women are diagnosed with cancer each year in the United States.Ten percent are women under the age of 40, including more than 48,000 new cancer diagnoses in adolescent and young adult (AYA) women ages 15 to 39 years and approximately 4.0/).5000 new diagnoses in pediatric girls between the ages of birth through 14 years [1,2]
Cancer treatments can lead to primary ovarian insufficiency (POI), infertility, and long-term cardiovascular, cognitive, and skeletal risks associated with menopause
Despite the recommendations that providers address the possibility of infertility with proposed cancer treatments and refer patients to specialists for further management, disparities persist in oncofertility care at diagnosis and in survivorship [5,6]
Summary
Almost one million women are diagnosed with cancer each year in the United States. Ten percent are women under the age of 40, including more than 48,000 new cancer diagnoses in adolescent and young adult (AYA) women ages 15 to 39 years and approximately. POI is a reproductive LE affecting 12% of female childhood cancer survivors treated with alkylating agents and radiation [8]. Young adult survivors treated between the ages of 18 and 39 years will be 40% less likely to conceive than age matched controls [9] Alkylating agents such as cyclophosphamide cause vascular toxicity to reproductive organs as well as direct DNA damage to growing and dormant cells. This leads to menstrual changes, acute ovarian failure, and DOR [5]. Radiation therapy (RT) increases the risk of infertility, depending on a patient’s age, pre-treatment ovarian reserve, total radiation dose, and fractionation schedule.
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