The Needs and Practices of Fertility Preservation for Patients With Hematological Malignancies: A Medical Center Experience in Taiwan

Abstract

Background: The incidence of hematologic malignancies has increased steadily in Taiwan. Along with the improvement of medical treatment, the survival of patients with hematologic malignancies has greatly improved. Cancer treatment may cause temporary or permanently infertility, which may lead to psychological distress and reduced quality of life. As patients live longer, the consequences of cancer treatments and fertility preservation are of increasing importance. Aim: The aims of this study was to understand the knowledge, needs and experiences of fertility preservation (FP) of patients with hematologic malignancies, and the perceptions and practices of healthcare providers concerning FP for patients with hematologic malignancies. This study also aimed to identify the challenges of FP in health care settings. Methods: In-depth interviews with 13 patients and 13 health care providers along with on-site observation were conducted. Results: Research findings were presented in three parts, respectively addressing patients' needs and attitudes, health care providers' perspective, and problems of current treatment procedures. In the first part, findings showed that among all the 13 interviewed patients, 10 had received counseling, and among them 4 had successfully completed FP. Most patients were unaware of infertility risk of cancer treatment and uninformed with FP information. At the time of cancer diagnosis, most patients were preoccupied with cancer treatment and own survival, but once informed, most of them expressed an aspiration to preserve fertility. In the second part, healthcare providers were found to encounter multiple barriers in initiating discussions about FP with patients, which included the health conditions of patients, the urgent need for treatment, and their perceived insufficiency in knowledge concerning FP procedures and in awareness of experiences of other cases. In the third part, the findings indicated that patients faced several challenges, including the passive attitudes of their physicians, the lack of the counselors or coordinators about FP, and the lack of collaborative guidelines or practices among different subspecialties. Conclusion: The fertility issues of patients with hematologic malignancies deserve attention, as their survival rate has been improved. To ensure the provisions of more friendly medical care resources and to improve life quality of patients with hematologic malignancies, the researcher proposed the following suggestions to the health care team: to provide patients the information concerning the infertility risks caused by cancer treatment and consultation services, establish and implement treatment procedures that incorporate FP, strengthen collaboration across subspecialties, communicate with patients about FP before the initiation of cancer treatment, and provide medical assistance to patients in needs.