Discuss Fertility Issues Research Articles

Practice Patterns and Attitudes Regarding Pregnancy and Parenthood After Lung Transplantation

Background. Parenthood after lung transplantation (LuTx) is uncommon. Although data exist regarding practice patterns surrounding pregnancy after heart transplantation, there are no data specific to LuTx recipients and parenthood more broadly. Methods. We conducted a voluntary, anonymous online survey between October and December 2021. It was distributed electronically to select LuTx units and advertised to LuTx providers internationally. Results. A total of 103 responses were included in our analysis. Respondents were primarily women (n = 63; 62%) and included LuTx pulmonologists (n = 59; 58%) or nurses and transplant coordinators (n = 28; 27%). The majority were from centers performing >40 LuTx annually (n = 53; 52%) and had >10 y of transplant experience (n = 56; 55%). Most respondents discuss fertility issues with recipients (n = 63; 62%), but centers lacked clear policies relating to female (n = 51; 70%) and male (n = 62; 83%) fertility and parenthood. Few were aware of policies regarding assisted reproduction and fertility preservation (n = 13; 13%) or pregnancy (n = 23; 22%). Many cited ethical concerns regarding parenthood post-LuTx (n = 38; 37%), but most were supportive of the use of surrogacy by female recipients (n = 74; 92%) and felt there were no contraindications to parenthood in male recipients (n = 59; 59%). Although geography influenced some logistical issues around care provision, general attitudes toward parenthood in LuTx recipients were unaffected by respondent age, sex, location, or experience. Conclusions. Although providers were overall supportive of post-LuTx parenthood, the absence of peer-reviewed evidence, expert consensus, and policy-driven guidance may be a significant barrier to safe and successful parenthood in LuTx recipients.

Oncofertility and Pregnancy in Adolescent and Young Adult Cancers: Physicians' Knowledge and Preferences in India.

The treatment outcomes of adolescent and young adult (AYA) cancers have improved with advanced oncology care. Hence, fertility preservation (FP) and post-therapy pregnancies (PTPs) become vital issues. An online survey link with 17 questions regarding oncofertility and PTPs was circulated among oncologists to assess the knowledge, understand the oncofertility care patterns, and seek suggestions to improve oncofertility services. The median age of 179 respondents, predominantly medical oncologists (68.7%), was 37 years (IQR, 10; range, 29-74), working in academic centers (39%) having a median experience of 4 years (IQR, 4; range, 1-42); 23 (12.8%) had dedicated AYA cancer units. Although a quarter (19%-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8%-11%) refer >90% for FP, with significantly higher (P < .05) discussions and referrals in males and by more experienced oncologists (P < .05). Forty-six (25.6%) were not well versed with international guidelines for FP. Most (122, 68.1%) oncologists knew about the referral path for semen cryopreservation; however, only 46% were knowledgeable about additional complex procedures. One hundred and ten (61.5%) oncologists never or rarely altered the systemic treatment for FP. Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices are education, and enhanced and affordable access to FP facilities. Seventy-four (41.3%) respondents knew about international guidelines for PTPs; however, only half (20%) of them often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and pregnancy outcomes among survivors. Oncologists are uncertain about the guidelines, FP practices, referral pathways, and PTPs. Multipronged approaches to improve awareness and provision for affordable oncofertility facilities are needed to enhance AYA cancer outcomes in India, which will be applicable to other low- and middle-income countries too.

Investigation of Fertility Preservation Education Videos for Pediatric Patients Based on International and Historical Survey.

Purpose: Recently, direct communication with children about cancer seems to have shifted, but little is known about communication regarding discussions of future infertility risk due to cancer therapy. This study conducted cross-cultural comparisons between Japan and the United States to clarify communication patterns about cancer notification and develop appropriate information about fertility issues. Methods: An online survey was distributed to members of the Japanese Society of Pediatric Hematology/Oncology in July 2019 and the American Society of Pediatric Hematology/Oncology in July 2020. Based on the results from the survey, we developed three types of educational videos: a prepubertal version A, B, and a pubertal version. Next, we conducted a survey to assess whether these were appropriate for clinical practice. Results: We analyzed 325 physicians in Japan and 46 in the United States. In Japan, 80.5%, 91.7%, and 92.1% of the physicians notified patients aged 7-9, 10-14, and 15-17 years of their cancer diagnosis directly, respectively, compared within the United States, where the rate was 100%, regardless of age. Further, 9% and 45% of physicians in Japan and the United States, respectively, discuss fertility issues directly with patients aged 7-9 years. In the survey to assess the educational videos, 85% of the physicians preferred to use the educational videos in clinical practice. Conclusion: This is the first step in bringing concordance to communication patters for emerging cancer care around the globe and that this study and its intervention arm provide guidance in ways that ensure global equity in care.

Hidden trauma: shedding light on the relationship between gun violence and infertility

ObjectiveTo study the existing data on the relationship between penetrating abdominopelvic injuries and fertility guidance on managing fertility concerns of these patients using a case report and scoping review.DesignCase report and scoping review.SettingNot applicable.Patient(s)People who have experienced abdominopelvic trauma from gun violence or in the course of combat.Intervention(s)None.Main Outcome Measure(s)We extracted case report data from electronic health records. We performed a scoping review using PubMed and Scopus. Search terms were related to penetrating abdominopelvic trauma, gunshot wounds (GSW), war, and fertility/infertility. We evaluated the study year, age and race, mechanism of injury, fertility outcomes, and how fertility concerns were addressed with patients who experienced penetrating abdominopelvic trauma.Result(s)In the case report, the couple had 10 years of infertility. The male partner experienced an abdominopelvic GSW before attempting to conceive. After evaluation, he was diagnosed with retrograde ejaculation. He recalled being advised that his GSW might affect his future fertility. The couple has discontinued care.For the scoping review, 879 sources were identified and 25 studies were included in the review. Among the studies conducted in the United States, most patients included were African American.Eighty-eight percent (n = 22) of the sources acknowledged the importance of fertility or used fertility-related outcome measures. One study commented on how to address fertility concerns with victims of abdominopelvic penetrating trauma.Conclusion(s)There is a paucity of data on the intersection of penetrating abdominopelvic injuries and fertility or guidance on how to discuss fertility issues with patients.

Facing the unknown: uncertain fertility in young adult survivors of childhood cancer.

The purpose of this research was to describe the challenges young adult childhood cancer survivors (ACCS) experience of living with an unknown fertility status. In this qualitative study, we analyzed data from in-depth interviews with 25 ACCS (15 females, 10 males) using content-driven inductive thematic analysis and constant comparative techniques. Three themes provide insight into ACCS' experiences of living with an uncertain fertility status. (1) The marked psychological burden, which included fear, worry, anxiety, and sadness, was ubiquitous. (2) Romantic relationships were negatively affected and entailed fear of disappointing one's partner, the difficulty of discussing fertility issues, and shying away from romantic relationships. (3) Communication challenges with healthcare providers were apparent across the cancer trajectory, made worse by provider knowledge gaps and dismissal of fertility concerns. (4) Well-known gender stereotypes about pregnancy and childrearing were replicated, while the emotional and life impacts that uncertain fertility could exert on males were minimized. This study provides beginning insights into the experiences of young ACCS as they navigate an unknown fertility status and highlights existing gaps in fertility-related healthcare services. Uncertain fertility has implications for survivors' wellbeing that remain poorly addressed by the existing structure of cancer survivor and fertility services. Assessing and addressing the fertility-related needs of ACCS will continue to be a vital component of patient-centered care in the future, and research to develop comprehensive support, resources, and processes of care are vital to meet this priority need.

A web-based survey of reproductive awareness and choices in women with endometriosis

ObjectiveOur aim was to study fertility issues, attitudes towards reproductive techniques and fertility preservation options in women of reproductive age with endometriosis. Study designIn 2018 we conducted a web-based survey on fertility issues in women aged 18–40 years with endometriosis. Participants were recruited via advertisements on social media and local endometriosis support groups. Participants completed a self-developed online questionnaire evaluating the following dimensions: sociodemographic, medical data, parental project, knowledge and attitudes toward endometriosis and fertility, means used to access information, and reproductive choices. ResultsThe majority of women (96 %) worried about the impact of endometriosis on their fertility. Approximately half of them (52 %) reported having received sufficient information concerning the effect of endometriosis on fertility from their doctor, whereas 31 % had discussed fertility issues with their doctor but desired further information. In contrast, only a minority (27 %) of women considered themselves well-informed on fertility preservation options. Information given by specialists on endometriosis and reproduction was considered most useful. Information mediated through patient support groups was also highly rated, whereas information given by the general gynecologist was less highly rated. The majority of women would consider assisted reproductive techniques (74 %) or adoption (70 %) in case of infertility. Interestingly, 72 % of women would undergo oocyte vitrification for fertility preservation, whereas only 37 % would resort to oocyte donation. ConclusionThis is the first survey to address the topic of fertility issues from the patient’s perspective in women with endometriosis. The vast majority of women attach great importance to a discussion about fertility possibilities and only a minority of women consider themselves well-informed. Our results highlight the importance of addressing the issue of fertility in women with endometriosis. Special attention should be given to information and counselling about fertility preservation options since most women consider their knowledge on the topic insufficient. Knowledge and attitudes to counsel endometriosis patients on fertility issues and fertility preservation options should be included in the training curricula of gynecologists. Adequate information on reproductive aging, risk factors for infertility, and reproductive choices, including oocyte vitrification, should be incorporated into follow-up visits for endometriosis patients.

Abstract P2-13-17: Fertility concerns and treatment decision-making among young women with breast cancer

Abstract BACKGROUND Fertility can be diminished by adjuvant chemotherapy or by age-related decline in ovarian reserve in young women with breast cancer (BC). We sought to better understand the burden of concern about fertility, utilization of fertility preservation strategies, and the impact of fertility concerns on treatment decision-making among young women newly diagnosed with BC enrolled in a large multi-site study. METHODS The Young and Strong study was a cluster-randomized study that tested the effect of an educational and supportive care intervention for young women with BC (≤45) and their oncologists, at community and academic sites across the US. Patients were surveyed following diagnosis at enrollment (within 3 months of diagnosis), and at 3, 6 and 12 months thereafter. The surveys included sociodemographic and psychosocial measures (HADS anxiety and depression; Perceived Stress Scale), as well as a modified Fertility Issues Survey, which assessed fertility concerns and preservation. Treatment and tumor pathology data were abstracted from the medical record. Logistic regression was used to identify sociodemographic, clinical, and psychosocial factors that were associated with fertility concern. Variables with p ≤ 0.20 in univariable analyses were evaluated in the multivariable model using stepwise selection; variables achieving significance at p &amp;lt; 0.05 were included in the final model. RESULTS Of 467 women enrolled from 54 sites (14 academic, 40 community), 419 had evaluable data regarding treatment decision-making. Median age of participants at diagnosis was 40 yrs (range 22-45), 11% were African American, 80% were married/lived with a partner, and 75% had children. 35% of tumors were stage I, 51% stage II, and 14% stage III; 82% of women were treated with chemotherapy. At the time of treatment decision-making, 133 (32%) were concerned about fertility, varying by age, with fertility concern reported by 73%, 28% and 13% of those age ≤35, 36-40 and &amp;gt;40 (p&amp;lt;.01), respectively. 67 (16%) said their treatment decisions had been affected by fertility concerns, including 62 of the 133 (47%) with fertility concern. 12/419 (3%) chose one chemotherapy regimen over another, 4 (1%) chose not to take hormonal medication, and 32 (8%) chose or may choose to take it for less than 5 years. 251 (60%) reported having discussed fertility issues with their physician before starting therapy, including 117/133 (88%) of women with fertility concern. 29 (7%), including 27/133 (20%) of the concerned, took special steps to lessen the chance of infertility: 14 underwent cryopreservation of embryos, 14 cryopreservation of eggs and 12 took GnRH agonist or pursued other strategies. In the multivariable model, history of difficulty becoming pregnant (versus none, OR=3.86, 95%CI: 1.84-8.1) was associated with greater concern about fertility. Older age (OR=.75 per 1-year increase, 95%CI: 0.69-0.81) and having more than one child at diagnosis (versus never delivered, OR=0.14, 95%CI: 0.05-0.40) were associated with less concern about fertility. Race, being partnered, high-education, income, symptoms of depression, stress or anxiety at diagnosis, tumor stage, hormone receptor status and receipt of chemotherapy were not independently associated with concern about fertility in the multivariable model. CONCLUSION In a geographically and ethnically diverse study of young women with newly diagnosed BC in the U.S., many were concerned about fertility, with potential impact on their treatment decisions. For the majority of women, these concerns were discussed with their providers, though only a minority underwent fertility preservation strategies prior to treatment. Citation Format: Elisabeth Etaix, Yue Zheng, Shoshana Rosenberg, Kathryn J Ruddy, J Russel Hoverman, Karen M Emmons, Ann H Partridge. Fertility concerns and treatment decision-making among young women with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-17.

Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers

ObjectivesMost research addressing needs and concerns of young patients with breast cancer (≤40 years) is retrospective. The HOHO European protocol is a prospective multicenter cohort study of young women with newly diagnosed breast cancer, about fertility, psychosocial and quality of life concerns. Here we report the baseline data and focus on predictors of fertility concerns. Materials and methodsPatient surveys and medical record review were used. The baseline survey included sociodemographic, medical and treatment data as well as questions on fertility concerns and preservation strategies. Subscales from the CAncer Rehabilitation Evaluation System-Short Form (CARES-SF) were administered to measure specific quality of life aspects. Uni- and multivariable modeling were used to investigate predictors of greater fertility concern. ResultsAmong 297 eligible respondents, 67% discussed fertility issues before starting therapy, 64% were concerned about becoming infertile after treatment, and 15% decided not to follow prescribed therapies. Fifty-four percent of women wished future children before diagnosis; of these, 71% still desired biologic children afterwards. In multivariable analysis, not having children was the only patient characteristic significantly associated with fertility concerns at diagnosis. Twenty-seven percent used fertility preservation strategies. Women who received chemotherapy reported greater physical (p = 0.021) and sexual difficulties (p = 0.039) than women who did not. Women who were married or had a partner reported less psychosocial problems than single women (p = 0.039). ConclusionsYoung women with newly diagnosed breast cancer have several concerns, including, but not limited to, fertility. The HOHO European study provides valuable information to develop targeted interventions.

A Systematic Review of Professionals' Experiences of Discussing Fertility Issues with Adolescents and Young Adults with Cancer.

Impaired fertility is one potential late effect of cancer, with 15% of adolescents and young adults with cancer (AYAC) at a high risk. Guidelines state that fertility advice should be available at diagnosis; however, research shows that this is not routinely provided. This can negatively affect patients' emotional well-being, mental health, and satisfaction with care. This review aimed to synthesize and critically evaluate studies investigating professionals' experiences of discussing fertility issues with AYAC patients and to understand the barriers and facilitating factors to having these conversations with this specific age group. Peer-reviewed qualitative and quantitative studies were identified by systematically searching eight databases. Fifteen articles reporting from 14 studies were included in the review. Participants reported patient, parent, professional, and institutional factors that influenced fertility discussions. The most commonly reported barriers were the lack of patient educational materials and staff training. Participants were more likely to discuss fertility with patients who were male; had less severe disease; and raised the issue of fertility themselves. The findings suggest that professionals' own values and opinions influence the likelihood of fertility being discussed, with implications for guidance and training. Further, institutional barriers lead to a lack of consistent provision for patients both nationally and internationally. A paucity of research looking solely at AYA populations was noted. A need for research comparing the experiences of different professional groups and exploring the extent to which reported barriers impact on fertility discussions was highlighted. There is also a need for higher-quality qualitative research adopting stronger methodology.

Fertility and cancer: Understanding the barriers to accessing information and resources.

116 Background: Some cancer treatments may lead to infertility in individuals diagnosed during their reproductive years. Infertility can affect a cancer survivor’s long-term quality of life by causing depression as well as reduced life satisfaction and increased anxiety. Addressing fertility concerns is a major component of survivorship care. Methods: In 2017 LIVESTRONG launched a national survey to assess whether patients are being informed about potential fertility risks due to a cancer diagnosis and/or related treatments; whether they are receiving necessary education and access to resources to make informed decisions about fertility preservation; and the financial burden of fertility preservation. A total of 1,064 people diagnosed with cancer between ages of 15-39 during 2006 to 2017 responded to the survey. Results: Seventy-nine percent of respondents said a health professional had discussed fertility issues with them, but only 51% were referred to a fertility specialist. Respondents diagnosed between 2011 and 2017 were more likely to report fertility discussions compared to those diagnosed between 2006 and 2010 (84% vs. 69%; p&lt;.001), and to be referred to a fertility specialist (58% vs. 33%, p &lt;.0001). More educated respondents and those with health insurance at time of diagnosis were more likely to report fertility discussions than those who did not (96% vs. 85%; p=.04). The most frequently discussed topics were possible risks to fertility (89%), methods of fertility preservation (70%), whether the respondent wanted any/or more children (64%), and timing for fertility preservation (50%). Insurance and financial issues were less frequently discussed: costs of fertility preservation (37%), insurance coverage (26%), and financial assistance (30%). Forty-four percent did not take steps to preserve their fertility. Conclusions: Many respondents reported not preserving fertility before treatment because they were not referred to a fertility specialist (30%) or insurance did not cover the costs (20%). All patients diagnosed in their reproductive years should be informed of infertility risks and receive information/resources on preservation options, regardless of education, income level, and insurance status.

Nurses attitudes and practices towards provision of survivorship care for people with a haematological cancer on completion of treatment.

The purpose of this study is to assess cancer nurses' perceptions of responsibility, confidence levels and practice in relation to survivorship care for people with a haematological malignancy on completion of treatment. A prospective cross-sectional survey was conducted. An online survey was distributed to members of two Australian professional bodies. A total of 310 cancer nurses participated in the study, representing a response rate of 28%. The participants generally agreed that all survivorship care items were part of their role. Of the 17 survivorship care items, the three items receiving the lowest confidence scores were discussing fertility issues, discussing employment and financial issues and discussing how to identify signs of cancer recurrence. The least performed survivorship care items were discussing fertility issues, communicating survivorship care with primary healthcare team (i.e. general practitioners) and discussing sexuality issues. Older age, more years of experience, having a post-graduate qualification and working in non-metropolitan area were associated with higher levels of perception of responsibilities and confidence (p < 0.05). The top ranked barriers to survivorship care were reported to be lack of end-of-treatment consultation dedicated to survivorship care, time and an appropriate physical space for delivering care. Cancer nurses perceive key aspects of survivorship care to be part of their role, however there remains variations in practice and confidence with respect to implementation of survivorship care practices. Interventions that focus on enhancing the capability of cancer nurses and eliminating barriers identified in this study have the potential to improve quality survivorship care provision.

Are women and men well informed about fertility? Childbearing intentions, fertility knowledge and information-gathering sources in Portugal

BackgroundThe postponement of parenthood may increase the number of couples experiencing infertility and prolonged time to pregnancy. Previous research has revealed that childless people are not well informed regarding fertility, which may threat their childbearing intentions. This study aimed to examine fertility knowledge and childbearing intentions held by Portuguese people and their use and perceived usefulness of information sources on fertility.MethodsParticipants were recruited using a random-route domiciliary approach. A total of 2404 individuals aged 18–45 were asked to complete a structured questionnaire evaluating socio-demographic characteristics, childbearing intentions, fertility knowledge and information-gathering sources regarding fertility.ResultsIn total, 95.5% of the participants indicated the desire to have children in the future, and 61.7% reported that having children would contribute to life satisfaction. Most of the participants expressed the desire to have two children in the future. The discrepancy between the numbers of planned and desired children was higher in men, in participants with lower education levels, in professionally active participants and in the unemployed participants. Relationship stability seemed to be more important in influencing childbearing decisions than financial stability or family support.Participants’ knowledge regarding fertility was poor. Women, the participants who were older than 25, the participants with longer education and the participants with higher income exhibited the greatest levels of knowledge of fertility, although this knowledge was only slightly enhanced in these subgroups. Also, the participants overestimated both the chances of spontaneous pregnancy and the success rates of assisted reproduction techniques. Finally, the results revealed that websites were the main information sources used by the participants and only 18.0% of the participants had previously discussed fertility issues with their doctors.ConclusionsAlthough Portuguese men and women reported the desire to have children in the future, their knowledge regarding fertility and infertility risk was poor. In addition, participants used more general sources of information, such as website, but not specialized sources, such as their doctors. There is a real need to work with general practitioners to empower them to provide adequate fertility information to every childless patient.

Oncologists and hematologists’ perceptions of fertility-related communication – a nationwide survey

Background: Despite the negative impacts of several cancer treatments on fertility, many patients do not recall having fertility-related discussions with their physicians. This study was conducted to identify those factors related to physicians’ discussing the treatment impacts on fertility with cancer patients of reproductive age.Material and methods: In this nationwide survey of cancer care physicians (n = 329, response rate 55%), oncologists and hematologists (mainly) completed a questionnaire on practice behavior, barriers, attitudes and confidence in knowledge regarding treatment-related fertility risks. Logistic regression analyses were conducted to identify factors associated with not routinely discussing fertility issues with patients.Results: Most of the physicians agreed that they were responsible for discussing fertility issues with patients of reproductive age (91%), but approximately 30% did not do so regularly. Those factors decreasing the likelihood of discussion were: patient already had children (female/male OR 3.0/6.9), high workload (OR 3.3/4.8), seeing <5 female/male patients of reproductive age weekly (OR 3.2/3.4) and access to a reproduction clinic (OR 5.2/4.2).Conclusions: Most Swedish oncologists and hematologists regularly discuss impact of treatment on fertility with their patients. Those factors having a negative impact on fertility discussions may guide targeted organizational and educational efforts to further improve fertility-related communication in cancer care.

Physicians' practice of discussing fertility preservation with cancer patients and the associated attitudes and barriers.

The aim of this study is to describe physicians' clinical practice of discussing fertility issues with cancer patients and determine the factors associated with such discussion. In this cross-sectional study, a nationwide Internet survey was conducted among physicians who provided daily medical care to cancer patients at hospitals or clinics. Participants answered a questionnaire assessing characteristics, discussion practices, attitudes, and barriers regarding fertility preservation. Among the 180 participants, 42% discussed fertility issues with patients daily, and 30% had experience in referring patients to fertility preservation specialists. A multivariate logistic regression analysis showed that those who agreed or strongly agreed with the statements "physicians are responsible for discussing fertility preservation" (OR=2.04, 95% CI 1.14-3.63, p<0.05) and "patients who have an exceedingly aggressive disease and need immediate cancer treatment should not be told about fertility issues" (OR =1.84, 95% CI 1.09-3.10, p<0.05) were nearly twice as likely to discuss fertility issues with patients. Compared to Western countries, fertility issues are less likely to be discussed in Japan. To increase opportunities for patients to discuss fertility issues, the ASCO guidelines should be widely understood. Additionally, these results suggest that physicians who are more likely to discuss fertility issues might feel more conflicted about whether they in fact should discuss such issues with patients with poor prognosis or insufficient time for cancer treatment.

Factors associated with frequency of discussion of or referral for counselling about fertility issues in female cancer patients.

Current practices in counselling of female cancer patients with respect to fertility issues need considerable improvement, particularly given the general underuse of fertility preservation options and the negative impact that infertility can have on quality of life. We investigated the relationship between physicians' and physician-related factors and the frequency of physicians discussing fertility issues and referring to a reproductive specialist. We invited 1,832 physicians in the Netherlands who had treated at least five reproductive-age female cancer patients within the past year to complete a questionnaire. Of the 748 respondents, 406 met our inclusion criteria, and 280 participated. Analysis revealed that 79% of the participants usually or always discuss fertility issues. Specialty, confidence in knowledge regarding fertility issues and a lack of reproductive specialists in their region contributed independently to the variance in the frequency of discussing fertility issues. Moreover, 54% either regularly or always refer. Specialty and frequency of discussion contributed independently to the variance in referral. In conclusion, although high, frequency of discussion of fertility issues is not optimal, and referral seems limited. Patients would benefit from more knowledge among physicians regarding fertility issues and referral options, both in terms of informed choice, and more importantly, quality of life.

Oncofertility Knowledge, Attitudes, and Practices of Canadian Breast Surgeons.

Guidelines recommend that oncologists discuss treatment-related fertility issues with young cancer patients as early as possible after diagnosis and, if appropriate, expedite referral for fertility preservation (FP). This study sought to determine the attitudes and practices of Canadian breast surgeons regarding fertility issues, as well as barriers to and facilitators of fertility discussion and referrals. Semistructured telephone interviews were conducted with 28 site lead surgeons (SLSs) at 28 (97 %) of 29 centers (25 % cancer centers, 64 % teaching hospitals) across Canada participating in RUBY, a pan-Canadian research program for young women with breast cancer. In addition, 56 (65 %) of 86 of their surgical colleagues (non-site lead surgeons [NSLSs]) completed an online survey of their oncofertility knowledge, attitudes, and practices. Of the 28 SLSs (43 % male, 36 % in practice <10 years), 46 % had inadequate oncofertility knowledge, 25 % discussed fertility only if mentioned by the patient, 21 % believed fertility discussion and referral were the mandate of the medical oncologist, and 45 % did not know of an FP center in their area. More than 80 % of the NSLSs (54 % male, 30 % in practice <10 years) were unfamiliar with oocyte or embryo cryopreservation; 36 % never or rarely discussed fertility issues; and 51 % thought referral to a fertility specialist was not their responsibility. Oncofertility knowledge was low among the SLSs, especially the NSLSs, and barriers to referral were identified. An oncofertility knowledge translation intervention specifically for breast surgeons is being developed to increase surgeon knowledge and awareness of oncofertility issues and referral.

Fertility concerns and preservation strategies in young women with breast cancer.

Prospective study of fertility concerns and preservation strategies in young women with breast cancer was a prospective survey of attitudes regarding fertility among younger women (age 40 and under) with breast cancer in the US (1). The study examined whether or not fertility was discussed when the patient was diagnosed, whether or not the patient had fertility concerns when treatment began, what steps could be taken to preserve fertility, and what effect fertility concerns actually had on treatment decisions. The concept of survivorship, or helping individuals diagnosed cancer to lead full lives, has gained widespread acceptance. In Europe and the US, guidelines have been issued predicated on the recognition that fertility preservation (FP) should be considered for all patients with cancer who are of reproductive age and who will be undergoing anti-cancer drug therapy (2-4). Other reports, however, have suggested that breast cancer specialists’ knowledge and their attitudes towards actively FP were related to their efforts to provide information to patients (5). These studies also surmised that there are differences in the information and options offered to patients depending on the physician. This study by Ruddy et al. reported that 68% patients discussed fertility issues with their physicians before starting therapy. Previous studies from Europe and the US have found that patients are not adequately informed of the effects of drug therapy on reproductive function, including early menopause, or of the FP (6-11). Those previous studies noted differences in whether or not FP was explained depending on aspects such as the patient’s age at diagnosis, whether or not the patient had children, the patient’s educational level, the type of drug therapy, and the stage of cancer. Several problems for oncologists are not known a reproductive specialist to confer with and time constraints upon clinical practice (5). Issues that need to be dealt with are creation of an information network for oncologists and reproductive specialists and establishment of a system for collaboration.

Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer

Most research regarding fertility in young women with breast cancer has focused on long-term survivors. Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial cancer diagnosis. As part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age ≤ 40 years. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items. Univariable and multivariable modeling were used to investigate predictors of greater fertility concern. Among the first 620 eligible respondents included in this analysis, median age was 37 years (range, 17 to 40 years); 425 women (68%) discussed fertility issues with their physicians before starting therapy, and 319 (51%) were concerned about becoming infertile after treatment. Because of concerns about fertility, four women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy regimen over another, six (1%) considered not receiving endocrine therapy, 19 (3%) decided not to receive endocrine therapy, and 71 (11%) considered receiving endocrine therapy for < 5 years; 65 (10%) used fertility preservation strategies. Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy. Many young women with newly diagnosed breast cancer have concerns about fertility, and for some, these substantially affect their treatment decisions. Only a minority of women currently pursue available fertility preservation strategies in this setting.

Implementation Of a Systematic Approach To Increase Occurrence and Documentation Of Fertility Discussions In Newly Diagnosed Acute Leukemia Patients Prior To Induction Chemotherapy

The American Society of Clinical Oncology established guidelines on fertility preservation in cancer patients in 2006. However, recent data suggests that the guidelines are not followed in many oncology cases. Several studies have begun to examine the rate in which fertility discussions occurred, appearing as low as 34% in some reviews. A recent study published by Gwede, et al., suggests that less than 50% of adult patients with cancer who are of childbearing receive adequate education about the options before cancer treatment. New acute leukemia patients are in a particularly difficult situation as they typically need to start chemotherapy within days of being diagnosed. The urgency to begin chemotherapy, coupled with a potentially life threatening illness, leaves many medical professionals to focus on the leukemia therapy versus discussions regarding other potential long term side effects of treatment. However, medical professionals agree that it is still essential that patients be educated on the potential impact of chemotherapy on fertility and any possible options for patients protect their fertility. In order to assess programmatic performance in this area, 27 newly diagnosed leukemia patient charts were audited for the documentation of a fertility discussion. This chart review revealed that 12 of 27 (44%) patients had documentation indicating that a fertility discussion took place prior to the start of chemotherapy. In an effort to improve the occurrence and documentation of fertility discussions in newly diagnosed acute leukemia patients, a process improvement plan was put into place. A task force, lead by the program's Psychologist educated the team on the need for fertility discussions and what documentation needed to occur. Barriers identified as impeding fertility discussions included fear of increasing emotional distress, lack of knowledge of what fertility options existed for patients, and a reminder to bring up fertility and/or document discussions. Due to the underlying emotions related to both a new cancer diagnosis and potential fertility issues, critical team members were identified and educated to discuss fertility issues with patients. The entire treatment team was encouraged to remind those critical team members to have and document the fertility discussion with patients. After implementing a systematic, multi-disciplinary plan and staff education, a new set of 27 newly diagnosed leukemia patient charts were reviewed for documentation of a fertility discussion. After the intervention, 27 of 27 patient charts had documentation that a fertility discussion took place prior to the patient starting induction chemotherapy. As found in a previous review by Reinecke, et al., the inclusion of an internal champion and education of staff worked well to ensure that these discussions occurred. This trend reinforces the use of a multidisciplinary team, process improvement and education as ways to ensure all aspects of patient care are covered. Disclosures:No relevant conflicts of interest to declare.

Oncologists’ practice and attitudes regarding fertility preservation in female cancer patients: a pilot study in the Netherlands

Purpose: The aim of this study was to assess oncologists’ practice and attitudes regarding treatment-related infertility and fertility preservation in female cancer patients of reproductive age.Participants and methods: Recruitment letters with a 7-item questionnaire were sent to 454 oncologists.Results: Two hundred and six of the 454 physicians (45%) responded and 96 questionnaires were used for analysis. The sample included 28 (29%) gynaecologists, 22 (23%) medical oncologists, 19 (20%) surgeons, 16 (17%) radiotherapists and 11 (12%) haematologists. Sixty-two percent of the physicians took action to protect ovarian function before or during gonadotoxic therapy. The most important reason for not offering fertility preservation was “factors concerning the disease”. About one-third of the oncologists did not discuss fertility issues. Nearly half of the physicians (43%) would offer fertility preservation options, if they were standardized. High importance was given by almost all physicians (96%) to quality of life in general after gonadotoxic therapy and to the provision of information about fertility preservation options (81%). However, when asked about the importance of infertility after a malignancy, a smaller majority of the physicians (59%) gave it high importance.Conclusion: Most physicians considered infertility to be a major issue to be discussed, and most intended to take action to protect ovarian function before or during gonadotoxic therapy.