Discuss Fertility Issues Research Articles

Physician perceptions and practice patterns regarding fertility preservation in hematopoietic cell transplant recipients

Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.

Oncologists’ Confidence in Knowledge of Fertility Issues for Young Women with Cancer

We sought to identify factors associated with greater cancer-related fertility knowledge in a national survey of oncologists. We surveyed 344 oncologists from a sampling pool drawn randomly from the AMA Masterfile. We conducted multiple linear regression to determine the relationship between confidence in knowledge and oncologists' characteristics. Respondents' average age was 48.5, and 75.3% were male. The average confidence in knowledge summary score was 23.8 (SD 6.4, range 8-40). In multivariable regression, confidence was higher among oncologists with more information resources, a sense of responsibility to discuss fertility issues and among gynecologic oncologists vs. other oncology specialties. Physician age, gender, and practice setting were not associated with fertility-related knowledge. Oncologists lack confidence in their knowledge of fertility issues in young women with breast cancer. Increasing professional responsibility to discuss fertility and greater information access could improve the depth and breadth of education regarding fertility issues among oncologists and their young patients.

Abstract P5-08-01: Oncology Clinicians’ Knowledge, Attitudes and Practices Regarding Fertility Preservation

Abstract Background: Many breast cancer survivors of child-bearing age wish to become parents after therapy and are concerned about the possibility of treatment-induced infertility. Educating patients about the effects of therapy on fertility, early menopause, and fertility preservation options prior to treatment may optimize a survivor's quality of life after treatment. It is unclear whether oncologists feel qualified to discuss fertility issues with their patients, and if not, what barriers prevent such discussions. Methods: An IRB approved cross-sectional survey was developed at Memorial Sloan-Kettering Cancer Center (MSKCC) in order for clinicians to self-evaluate their knowledge, attitudes, and behaviors regarding fertility preservation. Survey items were derived from existing surveys in the literature and input from a multidisciplinary committee. The web-based survey was systematically administered to all MSKCC ambulatory clinicians. Repeated email reminders were sent to optimize responses. Results: 76 breast cancer clinicians at MSKCC and our regional network sites completed the survey between 2/9/09 and 2/25/09. Among respondents, there was widespread agreement (97% (70/72)) that patients should be informed of fertility preservation options, but fewer respondents (51% (37/72)) consistently discussed effects of treatment on fertility with their patients. Only 47% of clinicians (35/74) reported access to information about effects of treatment on fertility. Many physicians cited lack of training in fertility preservation, time constraints, and lack of referral information as barriers to educating patients. No significant difference existed in practice or knowledge between physicians who were practicing for ≤ 5 years vs ≥ 5 years. Conclusions: Physicians report that lack of education, resources and insufficient time hinder fertility preservation discussions with patients. Physicians might benefit from educational efforts regarding the effects of treatment on fertility and new fertility preservation techniques in order to effectively counsel their patients. Time limitations may be overcome by developing educational resources and collaborating with other clinical staff (e.g., nurses) to provide this vital information to patients. These findings are informing an institution-wide educational fertility program. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-08-01.

Multicenter review of fertility preservation and contraceptive information provided to cancer patients.

e19640 Background: Cancer treatments can adversely affect fertility. Guidelines are available to help physicians both in approaching this topic and in making recommendations as fertility preservation options are constantly developing. Patients desire information on how treatments affect fertility. Assessing patients' awareness of these issues is necessary to guide future discussions with patients being treated with cytotoxic agents. Methods: An anonymous survey of patients, 50 years or less, having chemotherapy in 3 institutions in Cork, Ireland (population 400,000) was undertaken with prior ethics approval. We aimed to assess if fertility issues had been addressed prior to chemotherapy administration and if the patient was satisfied with the discussion. We also examined the degree of patient concern about fertility issues, the utilization of contraception and fertility preserving methods and patient perception of their efficacy. Results: Forty-eight patients participated; mean age 36.5 years (standard deviation: 9.6 years). Thirty-nine patients were female (81%). Half of the patients (24/48) had breast cancer and 79% (38/48) had a primary tumor. Most patients were single (41.6%) and 56.3% already had children. Of those surveyed, 31.3% wanted or strongly wanted more children (27% were unsure). A majority (77%) reported that their doctor had discussed fertility issues and these patients were more likely to feel that their concerns had been addressed (p<0.0001). Younger patients were more likely to have discussed fertility issues (p=0.0095). Only 18.8% (9/48) of patients were using contraception. Those using contraception were more likely to have discussed fertility issues with their doctor (p=0.05). If fertility issues were discussed, so too were contraception and the ability to have children (p<0.0005). Some patients (10.4%) were unaware that chemotherapy can affect fertility and many were unsure (39.6%). No associations were seen between fertility discussion and cancer type, stage, marital status or gender. Conclusions: It is important that fertility and contraceptive issues are raised in patients having chemotherapy in order to address concerns and influence contraceptive practices. No significant financial relationships to disclose.

Fertility preservation in girls during childhood: is it feasible, efficient and safe and to whom should it be proposed?

In prepubertal and adolescent girls, fertility may be impaired by gonadotoxic treatments, repeat ovarian surgery or genetic disorders. Cryopreservation of ovarian cortex is an existing option to preserve fertility in these young girls at risk of premature ovarian failure (POF). The efficacy, feasibility and risks of ovarian cryopreservation in children must be assessed in order to validate the technique. Here, we conducted a review of ovarian cryopreservation in adults and, more specifically, in children using the PubMed databases. In addition, our own experience with ovarian cryopreservation in children was evaluated and compared with the literature. Analysis of the literature and six published series on ovarian cryopreservation in children, as well as our own series of 58 cases, show that there is no reason to doubt its efficacy in this young population. However, no consensus has yet been reached on the indications for the technique. Indeed, with existing models, the real risk of POF may be over- or underestimated. Our review suggests that ovarian cortex cryopreservation is feasible and as safe as comparable operative procedures in children. Although no births have yet resulted from freeze-thawing of prepubertal ovarian cortex, the results of this approach in adults are encouraging. However, the absence of consensus on the indications for fertility preservation, as well as the optimal timing and quantity of ovarian cortex for cryopreservation, should be taken into consideration when discussing fertility issues with girls at risk of POF and their parents.

Do doctors discuss fertility issues before they treat young patients with cancer?

Do doctors discuss fertility issues before they treat young patients with cancer?

Oncologists' knowledge of fertility preservation options: a national survey

OBJECTIVE: Infertility can be a devastating side effect of cancer treatment in younger women, but ∼1/3 of young women fail to recall discussion of these issues with their oncologists prior to treatment. Oncologists may not discuss these issues because they lack confidence in their knowledge of treatment-associated fertility issues. We sought to determine oncologists' confidence in their knowledge of fertility issues and the factors associated with greater confidence. DESIGN: National Survey of US Oncologists. MATERIALS AND METHODS: A random national sample of Med/Onc, Hem/Onc, Rad/Onc, and Gyn/Onc physicians was drawn from the AMA Master File. Oncologists treating >5 women/yr aged 21-45 were eligible to participate. Recruitment letters and emails provided a link to an on-line survey that included 8 questions regarding their confidence in knowledge of fertility issues related to cancer. Responses were based on a 5pt likert scale from which a summary scale was created (Cronbach α= 0.84). Multiple linear regression was conducted to determine the factors associated with confidence in their knowledge of fertility issues. RESULTS: 326/1702 eligible participants responded. Mean age was 48.5 and 75.2% were male. The majority of clinicians were community-based (60%). Average score on confidence in knowledge scale was 23.8 (SD 6.4, range 8-40). Higher scores were associated with Gyn-Onc sub-specialty, access to educational resources regarding fertility and cancer, and perceiving discussion of fertility preservation options as their responsibility (p<.001). Age, sex, and practice setting were not associated with confidence in knowledge. CONCLUSIONS: This is the first nationally representative survey regarding confidence in knowledge among oncologists regarding fertility and female cancer treatments. Our results suggest that providing relevant resources to oncologists and creating a sense of responsibility to discuss fertility issues may increase knowledge and improve communication of these important issues.

Confidence in knowledge discussing fertility changes with cancer treatment

e20540 Purpose: Infertility can be a devastating side effect of cancer treatment in younger women, but approximately one third of young women fail to recall a discussion of such issues with their oncologist prior to cancer treatment. Oncologists may not discuss these issues because they lack confidence in their knowledge of treatment-associated fertility issues and fertility preserving options. We sought to determine oncologists’ confidence in their knowledge of fertility issues and the factors associated with greater confidence. Methods: A national sample of MedOnc, HemOnc, RadOnc, and GynOnc physicians was randomly drawn from the AMA Master File. Mailed recruitment letters provided a link to an on-line survey of fertility issues in cancer treatment. Only practicing oncologists who reported treating &gt; 5 women/yr aged 21–45 were eligible to participate. Physicians were asked 8 questions regarding their confidence in knowledge of fertility changes with cancer treatments and fertility-sparing options. Responses on a 5pt likert scale ranged from 1=not at all confident to 5= very confident and a summary scale was created from participants’ answers. Multiple linear regression was conducted to determine the socio-demographic characteristics, practice settings and attitudes regarding discussing fertility issues that were associated with confidence in knowledge scores. Results: 336/1702 eligible participants responded (20%). Avg years in practice was 15.7, mean age was 48.5 and 75.2% were male. A majority were community-based (60%). Average score on confidence in knowledge scale was 2.9 (SD 0.80) with Cronbach α= 0.84. Higher confidence in knowledge scores were associated with Gyn-Onc sub-specialty, access to educational resources regarding fertility and cancer, and greater sense of responsibility to discuss fertility preservation options (p&lt;.001). Age, sex, and practice setting were not associated with confidence in knowledge. Conclusions: This is the first nationally representative survey regarding confidence in knowledge among oncologists regarding fertility and female cancer treatments. Whether confidence in knowledge is a cause or result of resource access and sense of responsibility to discuss fertility issues should be explored in future research. No significant financial relationships to disclose.

Do doctors discuss fertility issues before they treat young patients with cancer?

Many children treated for cancer are at risk of infertility, but for girls and prepubertal boys, all fertility preservation techniques remain experimental. We have assessed UK practice relating to information provision about the effects of cancer treatment on fertility and options for fertility preservation. Paediatric oncologists prospectively completed a data form for each new patient registered over a 12 month period. Data were available on 1030 patients (68% of total registered). The effect of cancer treatment on fertility was discussed with 63% of patients. Of these, 61% were judged to be at high or medium risk of fertility problems. Discussions took place more commonly with boys than girls; the commonest reason for discussion not occurring was young age. The majority (83%) of post-pubertal boys assessed as high/medium risk of infertility were referred for semen cryopreservation. This rate fell to 39% of those in early puberty. Only 1% (n=4) of girls were referred to an assisted conception unit. These data indicate a high awareness of the potential adverse effects of therapy on fertility among UK paediatric oncologists. High referral rates for older boys indicate that current guidelines are followed, but there is a need for fertility preservation techniques for girls and younger boys.

Barriers to discussions of fertility issues prior to cancer treatment

20550 Background: Despite its importance, discussions regarding fertility changes related to cancer treatment may not occur. This qualitative study explored the barriers to these discussions from both oncologists and breast cancer survivors’ perspectives. Methods: Oncologists were recruited from a physician registry and cancer centers in authors’ state. Breast cancer survivors (BCS) were recruited from local support agencies and cancer centers. All BCS were premenopausal at diagnosis and completed treatment within the last three years. Experienced facilitators conducted two focus groups and nine individual interviews among oncologists (one focus group and three interviews) and BCS (one focus group and six interviews) which were tape-recorded, transcribed and entered into NVivo software to facilitate analysis. All authors read through initial transcripts to identify preliminary themes. A hierarchical coding structure was developed by author CD, which was then refined by all authors, adding additional codes to the structure as needed. Results: Common themes raised by both oncologists and BCS included: 1) the need for oncologists’ primary focus at the time of diagnosis to be cure; 2) patients are emotionally overwhelmed at the time of diagnosis which may hamper discussing fertility issues; 3) the need to tailor discussions regarding fertility to meet the individual needs of the patient, and 4) women’s right to be informed of fertility risks with treatment. Oncologists perceived more barriers to fertility discussions (structural, attitudinal, and knowledge) than did cancer survivors. BCS felt it was a right to pursue fertility preservation regardless of their personal or medical circumstances. Conclusions: Barriers to fertility discussions cited by both oncologists and BCS may account for research indicating these discussions do not always occur, or are inadequate. Research Implications: This study suggests the need to improve communication between oncologists and women diagnosed with breast cancer regarding fertility, and to address some of the structural and knowledge barriers to having fertility discussions prior to cancer treatment. No significant financial relationships to disclose.