Treatment-related Infertility Research Articles

Abstract PD7-08: Economic and time-related burden in young breast cancer patients wishing to preserve their fertility before undergoing cancer treatment

Abstract Background: Treatment-related infertility is one of many issues facing young breast cancer patients. Fertility preservation, using artificial reproductive therapy (ART), is a recommended method to maintain future reproductive function among cancer patients. However, medical costs for fertility preservation are often too expensive for young cancer patients who can be less economically secure, in addition to the costs of cancer treatment. Moreover, the ART process requires several weeks or more, and time spent in fertility preservation may potentially delay treatment. Pink Ring is a patient advocacy group for young breast cancer patients, established in Japan in 2012, which has been working on the issue of onco-fertility. We conducted a cross sectional web-based survey exploring the economic and time-related burden of young cancer patients in the reproductive age group. This study was supported by a research grant from the Foundation to Promote Cancer Research. Method: Pink Ring conducted a web-based survey, and 343 young breast cancer patients who responded were enrolled. We performed descriptive analysis of the data. Result: Among 343 young breast cancer patients, the mean age at the time of the survey was 38 years (20-49) and the mean age at breast cancer diagnosis was 34 years (20-49). At diagnosis, 167 (49%) of the women were married and 171 (50%) were single. At diagnosis, 99 (29%) women had had a child or children and 236 (63%) were childless. Regarding treatment-related infertility, 193 patients (56%) had had discussions with a medical health provider. However, 58 (17%) patients underwent a fertility preservation procedure. Among patients who underwent fertility preservation, 35 patients (60%) underwent embryo preservation, 23 (40%) underwent oocyte cryopreservation, and 4 (7%) underwent ovarian tissue cryopreservation. According to medical payment for a fertility preservation procedure, 26 patients (45%) paid less than $5000, 21 patients (36%) paid between $5000 and $10000 and 10 patients (17%) paid over $10000. Regarding cost-effectiveness, 51 patients (88%) considered that the medical payment was expensive. According to the duration of the fertility preservation procedure, 7 patients (12%) were treated up to 2 weeks, 8 patients (31%) were treated between 2 and 4 weeks, 21 patients (36%) were treated between 1 and 2 months, and 7 patients (12%) were treated longer than 2 months. Twenty-eight patients (48%) answered that planned cancer treatment was delayed because of a fertility preservation procedure. According to cancer treatment delay, 4 patients (14%) were delayed up to 4 weeks, 14 patients (50%) were delayed between 1 and 2 months, and 10 patients (36%) were delayed longer than 2 months. Among 285 patients who did not proceed with fertility preservation, the major reasons given for their decision were as follows: lack of awareness regarding treatment-related infertility and fertility preservation options (29%), economic-related burden (25%), and time-related burden (25%). Discussion: This survey revealed that fertility preservation was a burden not only for economic reasons but also in terms of time required for treatment for young breast cancer patients of reproductive age. Citation Format: Kitano A, Mifune M, Suzuki A, Hashizume A, Nakayama C, Motofuji Y, Suzuki H, Ichioka E. Economic and time-related burden in young breast cancer patients wishing to preserve their fertility before undergoing cancer treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-08.

Patient attitudes toward oncofertility care in male cancer patients receiving targeted and immune therapies.

e21593 Background: Tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) have resulted in durable response for many cancer patients. The impact of these agents on future fertility are not well described, and patients are often committed to long-term treatment without adequate oncofertility counseling. We sought to better characterize patient attitudes toward oncofertility and challenges faced by male cancer patients undergoing treatment with TKI or ICI. Methods: Men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men had received at least one dose of TKI/ICI. Detailed questionnaires addressing cancer history, possible effects of treatment on fertility, and obstacles to fertility preservation were completed. Results: Between January 2013 to September 2016, 51 men with a mean age of 46 years (SD 12, range 21-72), 65% white, completed questionnaires. Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI. At the time of diagnosis, 35% of patients indicated a desire to father future children, and 53% believed that cancer treatment might affect their fertility. Despite this, 45% were not asked whether having children was important to them, and 47% did not receive information from any provider on their oncology care team about the possible risks of TKI/ICI to future fertility. The majority of patients felt there was inadequate discussion of how treatment might affect testosterone levels (73%) and their ability to father a child (53%), yet only 14% recalled adequate referrals to a fertility specialist. Conclusions: These data demonstrate that male cancer patients perceive treatment-related infertility risks as important, yet have few opportunities to discuss these concerns with providers. Care plans to address oncofertility needs, especially as TKI/ICI are increasingly used in multiple cancer types, are needed as part of the diagnosis, treatment, and follow up of these patients. Larger retrospective and prospective studies are ongoing to further characterize this patient cohort.

PD13-10 BARRIERS IN ACCESS TO MALE ONCOFERTILITY CARE AMONG MEN RECEIVING TARGETED CANCER THERAPY

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I1 Apr 2017PD13-10 BARRIERS IN ACCESS TO MALE ONCOFERTILITY CARE AMONG MEN RECEIVING TARGETED CANCER THERAPY Joris Ramstein, Puneet Kamal, Katy Tsai, and James Smith Joris RamsteinJoris Ramstein More articles by this author , Puneet KamalPuneet Kamal More articles by this author , Katy TsaiKaty Tsai More articles by this author , and James SmithJames Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.698AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of Tyrosine Kinase Inhibitors (TKI) in men with certain malignancies has in many cases improved the course of illness from rapidly fatal to a chronic disease requiring long-term treatment. However, very little has been published on TKI effects on male fertility despite the potential for significant risk to fertility. Many major organizations have guidelines advocating fertility preservation (FP) for all patients at risk of impaired fertility from cancer treatment, yet it is unclear how often men receiving TKI are counseled on the fertility risks of their oncologic treatments and the need for FP. We sought to identify potential barriers to accessing oncofertility care, assess baseline understanding of treatment-related infertility, and characterize reproductive expectations of men receiving TKI treatment. METHODS A retrospective cohort of men receiving TKI at UCSF completed a single detailed questionnaire. Cancer history, consultation with treating physician about the possible effects on fertility, obstacles to fertility preservation methods and satisfaction with treatment decisions were addressed. RESULTS Fifty-one patients receiving TKI participated in the study. The mean age was 46 years (range 21-72). Thirty-one (61%) had chronic myelogenous leukemia and 26 (51%) had received prior treatment for cancer (11 surgery, 12 chemotherapy, 3 radiation). While 18 (36%) said they would like to have children in the future and 24 (46%) had some degree of concern that their cancer treatment might affect their fertility, 26 (51%) were not given any information about the fertility risks of TKI by their medical team, 30 (59%) were not able to discuss possible ways to protect their fertility, and 39 (76%) did not have the opportunity to discuss protecting their testicles from cancer treatments. Furthermore, 32 (63%) felt they had encountered some barrier to fertility care prior to receiving their cancer treatment, including 11 (22%) who were not provided a referral to a fertility specialist, and 14 (27%) who did not understand that the cancer treatment might affect their fertility. CONCLUSIONS Nearly half of the patients surveyed worried about the reproductive risks of TKI, and most felt they had not received enough information about these risks. Furthermore, the majority of men experienced barriers to oncofertility care. These findings highlight the need for medical providers to take a proactive approach to discuss potential fertility risks in men on TKI. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e274-e275 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joris Ramstein More articles by this author Puneet Kamal More articles by this author Katy Tsai More articles by this author James Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Addressing the risk of infertility in young women with breast cancer (BC): A quality improvement (QI) intervention.

72 Background: Many young women with early BC require systemic therapy (ST) which can result in ovarian damage leading to infertility. Fertility preservation (FP) can be performed prior to ST, however uptake is low. Data suggest oncology providers do not routinely discuss the risk of treatment related infertility (TRI) or FP with young women with BC. Methods: We created a QI protocol to ensure providers address fertility needs of young women with early BC. Non-pregnant women age 18-44 years with stage I-III BC who have not initiated ST are identified by screening clinic schedules. Clinicians are asked to follow a QI protocol requiring assessment of patients’ childbearing potential (CBP), risk for TRI and fertility goals (FG). If appropriate, FP is discussed and consultation with a fertility specialist arranged. A clinical team member completes a provider documentation form (PDF) summarizing the QI protocol steps accomplished. Results: Since implementation of the QI protocol, there have been 80 eligible women (mean age 38.6). At least one PDF was completed for 56 (70%), with the majority completed by breast surgeons. Among those with a completed PDF, 48 (86%) were of CBP, all but one of whom planned ST associated with a risk of infertility. According to the PDF, the risk of TRI was discussed in 34 (72%) while FG were assessed in 44 (94%), with 8 (18%) desiring fertility and 8 (18%) undecided about FG. Discussion of FP by the provider and/or a fertility specialist was documented in the PDF for 85% of those who desired fertility or who were undecided. In comparison to the PDF, discussion of FG was recorded in provider notes in 36 (45%) women with documentation in both provider notes and the PDF for 29 (36%). Provider notes documented discussion of FG in 94% of the women who desired fertility or who were undecided according to the PDF. Conclusions: Implementation of a QI protocol with required documentation ensures providers address fertility needs of young women with BC. Providers do not discuss the risk of TRI as frequently as assessing FG. Efforts are ongoing to increase completion rate of our PDF and to incorporate it into the electronic medical record. Follow-up regarding ST and uptake of FP in our cohort is ongoing.

Knowledge and Perceptions about Cancer Treatment-associated Infertility among Young Patients at a Tertiary Care Hospital in Pakistan

Introduction:Infertility after cancer treatment can cause significant emotional stress and grief for cancer survivors. In this study we assessed knowledge and perceptions among young cancer patients regarding the topic of cancer and infertility related to different treatment options.Material and Methods:This cross-sectional study was conducted on young cancer patients in the Clinical Oncology Department, JPMC, Karachi, from January to August 2013. Patients were requested to fill in questionnaires. Comparisons between gender and age groups were performed using the Student’s t test and Pearson’s Chi-squared. Significance was concluded with a two tailed p-value less than 0.05.Results:The survey included 368 cancer patients, 194 males and 174 females. Ninety percent of respondents of either gender were not aware that cancer or cancer treatment can cause infertility, this being age dependent (P=0.06). However, on being made aware, 98% of males and 91% of females wanted their oncologist to discuss treatment-related infertility prior to initiating cancer treatment (P=0.005) and 92% and 78%, respectively, wanted to consider fertility preservation techniques prior to treatment (P<0.0001). Of age groups 15-30 years and 31-50 years, 91 % and 81% wanted to consider FP prior to cancer treatment (P =0.011). Among 226 married individuals, 89% males and 79% females underestimated that effects that infertility issues might have on their relationships with their spouses.Conclusions:We recommend physicians and oncology care givers to initiate discussion of the topic of cancer and treatment-related infertility with young cancer patients during their initial management planning.

Timing should no longer be an obstacle to oocyte cryopreservation in patients with cancer.

Anticancer treatment-related infertility is preventable with oocyte cryopreservation, but this is often not considered a relevant issue, due to lack of knowledge and time. The aim of this study is to prove that adequate organization of an Oncofertility Unit and the use of new protocols for controlled ovarian stimulation (COS) can reduce the time required by the procedure, encouraging consultants and patients to preserve fertility before gonadotoxic treatments. A total of 125 patients diagnosed with malignant tumors were referred to the Oncofertility Unit of San Raffaele Hospital: 52 patients between April 2011 and October 2013 and 73 patients between October 2013 and November 2015. The 2 periods differ in office organization and type of COS protocol used. Between the 2 periods, a reduction in the mean number of days required from first counseling to the initiation (6.45 ± 1.058 vs 1.61 ± 0.228) and the end of the COS (17.83 ± 1.227 vs 13.70 ± 0.393) was observed (p<0.0001). No differences exist in the groups between the mean time required to complete COS (11.38 ± 0.360 vs 12.17 ± 0.309; p = 0.11) and mean number of frozen oocytes (8.458 ± 1.060 vs 10.30 ± 0.919; p = 0.22). Furthermore, in the second period, the number of patients who accepted fertility preservation increased (46.15% vs 64.38%; p<0.05). Renewed organization of the Oncofertility Unit and the newest random-start COS protocol allowed us to shorten the time for oocyte cryopreservation and start anticancer treatment on time.

Reply to C.F. Hess et al

How Relevant Is Treatment-Related Infertility for Individual Treatment Selection in Hodgkin Lymphoma? : Reply

A survey on fertility management in young women of reproductive age treated with chemotherapy.

Treatment-related infertility is an important issue for cancer survivors of reproductive age. We aimed to determine the understanding and management of fertility issues in cancer survivors by health care providers. We studied 112 patients aged 15-40years who underwent chemotherapy in Tokushima University Hospital. The gynecologists and oncologists who treated these patients were surveyed regarding their concerns about infertility issues in young cancer survivors. Of the 112 women studied, 57 had iatrogenic amenorrhea. Five were referred to reproductive specialists before or during treatment. Three patients with breast cancer were referred after treatment; they could not undergo fertility treatment due to ovarian failure after chemotherapy. Forty-five medical doctors answered the survey: 21 gynecologists (including 9 fertility specialists), 13 oncologists, and 11 surgeons. Of the oncologists and surgeons, 37.5% (9/24) referred their patients to fertility experts. They listed certain issues regarding the patients: (1) anxiety that the intervention will alter the prognosis by delaying cancer treatment, and (2) a lack of communication between the oncologist and the fertility specialist. Almost all physicians agreed that fertility counseling was needed before chemotherapy. This report showed the importance of oncofertility counseling and cooperation between oncologists and fertility specialists. Fertility in cancer survivors depends on type of cancer treatment applied, chemotherapy regimen, and age at treatment. Our institute is now equipped for oncofertility counseling and refers patients for fertility preservation prior to cancer treatment.

Formal evaluation of PYNK: Breast Cancer Program for Young Women-the patient perspective.

The aim of the present study was to assess patient satisfaction with pynk: Breast Cancer Program for Young Women so as to determine how the program might be improved and to provide feedback to donors. All pynk patients who had consented to have their information entered in our database and who supplied us with their e-mail address were invited to complete a 58-item online questionnaire consisting of multiple choice and open-ended questions. Domains included demographics, provision of written and spoken information, support, infertility risk, research awareness, attitudes toward discharge, and general feedback. Of 120 pynk patients approached, 61 (51%) participated. More than 90% were satisfied or very satisfied with the timing, usefulness, and clarity of spoken and written information given, and 69% found the service and support provided by the nurse navigator to be the most helpful component of the program. Of those who had received systemic therapy, 93% recalled a health care provider initiating a discussion of the risk of treatment-related infertility, and 67% were referred to a fertility clinic. On the negative side, 11%-27% were unaware of various services provided by pynk, and 11% were unaware of pynk's ongoing research. One third of patients were unhappy or ambivalent about the prospect of discharge from the program. Patient satisfaction with this novel program for young women with breast cancer is high. This study highlights the critical role that the nurse navigator plays in patient support and dissemination of information. In contrast to other reported surveys of young cancer patients, pynk patients are routinely given the opportunity to undergo fertility preservation.

Documentation of Fertility Preservation Discussions for Young Adults With Cancer: Examining Compliance With Treatment Guidelines.

Professional guidelines have been developed to promote discussion between providers and newly diagnosed young adults with cancer about the possibility of cancer treatment-related infertility, but previous research suggests many young adults fail to receive this information. The aim of this study was to examine rates of and factors predictive of oncologists' compliance with national guidelines for discussing potential treatment-related infertility with newly diagnosed young adults with cancer seen at an NCI-designated comprehensive cancer center. We reviewed data from the electronic medical record for new clinic encounters between medical oncologists and young adults with cancer (ages 18-39 years) from 2010 to 2012. Data from oncologist discussions of fertility preservation were abstracted, as were patient (age, sex, race, ethnicity, cancer type) and oncologist (gender, graduation year from fellowship) characteristics. A total of 1,018 cases were reviewed, with 454 patients (mean, 31.5 years; 67.8% women) meeting inclusion criteria. Overall, 83% of patients were informed about potential treatment-related infertility, with patients with breast cancer (85% informed), Hodgkin lymphoma (95% informed), non-Hodgkin's lymphoma (94% informed), leukemia (88% informed), or testicular cancer (100% informed) more likely to be informed than those with other cancer types (60%-74% informed). There was a significant effect for patient sex (odds ratio, 3.57; CI, 1.33, 9.60; P=.012), with women being more likely to be informed than men. Reported compliance with fertility preservation guidelines was greater than published rates. Higher compliance rates in female patients and in patients with cancers more common among young adults may reflect greater awareness of fertility-related concerns among these patients and their providers.

Abstract P4-11-13: Cancer-specific distress, life satisfaction and parenting concerns in young breast cancer survivors

Abstract Introduction It is known that young breast cancer (BC) patients tend to suffer more psychological stress and have lower quality of life than older women, are less sexually active and have more body image issues than healthy women of the same age. They may also be challenged by reproductive concerns. To our knowledge, no data exist about the effect of the disease on the life satisfaction of premenopausal BC patients. This study tries to elucidate life satisfaction in several aspects of daily life in this special cohort as well as aspects of cancer-specific distress and parenting concerns in order to improve our support strategies. Materials and methods In a cross-sectional study design, all patients with &amp;lt; 40 years at primary BC diagnosis treated at Breast Center, CCC LMU Munich (Germany) between 2006 and 2013 were eligible for participation. Standardized questionnaires assessing life satisfaction (Life Satisfaction Questionnaire; Fahrenberg et al, 2000) and cancer-specific distress (Questionnaire on Stress in Cancer patients; Herschbach et al, 2003), as well as a self-developed questionnaire on partnership, employment situation, family planning, demographic and medical data were mailed in 2014. Results 88 patients responded (55%). Compared with population data stratified for age and sex, patients showed significantly less satisfaction in the domains of health (p&amp;lt;0.001) and sexuality (p=0.002) but not in any other domains or overall life satisfaction. The patients' most pronounced cancer-specific problems were fear of cancer recurrence and fear of further hospital stays, diminished sexual activity, and psychosomatic problems like nervousness, fatigue and insomnia. Of those patients who retrospectively evaluated their decision for or against fertility preservation, 76.4% were satisfied with their choice. Current desire to have children was reported by 45.8% of patients and another 15.6% were uncertain, but only 21.7% actually planned to have children. The most frequently reported reasons to refrain from childbearing were shortened life expectancy, negative impact of pregnancy on prognosis, and treatment-related infertility. Discussion In our cohort, the general life satisfaction of young breast cancer survivors showed no difference from women without cancer, but these patients were not satisfied with their general health status and with their sexuality. Also, cancer-related fears and psychosomatic problems considerably stress young patients and thus need to be addressed by supportive care programs. There is also a need for counselling regarding childbearing after BC treatment. In contrast, fertility preservation seems to be well established in medical consultations. In conclusion, tailored supportive care programs have to be realized to respond the unique needs of young BC patients. Citation Format: Burgmann M, Hermelink K, Farr A, Heiduschka A, van Meegen F, Engel J, Harbeck N, Wuerstlein R. Cancer-specific distress, life satisfaction and parenting concerns in young breast cancer survivors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-13.

Novel intervention for decision support and distress in female cancer survivors considering fertility preservation.

114 Background: Treatment-related infertility is a source of long-term psychological distress in cancer survivors, particularly among women. Decisions about fertility preservation (FP) are made under conditions of high stress and time pressure, which may contribute to the relatively low uptake of FP among women with cancer. Little is known about the effect of interventions to support the decision-making process and reduce fertility-related distress in cancer survivors considering FP. We describe the design and preliminary data from a randomized trial to determine whether incorporating psychological assessment and intervention into the standard FP consultation enhances satisfaction with decision-making and psychosocial outcomes. Methods: We developed a brief intervention for women referred to our institution’s oncofertility service for consideration of FP. The intervention focuses on values clarification for decision support, identification of unmet psychosocial needs, and mindfulness and acceptance-based skills. Participants were randomized to usual care (consultation with a reproductive endocrinologist and nurse) or the intervention (usual care plus a 1-hour visit with a psychologist and two follow-up calls). Outcomes included feasibility measures and measures of decisional conflict (Decisional Conflict Scale) and satisfaction with the FP program (Client Satisfaction Questionnaire-8). Results: All 14 participants randomized to date have completed baseline and 1-month assessments. The mean age was 32 (SD = 7.5, range 20-44), and the majority were nulliparous (n = 9, 64%). All 7 intervention participants completed at least 1 follow-up call, and 5 (71%) completed both follow-up calls. Across all participants, Decisional Conflict Scale scores decreased from baseline (M = 24.8, SD = 17.2) to 1 month (M = 22.2, SD = 16.3). Overall satisfaction with the program at 1 month was high (M = 29 out of a possible 32). Conclusions: Incorporating a psychological assessment and intervention into a standard FP consultation appears feasible and may improve levels of decisional conflict over time. Women appeared to find the intervention helpful when contemplating FP.

Oncofertility and quality of life among adolescent and young adult survivors of childhood cancer.

222 Background: Although infertility risks due to childhood cancer treatment are well-documented, research on the psychosocial impact of treatment-associated infertility risks among adolescent and young adult (AYA) cancer survivors is limited. This study examined AYA pediatric cancer survivors’ perceptions of oncofertility and cancer treatment-associated infertility risks and associations with patient-reported quality of life (QoL). Methods: Patients ages 12 to 25 (n= 70, M age 19.4, 74% white, 57% female, a majority leukemia/lymphoma survivors) were recruited from a pediatric hematology/oncology clinic and local pediatric cancer survivor support organizations. Patients reported knowledge and beliefs about treatment-related fertility risks and reproductive health, and oncofertility information and support needs, and completed the Pediatric Oncology Quality of Life (QoL) scale. Results: Patients’ knowledge about infertility risks and fertility preservation options was low (M 13.5, SD 8.6, range 0-42): patients’ attitudes indicated treatment-related infertility risks was important (M 21.7, SD 7.0, range 0-40), they perceived they were at-risk for infertility (M 3.8, SD 1.0 range 1-5), and expressed unmet needs for supportive resources on reproductive health (M 13.6, SD 4.8, range 1-24). Greater perceived risks of infertility (r = .34, p = .004) and importance of fertility risks (r = .34, p = .004) were associated with lower QoL. In a multivariable model adjusting for patient age and gender, beliefs that reproductive health was important was associated with lower QoL (B = .68, p = .041). Conclusions: Population data demonstrate few AYA cancer survivors have opportunities to discuss fertility preservation with providers. Our findings indicate AYA cancer survivors perceive treatment-related infertility risks as important, associated with QoL, and with needs for more information about reproductive health and fertility preservation. Care models addressing AYA survivors’ infertility risks are needed as part of the diagnosis, treatment, and long-term follow-up of these patients.

Gonadal function, fertility, and reproductive medicine in childhood and adolescent cancer patients: a national survey of Japanese pediatric endocrinologists.

.An increasing number of pediatric cancer patients survive, and treatment-related infertility represents one of the most important issues for these patients. While official guidelines in Japan recommend long-term follow-up of childhood cancer survivors (CCSs), their gonadal function and fertility have not been clarified. To address this issue, we organized a working panel to compile evidence from long-term survivors who received treatments for cancer during childhood or adolescence. In collaboration with members of the CCS Committee of the Japanese Society for Pediatric Endocrinology (JSPE), we conducted a questionnaire survey regarding reproductive function in pediatric cancer patients. A cross-sectional survey was sent to 178 JSPE-certified councilors who were asked to self-evaluate the medical examinations they had performed. A total of 151 responses were obtained, revealing that 143 endocrinologists were involved in the care of CCSs. A quarter of the respondents reported having experienced issues during gonadal or reproductive examinations. Several survivors did not remember or fully understand the explanation regarding gonadal damage, and faced physical and psychological distress when discussing the risk of becoming infertile. Pediatric endocrinologists had anxieties regarding their patients’ infertility and the risk of miscarriage, premature birth, and delivery problems. Only a limited number of endocrinologists had experience with managing childbirth and fertility preservation. Many councilors mentioned the necessity for inter-disciplinary communication among healthcare providers. Both endocrinologists and oncologists should set and follow a uniform clinical guideline that includes management of fertility of CCSs.

Fertility counseling in cancer patients: A study of patients and physicians.

e17721 Background: In 2008, over 130,000 people in the US under age 45 were diagnosed with cancer. Due to increased survival rates, treatment-related infertility is a growing concern among patients...

Persistent DNA Damage in Spermatogonial Stem Cells After Fractionated Low-Dose Irradiation of Testicular Tissue

Testicular spermatogenesis is extremely sensitive to radiation-induced damage, and even low scattered doses to testis from radiation therapy may pose reproductive risks with potential treatment-related infertility. Radiation-induced DNA double-strand breaks (DSBs) represent the greatest threat to the genomic integrity of spermatogonial stem cells (SSCs), which are essential to maintain spermatogenesis and prevent reproduction failure. During daily low-dose radiation with 100mGy or 10mGy, radiation-induced DSBs were monitored in mouse testis by quantifying 53 binding protein 1 (53BP-1) foci in SSCs within their stem cell niche. The accumulation of DSBs was correlated with proliferation, differentiation, and apoptosis of testicular germ cell populations. Even very low doses of ionizing radiation arrested spermatogenesis, primarily by inducing apoptosis in spermatogonia. Eventual recovery of spermatogenesis depended on the survival of SSCs and their functional ability to proliferate and differentiate to provide adequate numbers of differentiating spermatogonia. Importantly, apoptosis-resistant SSCs resulted in increased 53BP-1 foci levels during, and even several months after, fractionated low-dose radiation, suggesting that surviving SSCs have accumulated an increased load of DNA damage. SSCs revealed elevated levels of DSBs for weeks after radiation, and if these DSBs persist through differentiation to spermatozoa, this may have severe consequences for the genomic integrity of the fertilizing sperm.

Fertility-sparing treatment in female genital cancer and breast cancer

Postponed motherhood is the reason why many women are diagnosed with cancer before they make the decision to conceive a child, but only a small number of the affected patients will receive any information about treatment-related infertility As far as female genital cancer is concerned, cervical cancer continues to be the most frequently diagnosed malignancy in women of childbearing age. In its early stages, it can be treated with surgical procedures which spare the genitals, i.e. surgical conization and vaginal radical trachelectomy with laparoscopic lymphadenectomy The advantages of these procedures have been observed in our experience. Also, a successful conservative 6-month treatment of endometrial cancer limited to the mucous membrane with progestagens following curettage of the uterine cavity has been reported in the literature. This paper also presents our own experience with fertility-sparing surgical treatment of ovarian cancer with borderline malignancy and invasive IA stage. Breast cancer affects over 7% of all cancer patients under the age of 40. Pregnancy after breast cancer treatment has been shown to develop properly and both, pregnancy and breastfeeding have no influence on cancer relapse. Protective shields for the adnexa or relocation of the ovaries should be used during radiotherapy in patients who wish to preserve their fertility In case of chemotherapy application of GnRH analogs has shown promising results in preservation of the ovarian function. Also, the development of new assisted reproductive technology has offered an increasing number of alternatives for young cancer patients who wish to preserve their fertility

Breast cancer, BRCA mutations, and attitudes regarding pregnancy and preimplantation genetic diagnosis.

Women with premenopausal breast cancer may face treatment-related infertility and have a higher likelihood of a BRCA mutation, which may affect their attitudes toward future childbearing. Premenopausal women were invited to participate in a questionnaire study administered before and after BRCA genetic testing. We used the Impact of Event Scale (IES) to evaluate the pre- and post-testing impact of cancer or carrying a BRCA mutation on attitudes toward future childbearing. The likelihood of pursuing prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD) was also assessed in this setting. Univariate analyses determined factors contributing to attitudes toward future childbearing and likelihood of PND or PGD. One hundred forty-eight pretesting and 114 post-testing questionnaires were completed. Women with a personal history of breast cancer had less change in IES than those with no history of breast cancer (p = .003). The 18 BRCA-positive women had a greater change in IES than the BRCA-negative women (p = .005). After testing, 31% and 24% of women would use PND and PGD, respectively. BRCA results did not significantly affect attitudes toward PND/PGD. BRCA results and history of breast cancer affect the psychological impact on future childbearing. Intentions to undergo PND or PGD do not appear to change after disclosure of BRCA results. Additional counseling for patients who have undergone BRCA testing may be warranted to educate patients about available fertility preservation options.

Perception and needs of reproductive specialists with regard to fertility preservation of young breast cancer patients

Treatment-related infertility is one of the important quality-of-life issues in young breast cancer (YBC) patients. Although existing guidelines recommend supporting fertility preservation (FP) of YBC, the perceptions of reproductive specialists (RS) has not been evaluated. We investigated the perceptions and needs of RS with regard to FP of YBC patients. A cross-sectional survey was sent to 423 certified RS registered to the Japan Society for Reproductive Medicine to self-evaluate their perceptions and needs regarding FP in YBC patients. Two hundred RS (47 %) responded to the survey. 99 % responded that RS should be engaged in FP of YBC patients. 88 % responded that they would like to treat YBC patients, while 46 % responded that cancer treatment is more important than childbirth, even when the patient is recurrence-free 5 years after primary treatment. Respondents affiliated to private clinics were more likely to accept both fertilized and unfertilized egg preservation than those affiliated with academic or general hospitals. 70 % responded that they were anxious about treating breast cancer patients: concerns regarding a greater or unknown risk of recurrence (66 %), insufficient knowledge about breast cancer (47 %), and lack of a patient's spouse/partner (24 %) were identified as major barriers in supporting FP for YBC patients. RS recognize the need for FP in YBC patients and are willing to participate in their care. Affiliation of RS was related to a positive attitude to egg preservation. Various concerns regarding FP among RS indicate the need for evidence that supports the safety of FP, inter-disciplinary communication, and practice guidelines.

Maintaining the reproductive potential of cancer patients during cancer treatment.

Cancer therapies are known to alter the reproductive potential in cancer patients. Due to improved survival rates in cancer patients of reproductive age, considerations of the long-term effects of cancer therapy have become more significant. Oncofertility is a new discipline in medicine that deals with maintaining the reproductive potential of cancer patients while they are receiving gonadotoxic cancer treatment. The purpose of this review is to explore how cancer treatment impairs reproductive functioning and present the current options for preservation of fertility in women. All patients with reproductive potential should be made aware of the possible treatment-related infertility and be offered appropriate fertility preservation options before cancer treatment is instituted. The hope is that, in the future, mechanism(s) can be developed to preserve immature germ cells in the ovary, so that they can be used for fertilization in vivo or in vitro.