Background Many young adult female cancer survivors (YAFCS) are at risk for premature menopause. This study characterized YAFCS’ post-treatment fertility information needs, reproductive concerns, and decisional conflict about future options for post-treatment fertility preservation (FP). Methods Participants completed a web-based, anonymous survey between February and March 2015. The survey included investigator-designed questions of perceived information needs, the Reproductive Concerns after Cancer Scale (RCACS), and the Decisional Conflict Scale (DCS). Analyses included Pearson’s correlations, t-tests, and multiple regression. Results Participants (N=346) averaged 29.9 years old (SD=4.1) and were 4.9 years post-treatment (SD=5.4; range, 0-27). Main analyses focused on a subgroup of YAFCS with uncertain fertility status who had not previously undergone/attempted FP and either wanted future children or were unsure (n=179). Across fertility information topics, 43-62% reported unmet information needs. The greatest reproductive concerns related to fertility potential and health of future offspring. The regression model controlled for a priori covariates including current age, age at treatment completion, income, relationship status, nulliparity, and prior fertility evaluation. Greater unmet information needs related to greater decisional conflict (β=0.43, p<.001); greater reproductive concerns were associated at the trend level (β=0.14, p=.08; F[8,118]=6.42, p<.001). Conclusions YAFCS with limited awareness or knowledge of their risk for premature menopause and FP options report higher levels of decisional conflict about future FP. Post-treatment survivorship care should include comprehensive reproductive health counseling, including post-treatment FP options and family-building alternatives.

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Children, adolescent and young adult (CAYA) males with cancer are at an increased risk for infertility, if their treatment adversely impacts reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of fertility preserving interventions. The PanCareLIFE consortium in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) reviewed the current literature and developed a clinical practice guideline (CPG) for fertility preservation in male CAYA cancer patients diagnosed before age 25 years, including guidance on risk assessment and available fertility preservation methods. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to grade the evidence and recommendations. Recognizing the need for global consensus, this CPG used existing evidence and international expertise to develop transparent, easy-touse and rigorously-developed recommendations that can facilitate the care of CAYA males with cancer at risk of fertility impairment and enhance their quality of life.

Improved survival rates among reproductive‐age females diagnosed with cancer have increased the focus on long‐term quality of life, including maintenance of the ability to conceive biological children. Cancer‐directed therapies such as high‐dose alkylating agents and radiation to the pelvis, which deplete ovarian reserve, radiation to the brain, which affects the hypothalamic‐pituitary‐gonadal axis, and surgical resection of reproductive structures can decrease the likelihood of having biological children. Standard fertility preservation strategies such as embryo and oocyte cryopreservation before the onset of therapy offer the opportunity to conserve fertility, but they may not be feasible because of the urgency to start cancer therapy, financial limitations, and a lack of access to reproductive endocrinologists. Ovarian tissue freezing is considered experimental, with limited data related to pregnancies, but it minimizes treatment delay. Studies evaluating gonadotropin‐releasing hormone analogues have had mixed results, although a recent randomized, prospective study in women with breast cancer demonstrated a protective effect. Fertility preservation programs are increasingly being developed within cancer programs. In this article, we describe risks to infertility and options for preservation, raise psychosocial and ethical issues, and propose elements for establishing an effective fertility preservation program. Cancer 2015;121:1532–1539. © 2015 American Cancer Society.

These preliminary findings suggest that unaddressed fertility information needs, concerns, and decision distress may affect general QOL among post-treatment YAFCS who hope to have children in the future. Future work should identify ways to optimally incorporate fertility counseling and support resources into survivorship care programs, including referrals to reproductive specialists as appropriate.