A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services

Abstract

Purpose: The American Society of Clinical Oncology issued practice guidelines in 2006 to provide critical information about fertility impact to adolescents and young adults (AYA) at the time of cancer diagnosis. Survivors continue to express concerns about their long-term reproductive health after cancer therapy even as treatment options for fertility preservation evolve. An underutilization of fertility preservation methods by cancer patients continues to persist. A review of the literature cites barriers and challenges that limit fertility information and preservation options for AYA cancer patients. Methods: A review of medical literature was conducted to examine current practice for patients receiving fertility information and the barriers to patients receiving fertility preservation services. Results: A total of 69 publications were included in this review. The review summarizes (1) patient experiences with receiving fertility information and (2) patient desires, barriers, and challenges to utilizing fertility preservation services. Conclusions: Despite advances in fertility preservation, there are challenges for patients to utilizing fertility preservation services. Barriers include the following: urgency to initiate treatment, inadequate information, clinic time constraints, and perceptions around patients' gender, age, cost, parity, race, relationship, and sociodemographic status influence whether patients receive fertility preservation consultation. Patients report a lack of adequate information to make informed fertility decisions.

Challenges in fertility preservation among male adolescent and young adult cancer survivors

“…This study highlights the discrepancy that exists between fertility desires and utilization of FP among AYA cancer survivors. Fertility has consistently been identified as an important concern for AYA cancer survivors, and the negative psychosocial outcomes of infertility are well documented . Unfortunately, routine FP care is frequently suboptimal among these individuals.…”

“…Clinicians may perceive patients as too immature, or uncomfortable with such discussions, and have been found to modify their counseling based on the patient's age, gender, religion, culture, and marital status . Despite these perceived concerns, research indicates that young patients appreciate when issues of fertility and sexual function are addressed, even those with no desire for future children . However, AYA are unlikely to initiate these conversations and clinicians must be proactive in their fertility discussions.…”

“…7Numerous barriers to FP have been identified by oncology patients, parents, and providers, including limited education, clinical constraints, difficulty accessing resources, perceived high cost, sensitivity of the topic, and focus on short-term treatment and survival. 4,5,8 Patients and clinicians alike may be deterred from FP by the fear that it will delay prompt initiation of treatment, a concern that is most relevant among female patients who have to undergo ovarian stimulation.Financial considerations are also a significant factor for patients who are considering FP. Sperm processing, cryopreservation, and storage fees can be costly, and are inconsistently covered by insurance.…”

“…5,8,9 Despite these perceived concerns, research indicates that young patients appreciate when issues of fertility and sexual function are addressed, even those with no desire for future children. 4,8 However, AYA are unlikely to initiate these conversations and clinicians must be proactive in their fertility discussions. Additionally, patients and their families should be educated about all options for sperm collection in addition to traditional sperm banking, including electroejaculation, testicular sperm extraction, and penile vibratory stimulation.…”

Disparities in Rectal Cancer: Moving from Descriptions to Solutions

“…For instance, fertility and body image concerns may be particularly important for the AYA population. 7,8 Educating physicians about fertility preservation options or educating surgeons on how to approach AYAs about life with an ostomy after rectal cancer surgery are viable solutions. These patient-physician communication skills should be instilled during medical school, reinforced during residency training, and maintained during our professional careers.…”