Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors

Abstract

BACKGROUND: Fertility counseling before cancer treatment has been advocated by clinical guidelines, though little is known about its long-term impact on the unique reproductive concerns of female adolescent and young adult (AYA) cancer survivors. The goal of this study was to measure the association between fertility counseling by fertility specialists before cancer treatment and subsequent reproductive concerns. METHOD: A cross-sectional analysis was performed among 747 AYA survivors aged 18-40 years who had been recruited from cancer registries and physician and advocacy group referrals between 2015 and 2017. Participants self-reported information on past fertility counseling at cancer diagnosis, cancer type and treatment, and current reproductive concerns, as measured using the multidimensional Reproductive Concerns After Cancer scale. Multivariable log-binomial regression models tested associations between fertility counseling and reproductive concerns. RESULTS: The mean age of the cohort was 33.0 years (standard deviation, 5.1 years), and the mean period since diagnosis was 7.7 years (standard deviation, 5.0 years). Seventy-three percent of participants were white, and 24% were Hispanic. Fertility counseling was reported by 19% of survivors; moderate to high overall reproductive concerns were reported by 44% of participants. In adjusted analysis, fertility counseling was significantly associated with moderate to high reproductive concerns (risk ratio, 1.22; 95% confidence interval, 1.02-1.45) and not modified by exposure to fertility-threatening treatments (P interaction = .23). CONCLUSION: A large proportion of AYA cancer survivors across cancer types and treatment exposures reported moderate to high reproductive concerns, suggesting that there is a need to address these cancer-specific reproductive health concerns after treatment. Higher concerns, even with counseling, suggests the need to improve the quality of fertility counseling throughout the cancer continuum. Cancer 2019;125:980-989.

A prospective study of women and girls undergoing fertility preservation due to oncologic and non‐oncologic indications in Sweden–Trends in patients’ choices and benefit of the chosen methods after long‐term follow up

“…Although FP counseling to individuals facing infertility risks due to cancer treatment has been clearly advocated for over a decade, young patients still report FP as one of the top five unmet needs during their cancer care . Moreover, women obtain more seldom information than men do .…”

“…Although FP counseling to individuals facing infertility risks due to cancer treatment has been clearly advocated for over a decade, 34 young patients still report FP as one of the top five unmet needs during their cancer care. 35,36 Moreover, women obtain more seldom information than men do. 37 Barriers for information provision and access to FP have been acknowledged, in particular low confidence in knowledge from practicing oncologists, 38 Our study is not without limitations.…”

Sexual Dysfunction and Reproductive Concerns in Young Men Diagnosed With Testicular Cancer: An Observational Study

“…18,19 However, recent results in young women with cancer have shown similar results with higher levels of reproductive concerns among those who had used fertility preservation. 41 The authors suggested that these findings could be explained by the increased information about the adverse treatment effects on reproductive potential that this group of women may have received. Although such an explanation could apply also to male patients, previous results have suggested that men perceive sperm banking to be performed in haste and not always after discussion and patient involvement in decision-making.…”

The desire for children among adult survivors of childhood cancer: Psychometric evaluation of a cancer‐specific questionnaire and relations with sociodemographic and psychological characteristics

“…Unfortunately, the uncertainty regarding the accuracy of participants' illness‐related worries mirrors their lived experience: It has been noted that cancer survivors' assumptions regarding their fertility as well as potential health risks are based on subjective beliefs rather than medical tests and might be overstated . Participants in our study gave reasons why they did not wish to undergo fertility testing, eg, to avoid assignments of blame.…”