Oncofertility in Canada: An Overview of Canadian Practice and Suggested Action Plan

Abstract

Background: Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, these fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. Methods: Here, we describe the services currently available in Canada and the challenges associated with their utilization. Finally, we outline strategies to help maximize and facilitate fertility preservation in the young cancer patient. Results: Despite an existing infrastructure to the oncofertility system in Canada, the ability of that system’s components to function together and to coordinate patient care is a challenge. Areas of weakness include poor access and referral to fertility services, a lack of readily available education for patients and health care providers, and inconsistent interdisciplinary coordination in patient care. Conclusions: The implementation of a framework for multidisciplinary resource allocation, education, patient referral, and established lines of communication may facilitate a functional oncofertility system in Canada.

Fertility preservation in cancer patients: The global framework

“…Fertility centres in Canada are enthusiastic about working together with other healthcare providers to offer fertility preservation services for cancer patients [48]. However, despite all required components are present in the Canadian system, their coordinated functioning remains challenging [52].…”

Systematic Review of Available Guidelines on Fertility Preservation of Young Patients with Breast Cancer

“…countries for a simple reason that a young age at diagnosis reserve enough in future reproductive time ( Ronn and Holzer, 2013;Reinecke, 2013). It is estimated that even at the best and most favorable scenario, undergoing antihormonal treatment alone can delay pregnancy for at least 5 years.…”

“…It needs the simultaneous functions of many components, which is a challenge. Many studies have shown that the most important weak points are poor access and referral to fertility services, low level of knowledge, and lack of available education for patients and health care providers (Forman et al, 2010;Klemp and Kim, 2012;King et al, 2012;Ronn and Holzer, 2013;Peate et al, 2013;. Fertility preservation in breast cancer patients is even more complicated in underdeveloped countries with unsatisfactory health care infrastructure.…”

“…Fertility preservation options have also been used for other diseases such as lupus, glomerulonephritis, myelodysplasia, and premature ovarian failure as well as in women who wish to preserve their ovarian function for future reproductive potential and delayed childbearing age (Posada et al, 2001;Imhof et al, 2004;Demeestere et al, 2007;Maltaris et al, 2007;Isachenko et al, 2007;Ajala et al, 2010;Rahimi et al, 2010;Dolmans et al, 2010;Michaeli et al, 2012;Husseinzadeh, 2013). Despite rapid progress in cryopreservation technology and existing other resources and infrastructure, fertility preservation for young breast cancer patients is in its early stage with many challenges (Posada et al, 2001;Imhof et al, 2004; National Collaborating Center for Women's and Children's Health (UK), 2004; Sonmezer and Oktay, 2004;Lee et al, 2006;Demeestere et al, 2007;Isachenko et al, 2007;Maltaris et al, 2007;Ajala et al, 2010;Dolmans et al, 2010;Ewertz and Jensen, 2010;Rahimi et al, 2010;Christinat and Pagani, 2012;Klemp and Kim, 2012;King et al, 2012;Michaeli et al, 2012;Klemp and Kim, 2012;King et al, 2012;Fields et al, 2013;Husseinzadeh, 2013;Husseinzadeh and Husseinzadeh, 2013;Leclere et al, 2013;Loren et al, 2013;Ronn and Holzer, 2013). The present study aimed to systematically review available guidelines on preservation of fertility in breast cancer patients.…”

Fertility Preservation in Reproductive-Age Women Facing Gonadotoxic Treatments

“…Any benefit of transposition can be lost when adjuvant chemotherapy is used 155,156 . Other fertility-sparing surgical options include cervical conization or trachelectomy for select early-stage cervical cancer patients, and unilateral oophorectomy or cystectomy in select ovarian neoplasms 157,158 .…”