What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

Jones, Georgina; Hughes, Jane; Mahmoodi, Neda; Smith, Ellie; Skull, Jonathan; Ledger, William

doi:10.1093/humupd/dmx009

Cited by 101 publications

(86 citation statements)

References 74 publications

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“…This aspect is obviously of great importance concerning cancer treatment, but it may be even more important for the patient. Studies have found that one of the biggest concerns for patients with malignant diseases is the time from cancer diagnosis to the initiation of treatment, as well as the concern for FP . Hence, minimizing the interval between FP‐referral and FP is not merely a matter of treatment demand, but also of great value to the psychological well‐being of the patients who are juggling thoughts of survival and the wish for future motherhood.…”

Section: Discussionmentioning

confidence: 99%

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Kristensen¹,

Pors²,

Poulsen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Young women with a cancer diagnosis often have very little time to decide whether or not to commence fertility‐preserving strategies before initiating potentially sterilizing cancer treatment. Minimizing the interval from opting for fertility preservation to completion of the procedure will reduce the potential risk of delaying cancer treatment. In the current study, we have evaluated the period of time from referral to ovarian tissue cryopreservation (OTC) to actual freezing of the tissue in a cohort of Danish women. Material and methods The study population comprised 277 consecutive patients with both malignant and nonmalignant diseases referred for OTC from four centers in the Danish network. Statistical analysis was conducted to analyze the impact of age, diagnosis, and referring center on the time from OTC‐referral to OTC. A literature search for “random start” protocols for controlled ovarian stimulation (COS) for fertility preservation in cancer patients was performed. Results The time from OTC‐referral to OTC was significantly influenced by diagnosis, age, and referring center. Women with malignant diseases other than breast cancer, such as sarcomas, pelvic cancers, and hematological cancers, experienced a significantly shorter interval to OTC (5 days) than women with breast cancer (7 days) and nonmalignant diseases including systemic, ovarian, and hereditary conditions (13‐17.5 days). Women over the age of 30 years experienced a significantly longer time to OTC (P < 0.03), and the diagnosis determined the length of the interval (P < 0.001). According to the literature, fertility preservation by oocyte vitrification requires 13‐14 days, as the average time for 1 round of COS was 11 days and oocyte collection can be performed 2 days later. Conclusions It is in the interest of both cancer patients and clinicians to perform fertility preservation as quickly and safely as possible. In a Danish setting, OTC provides a short interval of around 6 days from the patient choosing this option to completion of the procedure. This is considerably less time than what is needed to perform COS and oocyte vitrification, and therefore OTC might be considered the preferred choice of fertility preservation when urgency is needed.

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Section: Discussionmentioning

confidence: 99%

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Kristensen¹,

Pors²,

Poulsen

et al. 2019

Acta Obstet Gynecol Scand

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“…As healthcare has shifted over recent decades from a paternalistic approach to a shared decision‐making approach, tools are being developed to aid patients and their families when deciding upon options. In young adult survivors, studies have shown that fertility ranks highly among patients’ concerns, and adolescents have a strong desire to participate in decisions related to their cancer and treatment . This must be taken into account by clinicians when discussing future reproductive health with children and young adults at the time of diagnosis of cancer and at later stages in their cancer journey including through adult survivorship.…”

Section: Fertility Preservationmentioning

confidence: 99%

Survival from cancer in young people: An overview of late effects focusing on reproductive health

Newton

Friend

Feltbower

et al. 2019

Acta Obstet Gynecol Scand

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This paper provides a summary of the areas of survival from childhood, teenage and young adult cancers and the significant late effects that can arise from treatment; with particular focus on the area of reproductive health and the impact on both fertility and pregnancy. To complete this review, Web of Science and MEDLINE were used. Search terms included: “"survival AND childhood OR teenage OR young adult cancer", "late effects", "childhood cancer", "teenage AND/OR young adult cancer", AND "fertility after cancer" OR "pregnancy AND cancer" OR "fertility preservation”. Additionally, the clinical expertise of the authors was drawn upon. Childhood cancer is a thankfully rare occurrence; however, the incidence is increasing. Survival rates remain high and this means that a growing population of childhood and young adult cancer survivors are reaching adulthood. For some of these adults, although cured of their cancer, they are now facing a future with lasting effects on their health from their treatments. These effects, commonly referred to as late effects, are defined as health problems related either directly to the underlying cancer or to its treatment and which occur months or years after treatment has finished. Reproductive health is an important consideration for these patients, and although many will be able to conceive naturally, some will exhibit impaired fertility after their treatments. This can include difficulties at all points along the path from conception to delivery of a live, healthy offspring. High‐quality, large‐population evidence is sparse in many areas relating to fertility risk from treatment and the maternal and fetal health of childhood cancer survivors. Yet given the potential for complications, the authors advocate consideration of fertility at the time of diagnosis and before potentially gonadotoxic treatment.

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“…Fertility counseling is more often received by women who are younger, have lower parity, a higher educational level, higher income, non‐Hispanic white ethnicity, and insurance coverage . Among women who do receive counseling, lower use of fertility preservation has been associated with concerns about cost, treatment delay, and/or an adverse impact on their cancer treatment . In prior studies of reproductive‐age women diagnosed with cancer who wanted to retain their fertility, approximately 40% to 50% of women did not use fertility preservation …”

Section: Introductionmentioning

confidence: 99%

Fertility‐related experiences after breast cancer diagnosis in the Sister and Two Sister Studies

Bressler

Mersereau

Anderson

et al. 2019

Cancer

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Background Commonly used chemotherapies can be toxic to the ovaries. To the authors’ knowledge, the majority of studies evaluating receipt of fertility counseling for women in their reproductive years have been performed in specific settings, thereby limiting generalizability. Methods A nationwide sample of US women diagnosed with breast cancer before age 45 years completed a survey assessing the prevalence of fertility counseling. Age‐adjusted log‐binomial regression was used to estimate prevalence ratios (PRs) and 95% CIs for fertility counseling. Results Among 432 survivors diagnosed between 2004 and 2011, 288 (67%) had not discussed the effects of treatment on fertility with a health care provider before or during treatment. Fertility discussion was associated with younger age (PR, 3.49 [95% CI, 2.66‐4.58] for aged <35 years vs ≥40 years) and lower parity (PR, 1.81 [95% CI, 1.29‐2.53] for parity 1 vs 2). Approximately 20% of respondents reported that they were interested in future fertility (87 of 432 respondents) at the time of their diagnosis, but not all of these individuals (66 of 87 respondents) received counseling regarding the impact of treatment on their fertility, and few (8 of 87 respondents) used fertility preservation strategies. Among 68 women with a fertility interest who provided reasons for not taking steps to preserve fertility, reasons cited included concern for an adverse impact on cancer treatment (56%), lack of knowledge (26%), decision to not have a child (24%), and cost (18%). Conclusions Across multiple treatment settings, the majority of women of reproductive age who are diagnosed with breast cancer did not discuss fertility with a health care provider or use fertility preservation strategies. Discussing the potential impact of cancer treatment on future fertility is an important aspect of patient education.

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What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

Cited by 101 publications

References 74 publications

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Time from referral to ovarian tissue cryopreservation in a cohort of Danish women

Survival from cancer in young people: An overview of late effects focusing on reproductive health

Fertility‐related experiences after breast cancer diagnosis in the Sister and Two Sister Studies

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