Many Young Cancer Patients Not Well Aware of Fertility Preservation Options

Margaret Shnorhavorian, MD, MPH, FAAP, FACS

Margaret Shnorhavorian, MD, MPH, FAAP, FACS

Although it is important for clinicians and their patients who are receiving anticancer treatment to discuss patients’ fertility preservation options, a new study has found that whether these conversations take place and, importantly, whether ensuing action is taken, depends on a number of factors, among them, the patient’s gender, race/ethnicity, education, insurance, and childrearing status.

Little is known about the extent to which fertility discussions occur or about the patient characteristics associated with them, despite the deleterious effect cancer therapy may have on the future fertility of adolescent and young adult survivors.

To learn more about current practice, Margaret Shnorhavorian, MD, MPH, FAAP, FACS, of the University of Washington, Seattle Children’s Hospital, and colleagues conducted a population-based study involving 459 adolescent and young adult patients who were aged 15 to 39 when diagnosed with germ cell tumor, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia, or sarcoma between July 1, 2007, and October 31, 2008.

Eligible patients lived in one of seven geographically defined US regions in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. Participants completed a baseline questionnaire 6 to 14 months after their diagnosis and a follow-up survey after that (15 to 35 months after diagnosis). Medical record data were abstracted for all 459 patients.

Among the questions posed to ascertain receipt of appropriate counseling were:

• Have you ever been told that your cancer treatment may affect your fertility?
• Did a healthcare professional involved in your cancer care talk with you about option to preserve your fertility (eg, sperm banking or freezing of eggs, embyros or ovarian tissue) before you stated cancer treatment?
• Did you make arrangements for any time of fertility preservation?

Researchers identified several areas of concern. Overall, patients without insurance and patients already raising children younger than 18 years were more likely not to receive counseling regarding fertility preservation from providers than those who had no children.

Among men, patients receiving treatment that posed little or no fertility risk were also less likely to discuss fertility preservation. When it came to actually taking action, men without a college degree, men raising children younger than 18 years, and those lacking private insurance were all more likely to not make fertility preservation arrangements.

Approximately 75% of women in the study indicated they had been informed of the possible impact of their cancer treatment on fertility, but women were less than half as likely as men to report that fertility preservation options were discussed. Hispanic or non-Hispanic black women who had less than a college degree and had government insurance plan were not as likely to be advised that their cancer treatment may impact their fertility.

Further, the authors wrote that, “most striking, nearly one-third of males reported making arrangements for fertility preservation, a rate that was 4 to 5 times higher than that for females.”

“The access and health-related reasons for not making arrangements for fertility preservation reported by participants in this study further highlight the need for decreased cost, improved insurance coverage, and partnerships between cancer healthcare providers and fertility experts to develop strategies that increase awareness of fertility preservation options and decrease delays in cancer therapy as fertility preservation for adolescent and young adult cancer patients improves,” said Shnorhavorian in a statement.

Shnorhavorian M, Harlan LC, Wilder Smith A, et al. Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: a population-based study [published online July 27, 2015]. Cancer.