More Oncologists Must Address Fertility Issues

More Oncologists Must Address Fertility Issues

Approximately 30% to 80% of individuals treated for cancer are at risk for infertility. However, a national survey indicated that few oncologists adequately address fertility issues with discussion, referrals to reproductive specialists, and provision of educational materials (Abstract 9508).

“The loss of fertility is an immense concern to many individuals with cancer, and studies have shown that most patients will not raise the issue themselves,” said Gwendolyn P. Quinn, PhD, MPH, of the H. Lee Moffitt Cancer Center and Research Institute, who presented the study findings during the Patient and Survivor Care Oral Abstract Session yesterday. “Oncologists have a responsibility to discuss the risks of treatment and to refer patients to specialists who can discuss options.”

Dr. Quinn and colleagues developed a questionnaire with domains of knowledge, attitudes/perceptions, barriers, and practice patterns related to fertility issues. The survey was designed to determine how many oncologists were following the “American Society of Clinical Oncology Recommendations on Fertility Preservation in People Treated for Cancer,” which is available on ASCO.org. These recommendations state that oncologists should address the risks of infertility with patients who are treated during their reproductive years.

Although 77% of the 613 respondents said that they “always/often” addressed fertility issues with their patients of childbearing age, Dr. Quinn said such discussions varied widely, from a brief mention of risks to an in-depth discussion. A favorable attitude (high score in the attitude domain) was the greatest factor related to discussion of the topic; oncologists who had a favorable attitude were 4.9 times more likely to discuss the topic. Oncologists who had high scores in the knowledge domain were 2.6 times more likely to discuss risks and options for preservation.

Other important findings of the survey were that 24% “rarely/never” referred patients to reproductive specialists and 60% “rarely/never” provided educational materials. Nearly 38% were not familiar with the ASCO recommendations and of those who were familiar, only 22% referred to them regularly.

Among the respondents’ most frequently mentioned barriers to addressing fertility preservation were time constraints and the cost of preservation procedures. The greatest barrier was the belief that the patient was too ill to delay treatment to pursue fertility options.

“Oncologists should avoid preconceived ideas that fertility is not an issue because the patient is too sick, may not live, or already has children,” said Dr. Quinn. “Not having a discussion or arranging a referral eliminates important options for patients.” She suggested Fertile Hope© (www.fertilehope.org) as a resource for patients. A calculator on the site can help both patients and their oncologists determine the risk of infertility according to treatment.

“This is an eye-opening study in terms of identifying the priority and utilization of fertility preservation during cancer care,” said Kutluk Oktay, MD, FACOG, of the New York Medical College-Center for Human Reproduction, who discussed the studies on fertility issues. Dr. Oktay, who served as co-Chair of the ASCO Fertility Preservation Guidelines Committee, added, “We have to do something about this lack of knowledge. We have to be more proactive in getting the message to our colleagues.”