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 Out of 459 adolescents and young adults diagnosed with cancer in
2007 or 2008, more than 70 percent said doctors had explained their
risk of infertility. But less than 33 percent of men and less than
10 percent of women said they made arrangements for fertility
preservation.
Patients who already had children were also less likely to explore
fertility preservation than those who didn’t have children, the
study found.
Some patients may have thought fertility preservation would delay
treatment. Women, for example, might have to wait for the right time
in their menstrual cycle to harvest their eggs, said lead study
author Dr. Margarett Shnorhavorian, a researcher and pediatric
urologist at Seattle Children's Hospital and Research Institute.
“All patients – not just those without children – should have
discussions about fertility preservation,” she said by email.
While fertility care continues to evolve, the standard options for
teens and young adults are sperm banking for men and egg or embryo
banking for women. Younger children have fewer options because they
don’t produce sperm or eggs before puberty, but sometimes the
testicles or ovaries can be shielded during radiation.
To see how well cancer patients understood their fertility options,
Shnorhavorian and colleagues had them answer detailed
questionnaires.
Most participants were white, male, and covered by private health
insurance. Most were at least 21 when their cancer was diagnosed and
were not raising young children of their own.
Eighty percent of men were told they might become infertile, 71
percent discussed options to address the problem, and 31 percent
made preservation arrangements.
Nonwhite men were less likely to discuss their options, as were
participants who lacked insurance and those who already had
children.
Seventy-four percent of women said they were advised that therapy
could affect their fertility, but only 34 percent had discussed
preservation options. And just 6.8 percent made arrangements to
preserve their fertility.
Among the women who explained why they didn’t pursue this option,
many cited a lack of awareness or access to affordable options,
while 38 percent raised concerns that this might delay treatment.
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The relatively small size of the study made it impossible to draw
broader conclusions about women who did make fertility preservation
arrangements, the researchers acknowledge in the journal Cancer.
The study was done soon after the American Society of Clinical
Oncology (ASCO) recommended in 2006 that oncologists discuss
infertility risks with reproductive-age patients, the researchers
note.
“There is absolutely greater awareness today,” said Dr. Kutluk
Oktay, the senior author of the ASCO guidelines and the founder and
director of the Innovation Institute for Fertility Preservation in
New York.
It’s not surprising that young cancer patients and their parents may
be reluctant to raise questions about fertility, Oktay said by
email.
They “are under so much psychological and financial pressure that
they naturally try to avoid opening up a new front,” Oktay said.
Doctors need to bring up fertility issues, rather than waiting to be
asked, he added.
Advances in egg freezing and other fertility options for women may
also help narrow the gender gap seen in the study, noted Dr. Jani
Jensen, co-director of the in vitro fertilization program at the
Mayo Clinic in Rochester, Minnesota.
Because eggs need to mature before they can be collected and frozen,
the process for women typically takes 10 to 14 days, compared with a
single day for men, said Jensen, who wasn't involved in the study.
"It's not surprising, but it is disappointing, that many patients
who could benefit from fertility preservation aren't hearing the
message," she said.
"Fertility and childbearing become hugely important for many
patients during survivorship," Jensen added.
SOURCE: http://bit.ly/1S93FJg Cancer, online July 27, 2015.
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