Young Cancer Survivors Lack Information on Fertility Issues and Options

Young adult female cancer survivors have unmet informational needs and decisional conflict regarding posttreatment fertility preservation (FP), according to results of a new study. The results suggest survivorship care has gaps with regard to reproductive health counseling.

“The gonadotoxic effects of many cancer treatments are well established, and providers are increasingly addressing fertility issues with their patients,” wrote study authors led by Catherine Benedict, PhD, of the North Shore-Long Island Jewish Medical Center in Manhasset, New York. “However, the majority of women do not pursue FP before treatment, despite wanting biological children in the future.” This is due to a variety of issues, including lack of awareness of risk or FP options, time pressures or emotional distress, and others.

The authors noted that fertility information is among the most cited unmet needs among young adult survivors of cancer. To better understand the gaps in information and related issues, the researchers conducted a cross-sectional Internet-based survey, with 346 total respondents; for the main analysis they focused on 179 women who had uncertain fertility status, had not undergone or attempted FP, and either wanted children in the future or were unsure. The results were published in Cancer.

Most of the women (58%) reported that they did not have enough information concerning their risk of infertility. Similarly, most said they did not have enough information about the risk of early menopause (60%) and about options to preserve their fertility (51%), and many said they didn’t know enough about options for alternative family planning (43%).

The greatest reproductive concerns related to future fertility issues and health of future children. Most respondents (64%) were concerned about an inability to have children in the future, and 41% said it was stressful to think about getting pregnant. Furthermore, 59% of women said they were concerned about passing on a genetic risk for cancer.

Regarding FP options, only 13% of the respondents said they were fully informed on the topic; 70% said they did not have enough advice on FP, and 35% said they did not have enough support to make a decision.

On a bivariate analysis, greater decisional conflict was significantly associated with having greater unmet informational needs (r = 0.47; P < .001), as well as with reproductive concerns (r = 0.26; P = .001). The relationship between unmet informational needs and decisional conflict remained significant after adjustment for current age, age at treatment completion, income, and other factors.

“For those who hope to have children in the future, failure to provide information and address concerns with respect to fertility-related decisions may have lasting consequences for their future family-building options,” the authors wrote. “There is a critical need to develop resources both for survivors and for the use of clinicians in supporting patients in making informed, values-based decisions about their reproductive options.”