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Fertility issues: unlocking new options for people with cancer

Cancer treatment often causes infertility, but a pre-planning intervention can ease the transition into the overlooked conversation on fertility preservation

Cancer treatment often causes infertility, but a pre-planning intervention can ease the transition into the overlooked conversation on fertility preservation


Picture: SPL

Cancer survival rates have doubled in the UK in the past 40 years, resulting in 50% of people with cancer living ten years after diagnosis. A significant quality of life issue for survivors is the preservation of fertility to fulfil hopes of having a biological child of their own.

Cancer treatment, by its nature, often leads to infertility from injury to the hypothalamic-pituitary-gonadal-axis, damage or surgical resection of reproductive organs and administration of gonadotoxic therapies, such as chemotherapy or radiotherapy.

Preserve biological parenthood

Suitable pre-treatment planning and intervention can preserve biological parenthood for many children, adolescents, and adults diagnosed with cancer.

Vast improvements in fertility preservation have unlocked new options for many who would have been rendered sterile in the past.

Pre-treatment counselling on fertility preservation if left to our physician partners alone occurs in only 26% of cases.

In a cutting-edge response to this gap in care, the American Society of Clinical Oncology extended responsibility for discussion and referral about fertility beyond physicians to include nurses and other allied health professionals.

Missing the opportunity to present fertility options, at any age, is a disservice to oncology patients. A simple method of who, where, when, and how (which we've coined as W3H) can ease transitions into the often-overlooked conversation on fertility preservation.

W3H method

Who?

Any member of the healthcare team can initiate the discussion on fertility preservation methods with families of children, adolescents, and adults of reproductive age. Nurses as the primary advocate for complete patient care can quickly take this on.

When?

Discussion on fertility preservation ideally occurs shortly after diagnosis yet before initiation of therapy. The optimal time frame for this discussion is short, especially for women and children, as procedures for preservation take time and may delay time-sensitive treatment recommendations.

Where?

At any appointment in a quiet, respectful area where time can be afforded to have this discussion. Rushing through this conversation and tossing pamphlets at already stressed individuals and families will only increase a feeling of discomfort and awkwardness around this sensitive topic.

Remember, it is better to fumble through this critical topic earlier on in the process than to find out after treatment has started that fertility preservation options are no longer available.

How?

  • Review the patient’s records for previous notes or discussions around fertility and/or referrals to endocrine or fertility specialists. If these are lacking, take the initiative to start the conversation.
  • Before entering the room, gather all the information on options that are available for fertility preservation in your area, ensuring it is relevant to gender and age.
  • Tailor your proposal to the individual patient and/or family.
  • Ease into the discussion with a simple question on fertility, such as: ‘Has anyone discussed with you the possibility of you or your child not being able to have children when cancer treatment is complete?’
  • Take your queues to continue from the individual or the family members’ response.
  • Impart that you are willing to discuss options and be ready to provide them with written information to assist in their decision-making process. The consent process for fertility preservation can be complicated and cumbersome so all nurses need to familiarise themselves with the paperwork to assist in the completion of this time-consuming task.
  • Lastly, document your conversation and outcome. Nurses remain uniquely positioned to help normalise discussions on fertility preservation with oncology patients. 

 


References

McCray D, Simpson A, Flyckt R et al (2016) Fertility in women of reproductive age after breast cancer treatment: practice patterns and outcomes. Annals of Surgical Oncology. 23, 10, 3175-3178.

Keim-Malpass J, Fitzhugh H, Smith L et al (2017) What is the role of the oncology nurse in fertility preservation counseling and education for young patients? Journal of Cancer Education. doi:10.1007/s13187-017-1247-y


About the authors

Laurie Freeman is an assistant professor at the University of Windsor in Windsor ON, Canada

 

 

Brittany Postma, who also contributed to this article, is a graduate assistant at University of Windsor in Windsor ON, Canada

 

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