Patients With Fertility Concerns May Face Barriers to Fertility Preservation

Researchers analyzed data from 419 patients in the prospective Young and Strong study (https://www.clinicaltrials.gov/study/NCT01647607?term=NCT01647607), conducted during 2012–2013, which tested a fertility education intervention for women with breast cancer aged 22–45. The researchers associated patients’ concerns about fertility with their use of fertility preservation and treatment decisions, defining the concerned cohort as any participant who reported being “a little,” “somewhat,” or “very” concerned about fertility. Researchers also measured uptake of fertility preservation and sociodemographic information (age, ethnicity, education, marital status, employment, and income).

Approximately 32% (n = 133) of participants reported that they had concerns about fertility at the time of treatment decision. They tended to be younger, with a median age of 35 years, compared to 40 years among all participants. Of the concerned cohort, 20% (27) pursued fertility preservation.

“Decision-making about treatments was reported as affected by fertility concerns to some degree in almost half (47%) of the patients with concerns and 14% of those without concerns,” researchers said. Some of the patients’ specific concerns included a pregnancy increasing their risk of recurrence, caring for a child during a recurrence, and a child having increased risk of cancer.

Researchers attributed the lack of uptake to barriers such as cost and location and emphasized the importance of patient education on fertility. In a new joint position statement, ONS, the Association of Pediatric Hematology/Oncology Nurses (APHON), and the Canadian Association of Nurses in Oncology/Association Canadienne des Infirmières en Oncologie (CANO/ACIO) recommended that (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/fertility-preservation) “all individuals with cancer and their families, regardless of cancer treatment, prognosis, relationship status, gender, sexual orientation, or age,  receive evidence-informed information regarding their risk of treatment-related infertility and preservation options.”

“As a significant proportion of women are concerned about fertility at diagnosis that may impact their treatment decisions, it is critical to ensure that these issues are adequately addressed,” the researchers concluded.

ONS, APHON, and CANO/ACIO said that (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/fertility-preservation) oncology nurses and advanced practice providers should advocate for patient access to fertility preservation and “are uniquely poised to assess the complexity and intersectionality of the individual and family experience and to guide the individual and their family through the fertility preservation process.” 

ONS resources can help support your patient conversations about this important topic. Learn more with a huddle card (https://www.ons.org/huddle-cards/fertility-preservation-huddle-card) and the Oncology Nursing Podcast (https://www.ons.org/podcasts/episode-208-how-have-fertility-preservation-conversations-your-patients), as well as special considerations (https://voice.ons.org/news-and-views/nursing-considerations-for-adolescent-and-young-adult-cancer-survivorship-care) and communication (https://voice.ons.org/news-and-views/have-meaningful-conversations-with-pediatric-adolescent-and-young-adult-patients-and) for adolescent and young adult cancer survivors.