Leading US cancer centers neglect the future fertility of patients

Some of the most advanced and best-resourced cancer centers in the country fail to notify patients of risks to their fertility or to direct patients to speak with fertility specialists, says a new study. In 2006, the American Society of Reproductive Medicine published guidelines regarding fertility preservation advising oncologists to be prepared to discuss risks to patients' fertility and make the proper referrals. In many treatment centers, these guidelines seem to have gone unheeded. "If it turns out that there were things that could have been potentially done to help them preserve their fertility and those weren't done or those weren't talked about, then it's very upsetting, understandably," says lead study author Marla Clayman, an assistant professor of medicine at Northwestern University's Feinberg School of Medicine. Questions regarding fertility are frequently cited among adolescent and young adult cancer patients' frequent concerns in surveys, she adds.Researchers at Northwestern University phoned 39 comprehensive cancer centers to assess their fertility preservation resources. These centers are at the helm of experimental research. They are well-financed, often part of medical schools, or they are affiliated with other academic organizations. Phone survey participants were mainly staff affiliated with reproductive endocrinology, hematology or oncology divisions. Study results found that half of these centers had fertility preservation services available on site or referral systems in place. However, only about a quarter - 27 percent - of these centers employed fertility navigators or educators. Clayman says she understands an oncologist's principle goal is to save lives, but she believes cancer treatment centers ought to make an institutional commitment to providing fertility information to patients. "The vast majority of patients are not going to say, 'No, no. It's going to ruin my fertility don't give me treatment.' It's not an either or," she says. There are a number of options in fertility preservation: women can freeze embryos or cryopreserve their eggs. Other more experimental options such as freezing ovarian tissue have also surfaced in the last year. Men concerned about fertility have the option of sperm banking. Sometimes preserving a patient's fertility can delay treatment, but for certain slow-growing cancers, a few weeks difference may not be significant. These are the types of conversations patients should be having with clinicians, says Clayman. Doctors often take measures to make certain that patients are comfortable and to ensure fewer long-term side effects. "For many people the possibility of being infertile because of their cancer can result in psychological pain throughout a lifetime," says Clayman. Quality of life is important to cancer patients, particularly survivors. "You don't just want to have a life after cancer, you want to have the best life you can have after cancer, and we want that for everybody. The best that they can have - whether that means being in less pain, or whether that means having less psychological distress or whether that means being able to build a family that they want to build," says Clayman. Article: 20th December 2013 www.usnews.com