Fertility counselling

From Cancer Guidelines Wiki

Clinical Question

What impact does fertility counselling have on the quality of life, mental health and decision-making processes of people with cancer?

Infertility or impaired fertility brought about by cancer treatment is associated with an increased risk for heightened psychological distress and reproductive concerns from the time of cancer diagnosis through to survivorship.[1] Therefore, the opportunity to preserve fertility at the time of cancer diagnosis or later may assist in lowering levels of distress.

One component of fertility preservation management is fertility counselling, where patients are provided with information regarding the likely impact of gonadotoxic cancer treatment on their future fertility as well as information on suitable fertility preservation options. Fertility counselling aims both to assist in decision-making for fertility preservation treatment and also to provide psychological support at a difficult time for patients. Given its multipurpose role, fertility counselling may form part of an oncological or reproductive consult, and/or as a session with a mental health professional to further explore the implications of fertility preservation options as well as the emotional impact of threatened infertility.[2]

Quality of life and mental health

When considered as a separate psycho-social counselling session, fertility counselling may assist with decision-making and lower anxiety.[3] However, research is mixed, with another study demonstrating that although the presence of a psychologist in collaboration with a reproductive clinician is deemed to be helpful and appreciated by patients, an individual counselling session at the time of fertility preservation may elevate already heightened anxiety in the short term.[4] This is most likely due to the increase in psychological pressure inherent in confronting treatment choices and actively engaging with decision-making.

Fertility counselling at the time of cancer diagnosis may assist in lowering decisional conflict and decisional regret, while improving access to fertility preservation treatment.[5][6] Patients feel fertility counselling is most favourable when adequate time is taken to explore fertility preservation options and when they feel supported in their decision-making processes.[7] It is also likely to be advantageous if clinicians possess greater reproductive knowledge, with preference for counselling by a reproductive specialist when integrated into a medical consult and not an oncology clinician alone.[5]

Given that heightened emotional distress may be the primary reason why fertility preservation is not undertaken,[8] it is important that patients are adequately supported in exploring fertility treatment options by a suitably trained mental health clinician. Women who receive fertility counselling are also more likely to undergo pre-treatment fertility preservation.[8] Positive experiences of fertility counselling are associated with having enough time for counselling, the opportunity to ask questions, fertility preservation options clearly explained and discussed, being involved in decision-making and the presence of a psychologist in collaboration with reproductive specialist.[7][4]

Research suggests that short term fertility, psychosexual or educational interventions provided throughout cancer treatment or survivorship, tailored to either adolescent or young adult patients, or adult patients of reproductive age, may be beneficial. These fertility interventions were shown to increase fertility and sexual health knowledge, lower emotional distress and depression associated with infertility or poor reproductive outcomes, and increase quality of life by improving social interactions or symptom management.[9][10][11][12] As such, there appears to be merit in the provision of subsequent fertility counselling support throughout the cancer journey; in both managing ongoing fertility and family planning needs and reproductive complications and to assist in improving patient quality of life and mental health.

There is currently limited research evaluating the psychological impact of fertility counselling at the time of cancer diagnosis to assist in fertility preservation decision-making and support. Further research is needed to validate the best format for counselling or most suitable clinician to implement fertility counselling when fertility care is delivered as part of a multi-disciplinary team. The suitability of fertility counselling provision will depend on both the model of care implemented within local contexts and available resources within any health setting. Further implementation research is needed to best elucidate the most appropriate model of care for ongoing fertility support, throughout cancer treatment and survivorship.

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Evidence Summary

Evidence summary Level References
Fertility counselling and opportunity for fertility preservation are both associated with increased quality of life, including better physical, social and psychological health and lower decisional regret. I, II, III-2, IV [9], [11], [12], [5], [8], [3], [6], [13], [14]


Evidence-based recommendationQuestion mark transparent.png Grade
Fertility counselling should be offered to everyone with potentially curable cancer, ideally by a reproductive specialist and/or trained counsellor. Counselling should include education about fertility preservation options and support for patient decision-making.

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  1. Logan S, Perz J, Ussher JM, Peate M, Anazodo A. Systematic review of fertility-related psychological distress in cancer patients: Informing on an improved model of care. Psychooncology 2018 Nov 20 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30460732.
  2. Logan S, Perz J, Ussher J, Peate M, Anazodo A. Clinician provision of oncofertility support in cancer patients of a reproductive age: A systematic review. Psychooncology 2018 Mar;27(3):748-756 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28762627.
  3. 3.0 3.1 Chiavari L, Gandini S, Feroce I, Guerrieri-Gonzaga A, Russell-Edu W, Bonanni B, et al. Difficult choices for young patients with cancer: the supportive role of decisional counseling. Support Care Cancer 2015 Dec;23(12):3555-62 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25862346.
  4. 4.0 4.1 Razzano A, Revelli A, Delle Piane L, Salvagno F, Casano S, Randaccio S, et al. Fertility preservation program before ovarotoxic oncostatic treatments: role of the psychological support in managing emotional aspects. Gynecol Endocrinol 2014 Nov;30(11):822-4 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25054374.
  5. 5.0 5.1 5.2 Sobota A, Ozakinci G. Fertility and parenthood issues in young female cancer patients--a systematic review. J Cancer Surviv 2014 Dec;8(4):707-21 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25103606.
  6. 6.0 6.1 Chan JL, Letourneau J, Salem W, Cil AP, Chan SW, Chen LM, et al. Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv 2017 Feb;11(1):58-63 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27480882.
  7. 7.0 7.1 Bastings L, Baysal Ö, Beerendonk CC, IntHout J, Traas MA, Verhaak CM, et al. Deciding about fertility preservation after specialist counselling. Hum Reprod 2014 Aug;29(8):1721-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24916435.
  8. 8.0 8.1 8.2 Benedict C, Thom B, Kelvin JF. Young Adult Female Cancer Survivors' Decision Regret About Fertility Preservation. J Adolesc Young Adult Oncol 2015 Dec;4(4):213-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26697271.
  9. 9.0 9.1 Canada AL, Schover LR, Li Y. A pilot intervention to enhance psychosexual development in adolescents and young adults with cancer. Pediatr Blood Cancer 2007 Nov;49(6):824-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17226851.
  10. Meneses K, McNees P, Azuero A, Jukkala A. Evaluation of the Fertility and Cancer Project (FCP) among young breast cancer survivors. Psychooncology 2010 Oct;19(10):1112-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19918959.
  11. 11.0 11.1 Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE. Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol 2006 Apr 1;24(10):1620-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16575013.
  12. 12.0 12.1 Schover LR, Rhodes MM, Baum G, Adams JH, Jenkins R, Lewis P, et al. Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer 2011 Nov 1;117(21):4983-92 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21495025.
  13. Skaczkowski G, White V, Thompson K, Bibby H, Coory M, Orme LM, et al. Factors influencing the provision of fertility counseling and impact on quality of life in adolescents and young adults with cancer. J Psychosoc Oncol 2018 Jul;36(4):484-502 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29764330.
  14. Skaczkowski G, White V, Thompson K, Bibby H, Coory M, Pinkerton R, et al. Factors influencing the documentation of fertility-related discussions for adolescents and young adults with cancer. Eur J Oncol Nurs 2018 Jun;34:42-48 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29784137.

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A: Clinical question

B: Body of evidence

C: Literature search

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