Health professional awareness
Clinical Question One
How aware are health professionals of the need to discuss the risk of infertility with people diagnosed with cancer?
The level of awareness among health professionals of the need to discuss the risk of infertility varies widely. In Germany and America almost all oncologists and oncology nurses surveyed thought it was important to discuss oncofertility, while less than half of clinicians in small surveys in Hong Kong and Iran were familiar with fertility preservation techniques.
Despite awareness, many clinicians have a poor understanding of fertility preservation options available to patients diagnosed with cancer  and the risk of permanent amenorrhea for female cancer patients. A systematic review of 14 studies from the USA, United Kingdom, Canada, the Netherlands and Australia, found that health care professionals knowledge of fertility preservation was a significant barrier to discussing options with patients. In addition the impact of cancer therapies on ovarian function is infrequently assessed in clinical trials.(Cui 2021)
Evidence Summary One
|There is a wide variation in the awareness of health care professionals of the need for timely fertility discussion with people diagnosed with cancer. The lack of knowledge of current fertility preservation options is a barrier to this discussion.||IV||, , , , , , |
|Continuing education for health professionals about reproductive health, risk of infertility and fertility preservation options available for patients with cancer is essential.||C|
Clinical Question Two
Do all patients with cancer receive the opportunity to have a discussion with a health professional about the risk of infertility?
A review of medical records of adolescent and young adult patients with cancer in Australia identified 47% of patients had a documented fertility discussion, while other studies found documented fertility discussion rates ranged from 16-80%.
Studies have also evaluated patient recall of discussions about fertility. A systematic review by Tschudin et al found that rates of recall of fertility counselling by patients with cancer ranged from 34% to 72%. This was reflected in other studies of patient recall which ranged from 34% to 88%.
Studies of paediatric oncologists and families in Australian and New Zealand found that fertility discussions were less likely to occur for patients below the age of 12 years compared to older patients and for those at lower risk of infertility. There is a need to improve documentation of discussions. The timing and quality of conversations are also important as they influence decision-making in regards to treatment and fertility preservation. Discussions that feel rushed without providing time to adequately address fertility needs, or those occurring after the commencement of therapy (even if low risk to fertility), significantly increases regret.
Evidence Summary Two
|Despite international guidelines mandating discussion of infertility risk and provision of information prior to cancer treatment, this is not routinely performed as part of early cancer management. Documentation of fertility discussions is poor, hindering accurate reporting.||IV||, , , , , , , , , , , |
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- Buske D, Sender A, Richter D, Brähler E, Geue K. Patient-Physician Communication and Knowledge Regarding Fertility Issues from German Oncologists' Perspective-a Quantitative Survey. J Cancer Educ 2016 Mar;31(1):115-22 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25934223.
- Forman EJ, Anders CK, Behera MA. A nationwide survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. Fertil Steril 2010 Oct;94(5):1652-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19945099.
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- Ghorbani B, Madahi P, Shirazi E, Ardekani HS, Kamali K. Iranian Oncologists' Attitude towards Fertility Preservation in a Sample Group. J Reprod Infertil 2011 Jan;12(1):33-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23926497.
- Chung JP, Lao TT, Li TC. Evaluation of the awareness of, attitude to, and knowledge about fertility preservation in cancer patients among clinical practitioners in Hong Kong. Hong Kong Med J 2017 Dec;23(6):556-61 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29123075.
- Vindrola-Padros C, Dyer KE, Cyrus J, Lubker IM. Healthcare professionals' views on discussing fertility preservation with young cancer patients: a mixed method systematic review of the literature. Psychooncology 2017 Jan;26(1):4-14 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26890220.
- 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.
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- Banerjee R, Tsiapali E. Occurrence and recall rates of fertility discussions with young breast cancer patients. Support Care Cancer 2016 Jan;24(1):163-71 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25967235.
- Rentea RM, Poola AS, Fulbright JM, St Peter SD, Shah SR. Utility of pediatric female fertility preservation discussions following pelvic radiation. Pediatr Surg Int 2018 Jun;34(6):647-651 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29619566.
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- Tschudin S, Bitzer J. Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod 2009;Update 15(5):587-59.
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- 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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- Jayasuriya S, Peate M, Allingham C, Li N, Gillam L, Zacharin M, et al. Satisfaction, disappointment and regret surrounding fertility preservation decisions in the paediatric and adolescent cancer population. J Assist Reprod Genet 2019 Sep;36(9):1805-1822 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31399917.