Guidelines Urge Doctors to Discuss Fertility Preservation with Cancer Patients Early
Oncologists should discuss fertility preservation for people with cancer early, while there is still time for interventions to maintain patients' ability to have children, according to new guidelines released by the American Society of Clinical Oncology.
An expert panel was convened because of evolving evidence that "a substantial proportion of women (with cancer) were concerned about their fertility, but felt it had not been adequately addressed," panelist Dr. Ann H. Partridge, an oncologist from Dana-Farber Cancer Institute in Boston, told Reuters Health. "We need to do more to put this on the forefront for the younger cancer patients."
The panel conducted an electronic database search for clinical trials addressing the success and impact of fertility interventions for cancer patients, in which they documented 233 trial reports plus 43 supplementary studies or reviews. They found that few large or randomized studies have been conducted, so most of their data came from cohort studies, case series, small clinical trials or case reports.
The only proven fertility preservation method for men is sperm cryopreservation, while women can consider embryo cryopreservation, conservative gynecologic surgery, and ovarian transposition outside the field of radiation.
Clinical trials are currently investigating other techniques such as cryopreservation of testicular or ovarian tissue, cryopreservation of oocytes, and gonadal suppression. The authors note that testicular or ovarian tissue cryopreservation may be the only approach available to children before the age of puberty.
Studies suggest that only about half of oncologists discuss fertility preservation with their patients.
"It is eye opening that even when patients are facing cancer, they are also very concerned about their survivorship, including fertility," Dr. Partridge said. "Many oncologists assume that patients are just hoping to survive the cancer. I think our findings speak to the hope and increasing importance of survivorship issues in general."
Oncologists may also hesitate to discuss fertility preservation because of prohibitive costs. However, Dr. Partridge pointed out, there are programs such as Fertile Hope (www.fertilehope.org) that can provide information and even financial assistance.
The guidelines advise that oncologists raise these issues and refer patients to reproductive specialists at the earliest possible opportunity. But at the same time, they should take care to not present unrealistic expectations.
"The clinician has to read the patient," Dr. Partridge said. "Sometimes it might be too much for patients to digest on the day they receive the diagnosis, but oncologists should bring it up as soon as possible, using good clinical judgment, before it's too late to take the appropriate measures."
The guidelines are slated for publication in the June 20th issue of the Journal of Clinical Oncology and can be accessed now at www.asco.org/guidelines .
An expert panel was convened because of evolving evidence that "a substantial proportion of women (with cancer) were concerned about their fertility, but felt it had not been adequately addressed," panelist Dr. Ann H. Partridge, an oncologist from Dana-Farber Cancer Institute in Boston, told Reuters Health. "We need to do more to put this on the forefront for the younger cancer patients."
The panel conducted an electronic database search for clinical trials addressing the success and impact of fertility interventions for cancer patients, in which they documented 233 trial reports plus 43 supplementary studies or reviews. They found that few large or randomized studies have been conducted, so most of their data came from cohort studies, case series, small clinical trials or case reports.
The only proven fertility preservation method for men is sperm cryopreservation, while women can consider embryo cryopreservation, conservative gynecologic surgery, and ovarian transposition outside the field of radiation.
Clinical trials are currently investigating other techniques such as cryopreservation of testicular or ovarian tissue, cryopreservation of oocytes, and gonadal suppression. The authors note that testicular or ovarian tissue cryopreservation may be the only approach available to children before the age of puberty.
Studies suggest that only about half of oncologists discuss fertility preservation with their patients.
"It is eye opening that even when patients are facing cancer, they are also very concerned about their survivorship, including fertility," Dr. Partridge said. "Many oncologists assume that patients are just hoping to survive the cancer. I think our findings speak to the hope and increasing importance of survivorship issues in general."
Oncologists may also hesitate to discuss fertility preservation because of prohibitive costs. However, Dr. Partridge pointed out, there are programs such as Fertile Hope (www.fertilehope.org) that can provide information and even financial assistance.
The guidelines advise that oncologists raise these issues and refer patients to reproductive specialists at the earliest possible opportunity. But at the same time, they should take care to not present unrealistic expectations.
"The clinician has to read the patient," Dr. Partridge said. "Sometimes it might be too much for patients to digest on the day they receive the diagnosis, but oncologists should bring it up as soon as possible, using good clinical judgment, before it's too late to take the appropriate measures."
The guidelines are slated for publication in the June 20th issue of the Journal of Clinical Oncology and can be accessed now at www.asco.org/guidelines .
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