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Fertility Preservation: Ca Patients Not Always Told


 

Major Finding: Many oncologists are not likely to mention fertility preservation to cancer patients who have a poor prognosis, contrary to guidelines.

Data Source: A national 53-item survey of 513 U.S. oncologists.

Disclosures: The study was sponsored by the American Cancer Society. Dr. Quinn and her associates stated that they have no conflicts of interest.

ATLANTA — Physicians' attitudes may conflict with recommended guidelines for fertility preservation and reduce the likelihood that cancer patients will receive information about this reproductive option.

That conclusion was drawn from a national 53-item survey of 513 U.S. oncologists, specifically examining physicians' attitudes toward fertility preservation referral among cancer patients with a poor prognosis.

Sixty percent of respondents agreed with the statement that “fertility preservation is a high priority for me to discuss with newly diagnosed cancer patients,” while 26% were unsure and 14% disagreed, Gwendolyn Quinn, Ph.D., and her associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

Overall, 68% of oncologists agreed that “some patients with certain cancers, e.g., hereditary breast and ovarian cancer, should be informed about preimplantation genetic diagnosis,” also known as embryo screening, the investigators said.

When these oncologists were asked, however, if they support posthumous parenting, or the parenting of a child born from assisted reproduction subsequent to the patient's death, only 16.2% agreed, 51.5% were unsure, and 32.3% disagreed.

The statement, “Patients with a poor prognosis should not pursue fertility preservation,” evoked similar responses, with 45% of oncologists being unsure, 23% agreeing, and 32% disagreeing.

In a logistic regression analysis, only support of posthumous reproduction was a significant predictor of support for fertility preservation in patients with a poor prognosis, wrote Dr. Quinn of the H. Lee Moffitt Cancer Center and Research Institute, Tampa, and her associates.

Guidelines by the American Society for Reproductive Medicine recommend that physicians inform cancer patients about options for fertility preservation and future reproduction prior to treatment, and that “concerns about the welfare of resulting offspring should not be cause for denying cancer patients assistance in reproducing.”

Fertility, as an issue of quality survivorship, is also part of the agenda of most national advocacy groups, including the American Cancer Society, the Lance Armstrong Foundation, and the Young Survivors Coalition.

Many physicians assume a patient with late-stage disease or a poor prognosis is not a candidate for fertility preservation, Dr. Quinn said in an interview.

“There are multiple cases of couples/families using stored sperm or embryos to expand families after the death of the loved one,” she said.

“However, people may not go public with this because it can be perceived as 'strange' or odd. As a consequence, physicians may not be aware of what patients and families are doing,” she said.

The bottom line, however, is that all of the national guidelines that address fertility preservation specify that “all” patients should receive information on the matter. “It is not for the physician to pick and choose who gets the information,” Dr. Quinn said.

The majority of respondents were male (70%), white (76%), and Catholic (30%) and had children (85%). Most physicians had graduated from medical school in 1991 or earlier, and practiced primarily at a teaching hospital, university-affiliated cancer center, National Cancer Institute–designated center, or location other than a private oncology practice.

Dr. Quinn said that national guidelines are a slow and ineffective way to create behavior change, noting that the American Society of Clinical Oncology and American Academy of Pediatrics also have existing recommendations on fertility preservation.

One aspect of awareness raising that seems to work well is testimonials by patients about why fertility preservation is important to them, the regret and remorse they feel when they did not receive it, and the types of family-building options patients have pursued, she said.

'It is not for the physician to pick and choose who gets the information.'

Source DR. QUINN

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