Fertility Counseling for Cancer Patients Brings Long-Term Psychosocial Benefits


From the Annual Meeting of the American Society for Reproductive Medicine

DENVER – Long-term psychosocial outcomes in reproductive-age women with cancer are significantly better when the women receive pretreatment counseling regarding possible reproductive loss and the option of fertility preservation, according to a large survey.

The survey showed that while reproductive counseling by the oncology team is beneficial in terms of psychosocial outcomes, cancer patients who are referred to a reproductive endocrinologist and undergo fertility preservation via oocyte or embryo freezing subsequently report significantly less regret and higher satisfaction-with-life scores than those not receiving a referral, Joseph M. Letourneau reported.

He and his coworkers turned to the California Cancer Registry in order to study the impact of fertility preservation on psychosocial outcomes in young female cancer survivors. The registry has collected information on all cases of cancer diagnosed in the Golden State for the past 25 years.

The investigators utilized a survey instrument that incorporated three previously validated psychometric assessments of quality of life: the Decision Regret Scale, the Satisfaction With Life Scale, and the World Health Association 26-item Quality of Life BREF assessment. The survey had a 41% response rate, with complete responses received from 1,041 women having a history of leukemia, Hodgkin's disease, breast cancer, non-Hodgkin's lymphoma, or gastrointestinal cancer. Among the women surveyed, 918 had received pelvic radiation or systemic chemotherapy – treatments with the potential to compromise fertility. Respondents were currently a mean of 41.3 years of age, with 9.5 years since diagnosis of their malignancy.

Although the American Society of Clinical Oncology recommends that oncologists routinely discuss the possibility of reproductive loss and offer the option of fertility preservation for patients of reproductive age, only 61% of the California women reported that their oncologist mentioned that their treatment carried a risk of infertility. Five percent of women saw a fertility specialist prior to undergoing cancer therapy, and 4% underwent fertility preservation. Roughly 80% of referrals to a fertility specialist came from the patient's oncologist, the rest from the primary care physician or self-referral, according to Mr. Letourneau, a medical student at the University of California, San Francisco.

Regret, as measured on the Decision Regret Scale, was significantly less in women who reported being counseled by their oncology team about the reproductive risk of their pending cancer therapy. They had a mean score of 10.8 on the 5- to 25-point scale, compared with 12.6 in women who didn't receive counseling. Women who saw a fertility specialist had a mean score of 8.5, compared with 11.6 in those who did not. And those who preserved their fertility had a mean score of 6.5, vs. 11.6 in those who did not. A three-point difference on this scale is deemed clinically meaningful, he explained.

The WHO Quality of Life BREF assessment evaluates the domains of physical, psychological, and environmental health, as well as social relationships. Women who reported receiving counseling from their oncologist regarding the reproductive risk of cancer treatment scored significantly better in terms of physical and psychological health than those who did not. Social relationship scores were unrelated to reproductive counseling.

Mr. Letourneau said he had no relevant financial disclosures. His study received the American Society for Reproductive Medicine In-Training Award for Research from the society's mental health specialinterest group.

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