Fertility as a priority among at-risk adolescent males newly diagnosed with cancer and their parents

Abstract

Purpose Infertility is a frequent consequence of cancer therapy and is often associated with psychological distress. Although adult survivors prioritize fertility and parenthood, this issue remains unexplored among adolescent males. This study examined future fertility as a priority (relative to other life goals) at time of diagnosis for at-risk adolescents and their parents. Methods Newly diagnosed adolescent males (n=96; age=13.0-21.9 years) at increased risk for infertility secondary to cancer treatment prioritized eight life goals: to have school/work success, children, friends, wealth, health, a nice home, faith, and a romantic relationship. Patients' parents (fathers, n=30; mothers, n=61) rank-ordered the same priorities for their children. Results “Having children” was ranked as a “top 3” life goal among 43.8% of adolescents, 36.7% of fathers, and 21.3% of mothers. Fertility ranked 3rd among adolescents, 4th among fathers, and 5th among mothers. Future health was ranked the top priority across groups, distinct from all other goals (ps<.001), and fertility ranked higher than home ownership and wealth for all groups (ps<.001). For adolescents, low/moderate fertility risk perception was associated with higher fertility rankings than no/high risk perceptions (p=.01). Conclusions Good health is the most important life goal among adolescents newly diagnosed with cancer and their parents. In this relatively small sample, adolescents prioritized fertility as a top goal, parents also rated fertility as being more important than home ownership and financial wealth. Health care providers should communicate fertility risk and preservation options at diagnosis and facilitate timely discussion among families, who may differ in prioritization of future fertility.

Patient factors associated with sperm cryopreservation among at‐risk adolescents newly diagnosed with cancer

“…Despite adolescent males’ desire for children in the future, 9,34 this study found that a minority of adolescents newly diagnosed with cancer bank sperm prior to the initiation of cancer treatment. Historically, there has been a lack of clarity regarding the factors associated with adolescent sperm banking outcomes, but as this work demonstrates, adolescent factors, as well as parental and provider factors, all appear to play a role in this process.…”

“…5–8 As having children is one of the top three life goals among adolescents with cancer, 9 and infertility among adult survivors of childhood cancer is related to significant distress, worry, relationship difficulties, or challenges in finding a partner, 10–15 it is unclear why fertility preservation remains low in this group. It may be that at the time of diagnosis, future fertility is not an immediate concern for many adolescent patients.…”

Fertility preservation and cancer

“…Quinn et al demonstrated that parents consistently underestimated their daughters’ level of reproductive concern, expecting them to be satisfied with survival (74). Klosky and colleagues reported that 44% of adolescent male survivors ranked having children as a “top 3 life goal,” though only 21% of mothers and 37% of fathers similarly ranked this for their sons (75). …”

Fertility counseling and preservation: considerations for the pediatric endocrinologist

“…In the case of a minor, who should make the decisions about fertility preservation? While guidelines from major pediatric organizations acknowledge parents as having this role, studies show that parents and youth often have differing opinions about fertility and reproductive health (2,(75)(76)(77). Shouldn't the ability to reproduce be a right shared by all?…”