Fertility issues in patients with hematologic malignancies

Abstract

An essential component of a cancer patient's comprehensive care is addressing potential threats to his or her reproductive health. Providers should discuss the risk of infertility with newly diagnosed patients and offer the chance to consult with a reproductive specialist as early as possible. Standard fertility preservation options include embryo or oocyte cryopreservation for women and sperm banking for men; all options for pre-pubertal children are experimental. Patients with hematologic malignancies are a distinct population in whom standard options may present special challenges, and alternative management strategies are being explored. Unique approaches in hematologic malignancy patients include experimental techniques, such as hormonal therapy, referrals to reproductive specialists after cancer treatment, or discontinuation of tyrosine kinase inhibitor therapy in appropriate chronic myelogenous leukemia patients. Importantly, expedited communication between hematologists and reproductive specialists may greatly enhance the quality of care for these patients. Facilitation of referrals will both improve the quality-of-life and expand the prospect of parenthood in survivors. There are ample opportunities to advance the field of oncofertility through additional research, especially in hematologic malignancy patients.

Discussing reproductive health in spinal care, part II: fertility issues

“…This contrasts sharply to figures from oncology surveys in which 47 to 82 % refers to a fertility specialist. Oncology studies identified the following positive doctor predictors for referring: female sex, favorable attitude, gynecology or pediatrics as specialty, high frequency of discussing fertility and easy access to fertility specialist [31,35,38]. In the present survey, no positive predictors for referring, apart from high frequency of discussing fertility, were found.…”

“…This, together with other proven effective strategies to increase response rate, such as a monetary incentive and using mail-based questionnaires instead of web-based ones [33,34], yielded a response rate of 62 %. This is extremely high compared to similar surveys with response rates ranging from 15 to 37 % (mean 28 %) [31,32,[35][36][37][38]. However, it is likely that clinicians who are not interested in the topic of this survey, have declined invitations more often.…”

“…In similar oncology surveys, oncologists mentioned barriers such as lack of knowledge, unawareness to whom to refer to, lack of time and too advanced illness of the patient [37][38][39]. Further studies regarding these barriers for specifically spinal care clinicians are indicated.…”

Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach

“…In Table 1, the common forms of hematological malignancies that occur in girls and young women (ALL, AML, NHL, and HL) and their related risks of anticancer therapy-induced gonadotoxicity are listed in detail. In order to avoid or at least mitigate such devastating gonadotoxicity risks and complications, effective and comprehensive oncofertility strategies for preserving and restoring fertility in girls and young women with hematological malignancies should be offered before, during, and after anticancer therapy [9][10][11][12][13].…”

Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies

“…[64][65][66][67] Cancer treatments have the potential to destroy reproductive cells and can place women at risk for acute ovarian failure/premature menopause and men for temporary/ permanent azoospermia. 68,69 There are several fertility preservation options available, 70,71 however, counseling hematologic AYA patients about fertility threats is challenging due to the undefined risk and variable timing of gonadal failure, indeterminate likelihood and timing of gonadal recovery, and the unknown risks and efficacy of nonstandard but immediately available fertility preservation options. 70 Despite the available fertility preservation options, discussion, referrals, and treatment are inconsistent, and many AYAs initiate treatment without discussion or opportunity for fertility preservation.…”