Oncologists and hematologists’ perceptions of fertility-related communication – a nationwide survey

Abstract

Background: Despite the negative impacts of several cancer treatments on fertility, many patients do not recall having fertility-related discussions with their physicians. This study was conducted to identify those factors related to physicians' discussing the treatment impacts on fertility with cancer patients of reproductive age. Material and methods: In this nationwide survey of cancer care physicians (n ¼ 329, response rate 55%), oncologists and hematologists (mainly) completed a questionnaire on practice behavior, barriers, attitudes and confidence in knowledge regarding treatment-related fertility risks. Logistic regression analyses were conducted to identify factors associated with not routinely discussing fertility issues with patients. Results: Most of the physicians agreed that they were responsible for discussing fertility issues with patients of reproductive age (91%), but approximately 30% did not do so regularly. Those factors decreasing the likelihood of discussion were: patient already had children (female/male OR 3.0/6.9), high workload (OR 3.3/4.8), seeing <5 female/male patients of reproductive age weekly (OR 3.2/3.4) and access to a reproduction clinic (OR 5.2/4.2). Conclusions: Most Swedish oncologists and hematologists regularly discuss impact of treatment on fertility with their patients. Those factors having a negative impact on fertility discussions may guide targeted organizational and educational efforts to further improve fertility-related communication in cancer care.

Threatened fertility: A longitudinal study exploring experiences of fertility and having children after cancer treatment

“…In addition, having used FP seems to help both men (Armuand et al, 2015) and women (Corney & Swinglehurst, 2014) to be less troubled with concerns about their future fertility. The need to start treatment immediately has been reported to be a common reason for omitting fertility discussions in cancer care, especially with regard to women (Forman, Anders, & Behera, 2010;Micaux Obol et al, 2017;Ussher et al, 2016). In Sweden, all patients who receive treatment with a possible negative impact on fertility may undergo FP after evaluation, and the costs for the procedure are covered by the tax-funded health care.…”

Oncologists' and pediatric oncologists' perspectives and challenges for fertility preservation

“…A number of studies have investigated physicians' perspectives of FP care with focus on attitudes and barriers related to discussing impact on fertility and FP, experiences of discussing FP with patients and parents, and knowledge about FP . Recently, three literature reviews, covering 59 papers published between 2003 and 2016, presented consistent results regarding physicians' perspectives and challenges related to FP care involving both internal and external factors.…”

“…Results reveal that oncologists frequently report a lack of knowledge of treatment‐induced fertility impairments and FP procedures, especially regarding the options for girls and young women, as a barrier for communicating fertility with patients and families . Micaux Obol and co‐workers investigated factors associated with discussing fertility with adult patients and found that physicians' experience of working in cancer care contributed statistically significantly to discussing fertility . Oncologists and hematologists who had worked in the field less than 5 years, and those who saw few patients of reproductive age per week, were less likely to discuss fertility issues with their patients .…”

“…Micaux Obol and co‐workers investigated factors associated with discussing fertility with adult patients and found that physicians' experience of working in cancer care contributed statistically significantly to discussing fertility . Oncologists and hematologists who had worked in the field less than 5 years, and those who saw few patients of reproductive age per week, were less likely to discuss fertility issues with their patients . The FP procedures available for women are more complex than the measures available for men, and this is a rapidly changing field.…”

“…The FP procedures available for women are more complex than the measures available for men, and this is a rapidly changing field. It is therefore understandable that physicians in cancer care may have difficulties staying informed on the latest FP procedures available for females …”