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

Abstract

International guidelines recommend that health‐care providers initiate discussions about the impact of treatment on fertility with cancer patients of reproductive age, or with parents/legal guardians of children, as early as possible in the treatment process. Still, both physicians and patients confirm that this is not always the case. This literature review summarizes findings regarding oncologists' and pediatric oncologists' perspectives and challenges of providing fertility preservation care, and points out directions for development. The results concerning the challenges facing clinicians are consistent and encompass both internal and external factors. The internal factors relate to clinicians' characteristics and values and include their knowledge of fertility preservation, clinical experience, perceptions of patients' plans for children, and how comfortable they are to discuss sensitive issues. The external factors relate to the availability of health‐care services and the organization of care, including the clinicians' working conditions. Several strategies to overcome identified challenges for clinicians to provide high‐quality fertility preservation care are proposed. These include educational interventions to increase clinicians' knowledge about treatment‐induced fertility impairment and available fertility preservation measures, as well as interventions aimed to increase clinicians' readiness and competence to communicate with patients and their parents. In addition, different types of educational resources for patients have been suggested to improve patient‐provider communication about fertility preservation, such as age‐appropriate brochures and decision aids. Organizational approaches suggested to address the identified external factors include development and implementation of policies and guidelines as well as closer collaboration between oncological and fertility clinics. Also, modifications of electronic medical record systems may support clinicians by prompting the documentation of discussions about potential treatment impact on future fertility and about available fertility preservation options. The development and implementation of multifaceted oncofertility programs appears to be a promising way forward towards high‐quality fertility preservation care meeting patients' needs.

Fertility-related information received by young women and men with cancer – a population-based survey

“…Among women, being older than 35 years and already having children at diagnosis were additional factors negatively correlated with reported receipt of information about FP. This finding is in line with previous research [17,29] and may reflect physicians' values [28], as well as national restrictions of subsidized fertility treatments (e.g., IVF with cryopreserved oocytes/embryos) based on the patient's age and previous children. The finding that heterosexual women were more likely to report having received FP information compared to nonheterosexual women was unexpected, as same-sex female couples and single women in Sweden have access to subsidized assisted reproduction with donor sperm.…”

“…Participants with brain tumors were far less likely to report having received fertility-related information compared to participants with other diagnoses, in line with recent results from a population-based Australian study [21]. Possible explanations for the present findings are related to the patient, the organization of care, and the clinician [28,29,39].…”

“…Logistic regression models were used to investigate associations between independent variables, patient characteristics (clinical and sociodemographic variables), and dependent variables, receipt of information (Yes vs. No/ Unsure). Independent variables included in the analyses were selected based on previous research: sex [17], age [17,27,28], diagnosis [17], country of birth [29], education [24], sexual orientation [27], partner and parenthood status [27], and desire for children [17]. Univariable logistic regression was used to investigate associations between the independent variables and the dependent variables before performing multivariable logistic regression models for the two respective outcomes.…”

“…This finding may be related to patients' potential difficulties processing oral information in a language other than their mother tongue and suggests that the use of written information should be advocated. In addition, cultural and religious beliefs may impact FP care [28,29]. Obtaining information about potential risks of fertility impairment is essential for patients of reproductive age, irrespective of the patient's risk level.…”

Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review

“…This field lacks a systematic review that synthesizes and categorizes the multilevel facilitators and barriers that affect the full breadth of communication functions. Instead, recent review articles have explored barriers and facilitators related to narrow aspects of communication, such as clinical trial enrollment, 18,19 fertility preservation, 20 cultural differences, 21,22 incurable disease, 23 and shared decision making 24 . A broader review of barriers and facilitators of communication will inform clinical practice and highlight areas that have been insufficiently studied.…”