Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer

Abstract

Background The post-treatment quality of life (QOL) impacts of receiving pre-cancer-treatment infertility counseling and of pursuing fertility preservation have not been described in large-scale studies of reproductive age women with cancer. Methods 1041 women diagnosed between the ages of 18 and 40 responded to a retrospective survey and reported whether they received infertility counseling before cancer treatment and whether they took action to preserve fertility. Five cancer types were included: leukemia, Hodgkin’s disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Validated QOL scales were used: Decision Regret Score (DRS), Satisfaction with Life Scale (SWLS), and World Health Organization QOL BREF (WHOQOL-BREF). Results 560 women (61%) whose treatment could affect fertility were counseled by the oncology team, 45 (5%) were counseled by fertility specialists, 36 (4%) took action to preserve fertility. Pre-treatment infertility counseling by a fertility specialist and an oncologist resulted in lower regret than counseling by an oncologist alone (8.4 vs. 11.0, P<0.0001). The addition of fertility preservation (6.6 vs. 11.0, P<0.0001) was also associated with even lower regret scores than counseling by an oncologist alone.. Further improvements were similarly seen in SWLS with the addition of fertility specialist counseling (23.0 vs. 19.8, P=0.09) or preserving fertility (24.0 vs. 19.0, P=0.05). Conclusions Receiving specialized counseling about reproductive loss and pursuing fertility preservation is associated with less regret and greater QOL for survivors, yet few patients are exposed to this potential benefit. Reproductive aged women should have expert counseling and be given the opportunity to make active decisions about preserving fertility.

Fertility preservation in cancer patients: The global framework

“…However, significantly lower numbers actually proceed with fertility preservation procedures ( Table 2). Despite proven clinical and psychological benefit [41,44] and recommendations that cancer patients should be routinely asked about their interest to preserve fertility before starting cancer treatment (Table 1), nearly half of patients are not…”

Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls: a 17-year experience

“…These referrals are essential, as studies indicate that receiving pre-cancer treatment counseling regarding fertility preservation significantly increases QOL scores after cancer treatment in reproductive-age women [10]. Furthermore, receiving this counseling from a fertility specialist and subsequently attempting fertility preservation are both associated with increased QOL as compared to women who have been counseled solely by an oncologist [10].…”

Outcomes of ovarian stimulation after treatment with chemotherapy

“…As chemotherapy has improved survivorship after cancer and other medical illnesses in women of reproductive age, the importance of fertility is clear as these women age and become ready to start a family [14]. Due to ovarian damage from exposure to chemotherapy, these patients are more likely to experience infertility and require fertility treatment in order to conceive [15] In vitro fertilization (IVF) treatment protocols and fertility preservation cycles in patients treated with gonadotoxic chemotherapy are of interest to clinicians who wish to optimize care for these patients.…”