Setting Up an Ethical Oncofertility Practice in Developing Countries

Abstract

Fertility preservation for cancer patients is a relatively new field in medicine which requires interdisciplinary approach. Improving therapies and rising survival rates require to consider patient’s quality of life after cancer is cured which is relevant personal issue regardless of the individual income and the level of development of the country of origin. Fertility preservation offers possible solution but also raises ethical questions. We provide a summary of ethical principles embodied in professional guidelines together with options and restrictions to access fertility preservation in developing countries. We also make a suggestion that oncofertility counselling could be a pillar to address fertility preservation issues in cancer patients. Our proposed decisional support model is patient centred and focuses on patient values, personal philosophy and view of life emphasizing sensitivity to individual patient’s needs and wishes. Some fertility preservation concerns in oncology might be addressed mirroring already available expertise while some others will call for innovative and region specific solutions. Therefore, in addition to our proposal we also provide a list of organisations working in oncofertility field. DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21532 Bangladesh Journal of Bioethics 2014 Vol.5 (3): 6-17.

Talking about fertility in the context of cancer: health care professional perspectives

“…However, this discussion is often circumvented if physicians consider preserving fertility would lower chances of survival, or because they do not want to give patients ‘false hope’ of survival or future fertility (Linkeviciute et al . ), as was reported by some participants in the present study. If treatment starts before fertility preservation has been undertaken, it becomes a missed opportunity which can cause significant distress for patients (Schover ).…”

“…The currently established clinical pathway is based on informing patients about the effects of cancer treatment on fertility, discussion of how fertility can be preserved, and referral to fertility specialists and allied health professionals for support as soon as possible (Linkeviciute et al . ). One problem with this pathway is that it is up to the physician or head of the multidisciplinary team caring for the patient to raise the issue of fertility, and to facilitate the process of fertility preservation treatment, if appropriate.…”

Nurses’ experiences of undertaking fertility‐related discussions with teenagers and young adults with cancer: An interpretive phenomenological analysis

“…Oocyte cryopreservation is an option for females without a current partner and there have been successful cases of oocyte cryopreservation in female adolescents (De‐Vos, Smitz, & Woodruff, ). Alternatively, embryo cryopreservation is the established method for females who are in a stable relationship at the time of treatment (RCN, ); however, this may delay the initiation of cancer treatment by two to three weeks (Linkeviciute, Boniolo, & Peccatori, ). Testis or ovarian tissue cryopreservation, whereby tissue is surgically removed and preserved for later transplantation in adulthood, has the advantage of being rapidly achievable as no pretreatment is required (RCN, ).…”

Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico

“…48 Nonetheless, FP in patients with poor prognosis raises significant ethical dilemmas, such as the morality of denying FP when life expectancy is limited, the possibility of instilling false hopes of survival by offering FP options, and the matter of coverage for these strategies. 49 Importantly, given that a reduced lifespan is usually not a sufficient reason to withhold reproductive assistance, 50,51 physicians' main role should be to help patients make an informed, conscious choice by ensuring their appropriate understanding of prognosis, values and priorities, cost of procedures, and future arrangements for the child's welfare, always respecting patient autonomy. [52][53][54] As previously emphasized by others, fertility concerns are not limited to patients who possess specific characteristics.…”