How Cancer Centers Can Create a System for Addressing Fertility

Annually, approximately 150,000 men and women age 45 and younger are diagnosed with cancer. Fortunately, the five-year overall survival rate for these patients is about 80 percent.

Of these survivors, an estimated 30–75 percent of males and 40–80 percent of females are at risk for iatrogenic infertility from the cancer treatments they undergo, including chemotherapy, radiation and surgery.

Several standard and experimental fertility preservation techniques are now available to mitigate this risk. However, while numerous reports over the past decade have identified future fertility and parenthood as significant concerns for this group, studies continue to show that the risk of infertility and the options for preserving fertility are not discussed with a majority of patients on a routine basis.

Why Cancer and Fertility Care?

The LIVESTRONG Foundation believes that all cancer patients at risk for iatrogenic infertility have a right to be informed of their reproductive risks and of their options for moderating these risks.

To achieve this, we recommend all organizations that provide cancer care should implement a systematic approach to the disclosure of treatment-related fertility risks and the provision of referrals for patients interested in fertility preservation services.

This position is consistent with well-established tenets of medical ethics, which emphasize the primacy of patient autonomy; with legal precepts of informed consent, which can only be achieved if patients have complete information concerning the material benefits and risks of their treatment; with oncology practice guidelines and with LIVESTRONG’s mission to inspire and empower people affected by cancer now.

Institutional Recommendations for Cancer Centers

In order for cancer centers to build a systematic approach to fertility disclosure, the following components are needed:

Institutional Commitment - This may be achieved in a variety of ways, including through the implementation of a formal policy, guideline or standard operating procedures. To develop and sustain a deliberate practice of fertility disclosure, buy-in at the institutional level is critical. Institutional commitment should be formalized, documented, disseminated and referenced as a framework for clinical practice.

Institutional Ownership - Highly-motivated individuals (or teams of individuals) with a professional interest in cancer and fertility appear to be crucial to the development of systematic fertility approaches. These internal champions are often affiliated with complementary programs such as Adolescent and Young Adult (AYA) Oncology or Survivorship, and may already have some expertise with fertility. Once a systematic approach to cancer and fertility is developed, it must be assigned to a staff member (or a team) who is compensated for and whose job description includes its maintenance, oversight and evaluation.

Fertility Education Resources

Professional Education - Training should be conducted to expand providers’ knowledge of the medical and psychosocial aspects of cancer-related infertility, and on the current options available for fertility preservation. For example, periodic tumor boards, in-services, grand rounds, or online continuing medical education courses should be conducted. In addition, basic, searchable fertility information must be made easily available to clinicians; point-of-care access is particularly useful.

Information for Patients - Brochures or printed fact sheets should be made available in patient waiting rooms and/or new patient packets. Alternatively, they can be provided directly to the patient by the clinician. In addition, patients can be directed to internal or trustworthy external websites for supplemental information and resources such as financial assistance programs, counseling services, etc.

Contact LIVESTRONG Fertility Services to receive these types of cancer and fertility resources for your patients.

Patient Notification and Referral Process

The most vital aspect of a systematic approach to cancer and fertility is establishing a well-defined process for notifying at-risk patients. Forging relationships with institutionally-affiliated or other local sperm banks, fertility clinics and specialists is critical to a functioning cancer and fertility system. Identification of additional specialists who can provide investigational options is also suggested.

The patient notification process must include three elements:

  • Disclosure of the risk for infertility that the patient is facing due to his/her treatment plan.
  • Discussion of the options that are available to minimize the patient’s risk and to preserve fertility.
  • Offer of referral to a specialist for further fertility information and/or services.

The patient notification process must also be executed in a timely fashion, allowing the patient the widest range of options. It should contain appropriate content that is conveyed to the patient in terms that are easily understood, customized for the expected treatment and individual patient and sensitive to the intimate, personal nature of the information. The occurrence of the patient notification must be documented.

Read "Talking to Your Patients about Cancer and Fertility: Support for Oncologists"

Evaluation of Systematic Approach

Evaluation metrics should be used to assess the effectiveness of each of the recommendations and of the systematic approach as a whole.

Contact LIVESTRONG Fertility Services for more cancer and fertility information and support.

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