Some breast cancer treatments can impact a person’s ability to have children, but many doctors do not provide appropriate counseling and referrals to fertility specialists, summarizes a national survey.
The survey, presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in May 2009, underscored the importance of talking with your doctor before and throughout treatment if preserving your fertility is important to you. In their conclusions, the researchers said their findings suggest a need for training programs to help doctors learn how to communicate about fertility with women affected by cancer.
Medical and technological advances mean more and more women of childbearing age are living for years after a diagnosis of cancer. Researchers consider the preservation of fertility an important component in the overall care and quality of life of people affected by cancer.
Because of the impact some treatments may have on fertility, it is important for women and doctors to talk about childbearing options before treatment begins. But prior research shows that less than 50 percent of people receive sufficient information about how to protect their fertility before their doctor starts treatment.
This new national survey was conducted to evaluate oncologists’ attitudes and knowledge of fertility preservation guidelines issued by ASCO in 2005 and also to see if there were perceived barriers to doctor-patient communications about cancer treatment and fertility. The 2005 ASCO guidelines encourage doctors to talk about fertility preservation "at the earliest possible opportunity" before treatment begins.
Researchers mailed a 37-question survey to a random sample of more than 1,900 oncologists across the United States. The oncologists specialized in a variety of cancers, not just breast cancer. Of all doctors contacted, 613 doctors, or 33 percent of those polled, participated in the survey.
In addition to demographic questions, the survey asked about the knowledge, attitudes and practice behaviors related to fertility preservation and the doctors’ familiarity with and adherence to the ASCO practice guidelines on this topic.
A little more than one-third of participating doctors reported familiarity with the 2005 ASCO guidelines on fertility preservation. Among specialists, medical oncologists (who give chemotherapy and other whole-body medicines and often serve as the coordinating doctor for women affected by breast cancer) and hematological oncologists (who focus on cancers of the blood and tissues that form blood) were 2.1 times more likely than other doctors to report that they felt comfortable talking about fertility preservation.
Oncologists who held favorable attitudes about fertility protection were nearly five times more likely to discuss the effect of treatment on fertility than oncologists who reported unfavorable attitudes, the survey showed.
Although most of the oncologists who completed the survey (77 percent) said they discuss fertility preservation, less than one-quarter refer women to fertility specialists for counseling or provide them with educational materials. Of the barriers to physician-woman communications identified in the survey, the most frequently cited reason was the need to begin treatment immediately because of the stage of cancer. Other barriers included cost of fertility preservation options (which usually are not covered by insurance) and time constraints during the consultation process.
Future study should include the development of teaching tools to help doctors and nurses more readily communicate about fertility preservations concerns, the researchers concluded.
What Does This Survey Mean for Me?
If you hope to start a family some day, fertility preservation is an important part of your treatment-planning process. Ask your doctor to explain how your age and different treatment options could affect your ability to become pregnant.
You also may wish to ask your doctor, or consult with a fertility specialist, about the different techniques for preserving your ability to have children. If you’re not sure how to discuss your concerns with your doctor or nurse, or want more information, one resource is the Web site of the Lance Armstrong Foundation’s program Fertile Hope . To find a fertility specialist, visit the Web site of the American Society for Reproductive Medicine, which has a "find a doctor" tool under the "For Patients" section. Living Beyond Breast Cancer also has publications on fertility, pregnancy, adoption and other helpful topics.
G. Quinn et al. National survey of physicians practice patterns: Fertility preservation and cancer patients. Presented during the "Patient and Survivor Care" session of the 45th annual meeting of the American Society of Clinical Oncology. Abstract CRA9508. Published in J Clin Oncol 27:18s, 2009.