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Cancer patients do not have access to fertility support

Less than half of the doctors said that they referred patients to a reproductive specialist when patients had fertility concerns.

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Half of the cancer patients of childbearing age do not receive adequate information about the impact of treatment on their fertility, reducing their options for family planning and support, a new study suggests.

“If we look at the studies of regret after treatment of cancer is an area that is always called, is the reproductive regret. Women come back and say they never got the chance to discuss their fertility and now it is gone,” Dr. Donald Dizon, clinical co-director of the gynecologic oncology at the Massachusetts General Hospital Cancer Center, told Reuters Health.

“My hope is that this study emphasises the importance of the education of the fertility on all patients of childbearing age, regardless of the forecast,” said Dizon, who was not involved in the research.

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For the new analysis, Dr. Shanna Logan at the Kids Cancer Centre, Sydney Children’s Hospital in Australia and colleagues examined data from 23 previous studies conducted in seven countries from 2007 to 2016.

In the studies, the chance that healthcare providers and patients discussed fertility issues depending on the provider of the specialty of the patient, gender and age, and provider attitudes and knowledge of fertility preservation techniques.

In a study included in the review, 93 percent of doctors said that they routinely discuss fertility issues with their patients, but the medical records showed that only 74 percent actually did so.

In another study, nurse specialists will be discussed with the patient the possibility that the treatment may have a negative impact on the fertility 68 percent of the time, while only 40 percent of the surgeons reported to be involved in the discussion.

Less than half of the doctors said that they referred patients to a reproductive specialist when patients had fertility concerns. One study found that only 61 percent of the doctors were aware of an established referral path to a fertility clinic.

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Cancer and the treatment of cancer, either temporarily or permanently affect the fertility potential of 50 percent to 75 percent of the cancer survivors. The American Society of Clinical Oncology (ASCO) recommends that healthcare providers discuss as early as possible the risk of infertility and fertility preservation options with all the post-pubescent-patients who undergo the treatment of cancer.

Logan told Reuters Health via e-mail of young female patients reported greater barriers to receiving the right oncofertility support than male patients.

The sperm bank is often more readily available than the female retention techniques, she noted.

“At times, patients report that doctors felt embarrassed having these conversations, or not attach much importance to the subject of fertility,” Logan said.

She emphasized that patients want both verbal and written information related to their age and the type of tumor.

Logan is of the opinion oncofertility support is not uniform, because doctors are not all the same up-to-date information about the available resources.

Dizon agree. In a telephone interview, he said oncologists have not been trained in reproductive methods, so that they do not have to explain.

“I wish I could say that I was shocked that oncofertility support is not offered routinely, but I don’t know,” Dizon added.

Oncologists who are not familiar with these discussions need to refer patients to other experts, ” he said. But outside of the major medical centers, he noted, these services may not be available everywhere.

Dr. Paas-Patrick, director of the Yale Fertility Center and the Fertility Preservation Program in New Haven, Connecticut, told Reuters Health by phone, “We are making good progress with the patients be referred to a reproductive endocrinologist in a timely manner, but we still have a lot of work to do.”

Preservation of fertility must not endanger the patient’s chance of cure, Patrick said. He only needs 10 days for the planning of a fertility preservation strategy, such as collection or retrieval of eggs. When a patient needs to begin treatment immediately, ovarian tissue can be cryopreserved in 48 hours.

Logan said: “the Provision of oncofertility care at the time of diagnosis and survival, is integral in reducing later psychological problems and reduced quality of life in cancer survivors with impaired fertility.”

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