Discussion is an integral component of the cancer treatment plan.
In a June 19, 2015 article in US News and World Report, health reporter Lisa Esposito wrote about the effects of cancer treatment on fertility and what can be done to preserve fertility. Although the information was targeted to a public audience, it reminds us all about the importance of informing our patients about the effects of cancer treatment on fertility, and more importantly, having the discussion about childbearing goals with the patient and his or her partner. It may be even more important to discuss this with un-partnered patients, who may be so fixated on discussing the proposed treatment that they say they are not interested in discussing fertility. However, the discussion about fertility needs to occur so that patients will have childbearing options in the future if they so desire.
The field of fertility cryopreservation is expanding and includes sperm banking and egg harvesting and storage. Until 2012, embryo cryopreservation was the standard of care, but now egg cryopreservation is equally acceptable and enables single women without a current partner to preserve their fertility. It also reduces religious, cultural, and legal implications that may arise when embryos are stored and not used. One current issue, however, is that many patients encounter a long wait time to access these services, and may instead forego fertility preservation in order to start cancer treatment sooner. There are some fast-track fertility preservation programs in the United States, although in many cases, travel may be required and may not be an option for many patients in terms of time and affordability.
The bottom line is that we need to have a discussion about fertility with our patients—all of our patients. We need to refrain from making the assumption, for instance, that a 40-year-old woman with teenagers is not interested in preserving her fertility. We have the responsibility to bring up the topic of fertility and talk about it. Guidelines from the National Comprehensive Cancer Network and the American Society of Clinical Oncology state that patients should routinely be offered a referral with a reproductive specialist as part of the treatment plan process.