Advocating for Reproductive Health in Cancer Survivorship

Cancer treatment may leave some cancer survivors with fertility issues, but patients and survivors who are of reproductive age are consistently reporting fertility-related information as an unmet need. Thus, they are not receiving the care they need for it.

Study results, which were presented at the 2021 American Society of Clinical Oncology Annual Meeting, demonstrated that of 234 cancer survivors, more than half reported that their doctor did not talk about the potential fertility problems they may experience in survivorship. Additionally, one-fifth of survivors were not aware that there was an option to take steps for fertility preservation prior to starting treatment, such as banking sperm or freezing eggs.

“This means survivors are not receiving or cannot recall optimal cancer care,”
Julia Stal, lead study author and doctoral candidate in preventive medicine (health behavior research) at the University of Southern California in Los Angeles, said in an interview with Heal®.

“Rates of fertility counseling are likely to depend on tumor progression and patients’ need for timely treatment. However, a fertility discussion is needed to inform action or manage expectations of preservation among patients.”

Problems with fertility after treatment typically happen because of
the tumor location or because of treatment with gonadotoxic treatment modalities (treatment that temporarily or permanently damages ovaries or testicles), so these discussions should be happening more often.

“These fertility discussions are important to have because the goal is to provide patients with an actionable pathway by which they can make decisions for their reproductive futures,” Stal explained.

“The implications of providers not informing patients of possible fertility-related implications after cancer are multifold. Primarily, this may cause patients of reproductive age to be disproportionately affected by their cancer experience. It may also cause patients to lack the needed education to pursue fertility preservation options and ultimately can cause patients to lose their autonomy or their right to make an informed decision regarding their health care and reproductive futures.”

So, what does this mean for cancer survivors who did not have that conversation during treatment and now may be struggling?

Stal noted that options to preserve fertility post cancer treatment are limited, which may also affect survivors’ mental health.

She highlighted that in prior research, as reproductive concerns increased, so did depressive symptoms among cancer survivors at reproductive age, and roughly half of young adults have reported moderate to high reproductive concerns.

In another study, which included young adult breast cancer survivors, more than half reported that their family plans were not completed at the time of diagnosis and about 65% would have liked to have been counseled on fertility.

“Because family planning is informed by comprehensive fertility discussions and planned for through fertility preservation, without adequate fertility counseling, young adults are likely to lack knowledge surrounding their reproductive potential and are unlikely to family plan,” she said.

"Targeted reproductive health care is needed to mitigate these concerns.”

For cancer survivors who did not have this discussion and did not family plan prior to starting treatment, Stal recommends establishing care with a clinician who has expertise in oncofertility.

“I encourage survivors to advocate for themselves and ensure their needs are being met. Fertility-related unmet needs are one of the most frequently endorsed unmet needs among survivors of reproductive age and targeted, individualized health care is needed to mitigate these unmet needs,” she concluded. “(They) should connect with a specialist, someone with extensive training in reproductive health — even better if they have training in oncofer- tility, meaning reproductive health specifically for cancer survivors.”

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