Gender bias found in fertility counseling for cancer survivors

Robin Wulffson MD's picture
cancer survivor, fertility preservation, infertility, frozen ova, frozen embryos
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Recent medical advances have increased the number of cancer survivors. Following successful treatment and return to a normal life, a number of cancer survivors in their reproductive years desire to start - or complete - their family. Unfortunately, however, the cancer treatment can impact their therapy.

A new study by Swedish researchers has found that more men than women are counseled regarding fertility preservation before embarking on a treatment regimen. Researchers at the Karolinska University Hospital (Stockholm, Sweden) and the Uppsala University (Uppsala, Sweden) published their findings online in the Journal of Clinical Oncology.

The goal of the study was to investigate the perception of fertility-related information and use of fertility preservation in male and female cancer survivors who were of reproductive age. The authors reviewed data from population-based registers in Sweden and identified cancer survivors diagnosed from 2003 to 2007. Included in the study were cancer survivors who were age 18 to 45 years at diagnosis and had lymphoma, acute leukemia, testicular cancer, ovarian cancer, or female breast cancer that was treated with chemotherapy. A questionnaire was mailed to 810 eligible participants; 484 cancer survivors (60%) returned the questionnaire.

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The researchers found that the majority of male participants reported having received information about the impact of cancer treatment on fertility (80%) and fertility preservation (68%); more than half of the men banked frozen sperm (54%). The women were less informed. Less than half (48%) reported that they received information about treatment impact on fertility and 14% reported that they received information about fertility preservation. Only seven women (2%) underwent fertility preservation. Predictors for receiving information about treatment impact on fertility were a pretreatment desire to have children, male gender, and being age 35 years or less at diagnosis. Predictors for receiving information about fertility preservation included male gender, age 35 years or less at diagnosis, and having no children at diagnosis.

The authors concluded that a marked gender difference was found in regard to the receipt of fertility-related information and use of fertility preservation. They stressed that an urgent need existed for the dissemination of fertility-related information to female cancer victims. This would allow them to participate in informed decisions regarding their treatment and future reproductive ability.

Take home message:
This study should serve as a wakeup call to healthcare professionals caring for cancer patients. All cancer patients of reproductive age should be offered counseling in regard to the impact of the therapy on their fertility and options for fertility preservation. The study is important information for any cancer victim facing treatment. If a healthcare professional does not offer counseling, it should be requested by interested women. Cancer treatment with radiation and/or chemotherapy can impact fertility. If a woman is desirous of future fertility, in some cases, the treatment regimen can be modified to improve a woman’s chances of future childbearing. Women can have ova (eggs) or portions of their ovaries frozen for future use. Excellent results have been reported with this approach. Also, embryos can be frozen to be implanted at a future date. The foregoing methods may be of interest to a surviving spouse of a woman who does not survive her cancer. Embryos can be implanted in a surrogate in this situation.

Reference: Journal of Clinical Oncology

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