Obstet Gynecol Sci.  2020 Jul;63(4):480-489. 10.5468/ogs.20003.

Knowledge and awareness about fertility preservation among female patients with cancer : a cross-sectional study

• Mahey R
• Kandpal S
• Gupta M
• Vanamail P
• Bhatla N
• Malhotra N

• KMID: 2505038
• DOI: http://doi.org/10.5468/ogs.20003

Abstract

Objective
The incidence of women in the reproductive age group diagnosed with cancer has recently increased. However, very few patients opt for or are offered fertility preservation (FP) strategies because of a significant lack in awareness. The present study was conducted to evaluate the knowledge of the effect of cancer treatment on fertility and available options for FP.
Methods
This was a cross-sectional study conducted at a tertiary care center from March 2019 through August 2019. One hundred female patients with gynecological or nongynecological cancer and 18-40 years of age were interviewed. The participants were categorized on the basis of the modified Kuppuswamy socioeconomic status (SES) scale and the responses of the patients in the different categories were compared.
Results
More than half the patients (63%) were in the 20–35-year age group. Most of the patients (71%) were married, and of them, 28 (39.4%) desired to have children. Only 32% of the patients were aware of the detrimental effect of cancer and its treatment on future fertility, and of them, only 28% could specify the gonadotoxic effect of chemotherapy. Knowledge was significantly higher in the upper and middle SES levels than it was in the lower SES level (P<0.001). More than half of the patients (68%) were not aware of the existing FP options, whereas one-third of the patients (32%) were given information about FP by their physicians.
Conclusion
The overall awareness of the gonadotoxic effect of cancer therapy and available FP options in the present study was poor. Awareness of FP among both patients and clinicians needs to be increased.

Keyword

Cancer; Fertility preservation; Knowledge; Awareness; Chemotherapy

Figure

• 

  Fig. 1. Modified Kuppuswamy socioeconomic status scale.

• 

  Fig. 2. Oncofertility awareness according to (A) SES and (B) education of the patient. SES, socioeconomic status.

Reference

References

1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019; 144:1941–53.

2. van Dijk M, van den Berg MH, Overbeek A, Lambalk CB, van den Heuvel-Eibrink MM, Tissing WJ, et al. Reproductive intentions and use of reproductive health care among female survivors of childhood cancer. Hum Reprod. 2018; 33:1167–74.

3. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014; 64:83–103.

4. Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, et al. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol. 2008; 9:730–56.

5. Haggar FA, Pereira G, Preen DD, Holman CD, Einarsdottir K. Cancer survival and excess mortality estimates among adolescents and young adults in Western Australia, 1982–2004: a population-based study. PLoS One. 2013; 8:e55630.

6. Campo-Engelstein L. Consistency in insurance coverage for iatrogenic conditions resulting from cancer treatment including fertility preservation. J Clin Oncol. 2010; 28:1284–6.

7. Peate M, Meiser B, Hickey M, Friedlander M. The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review. Breast Cancer Res Treat. 2009; 116:215–23.

8. Woodruff TK. The Oncofertility Consortium--addressing fertility in young people with cancer. Nat Rev Clin Oncol. 2010; 7:466–75.

9. Irene Su H, Lee YT, Barr R. Oncofertility: meeting the fertility goals of adolescents and young adults with cancer. Cancer J. 2018; 24:328–35.

10. Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013; 31:2500–10.

11. Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018; 36:1994–2001.

12. Ethics Committee of the American Society for Reproductive Medicine. Fertility preservation and reproduction in cancer patients. Fertil Steril. 2005; 83:1622–8.

13. Corney RH, Swinglehurst AJ. Young childless women with breast cancer in the UK: a qualitative study of their fertility-related experiences, options, and the information given by health professionals. Psychooncology. 2014; 23:20–6.

14. Geue K, Richter D, Schmidt R, Sender A, Siedentopf F, Brähler E, et al. The desire for children and fertility issues among young German cancer survivors. J Adolesc Health. 2014; 54:527–35.

15. Yee S, Abrol K, McDonald M, Tonelli M, Liu KE. Addressing oncofertility needs: views of female cancer patients in fertility preservation. J Psychosoc Oncol. 2012; 30:331–46.

16. Niemasik EE, Letourneau J, Dohan D, Katz A, Melisko M, Rugo H, et al. Patient perceptions of reproductive health counseling at the time of cancer diagnosis: a qualitative study of female California cancer survivors. J Cancer Surviv. 2012; 6:324–32.

17. Sallem A, Shore J, Ray-Coquard I, Ferreux L, Bourdon M, Maignien C, et al. Fertility preservation in women with cancer: a national study about French oncologists awareness, experience, and feelings. J Assist Reprod Genet. 2018; 35:1843–50.

18. Letourneau JM, Smith JF, Ebbel EE, Craig A, Katz PP, Cedars MI, et al. Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer. Cancer. 2012; 118:4579–88.

19. Goodman LR, Balthazar U, Kim J, Mersereau JE. Trends of socioeconomic disparities in referral patterns for fertility preservation consultation. Hum Reprod. 2012; 27:2076–81.

20. Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci. 2017; 5:3264–7.

21. Howlader N, Noone A, Krapcho M, Miller D, Brest A, Yu M, et al. SEER cancer statistics review, 1975–2016. Bethesda (MD): National Cancer Institute;2020 [cited 2019 Apr 7]. Available from: https://seer.cancer.gov/csr/1975_2016.

22. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012; 62:10–29.

23. Biedka M, Kuźba-Kryszak T, Nowikiewicz T, Żyromska A. Fertility impairment in radiotherapy. Contemp Oncol (Pozn). 2016; 20:199–204.

24. Stensheim H, Cvancarova M, Møller B, Fosså SD. Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer. 2011; 129:1225–36.

25. Osmani AH, Haider G, Ali S, Ali F, Irfan M, Fatima DE. Knowledge and perceptions about cancer treatmentassociated infertility among young patients at a tertiary care hospital in Pakistan. Asian Pac J Cancer Prev. 2017; 18:3261–5.

26. Kim J, Mersereau JE. A pilot study about female adolescent/young childhood cancer survivors’ knowledge about reproductive health and their views about consultation with a fertility specialist. Palliat Support Care. 2015; 13:1251–60.

27. Duffy CM, Allen SM, Clark MA. Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol. 2005; 23:766–73.

28. Chin HB, Howards PP, Kramer MR, Mertens AC, Spencer JB. Which female cancer patients fail to receive fertility counseling before treatment in the state of Georgia? Fertil Steril. 2016; 106:1763–1771. e1.

29. Peccatori FA, Azim HA Jr, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24(Suppl 6):vi160–70.

30. Adams E, Hill E, Watson E. Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes. Br J Cancer. 2013; 108:1602–15.

31. Urech C, Ehrbar V, Boivin J, Müller M, Alder J, Zanetti Dällenbach R, et al. Knowledge about and attitude towards fertility preservation in young female cancer patients: a cross-sectional online survey. Hum Fertil (Camb). 2018; 21:45–51.

32. Chehin MB, Bonetti TC, Serafini PC, Motta E. Knowledge regarding fertility preservation in cancer patients: a population-based survey among Brazilian people during the Pink October awareness event. JBRA Assist Reprod. 2017; 21:84–8.

33. Ameri A, Novin K, Sourati A, Rashidi P. Awareness of female cancer patients about the risk of impaired fertility. J Adolesc Young Adult Oncol. 2019; 8:342–8.

34. Shnorhavorian M, Harlan LC, Smith AW, Keegan TH, Lynch CF, Prasad PK, et al. Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: a population-based study. Cancer. 2015; 121:3499–506.

35. Forman EJ, Anders CK, Behera MA. A nationwide survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. Fertil Steril. 2010; 94:1652–6.

36. Armuand GM, Rodriguez-Wallberg KA, Wettergren L, Ahlgren J, Enblad G, Höglund M, et al. Sex differences in fertility-related information received by young adult cancer survivors. J Clin Oncol. 2012; 30:2147–53.

37. Kim J, Deal AM, Balthazar U, Kondapalli LA, Gracia C, Mersereau JE. Fertility preservation consultation for women with cancer: are we helping patients make high-quality decisions? Reprod Biomed Online. 2013; 27:96–103.

38. Réseau Régional de Cancérologie OncoPaca-Corse. La Plateforme Régionale Cancer & Fertilité [Internet]. Marseille: Réseau Régional de Cancérologie OncoPacaCorse;2020 [cited 2019 Apr 7]. Available from: http://www.oncopaca.org/fr/page/la-plateforme-regionale-cancer-fertilite-oncofertilite.

39. Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, et al. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update. 2019; 25:159–79.