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Factors associated with the receipt of fertility preservation services along the decision-making pathway in young Canadian female cancer patients

  • Fertility Preservation
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Abstract

Purpose

This study investigated the factors associated with the receipt of fertility preservation (FP) services along the decision-making pathway in young Canadian female cancer patients. The roles of the oncologists were examined.

Methods

A total of 188 women who were diagnosed with cancer between the ages of 18–39 after the year 2000 and had finished active cancer treatment by the time of the survey (2012–2013) participated in the study. Logistic regression models and Pearson χ 2 tests were used for analyses.

Results

The mean ages of participants at diagnosis and at survey time were 30.2 (SD = 3.7) and 33.9 (SD = 5.9). One quarter (n = 45, 23.9 %) did not recall having a fertility discussion with their oncologists. Of the three quarters who had a fertility discussion (n = 143, 76.1 %), discussions were equally initiated by oncologists (n = 71) and patients (n = 72). Of the 49 women (26 %) who consulted a fertility specialist, 17 (9 %) underwent a FP procedure. Fertility concern at diagnosis was the driving force of the receipt of FP services at all decision points. Our findings suggest that not only was the proactive approach of oncologists in initiating a fertility discussion important, the quality of the discussion was equally critical in the decision-making pathway.

Conclusions

Oncologists play a pivotal role in the provision of fertility services in that they are not only gate keepers, knowledge brokers, and referral initiators of FP consultation, but also they are catalysts in supporting cancer patients making important FP decision in conjunction with the consultation provided by a fertility specialist.

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Notes

  1. Young Adult Cancer Canada http://www.youngadultcancer.ca/ and Rethink Breast Cancer http://rethinkbreastcancer.com/

  2. Princess Margaret Hospital, Sunnybrook Odette Cancer Centre, Toronto General Hospital, Women’s College Hospital.

References

  1. Practice Committee of American Society for Reproductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2013;100:1214–23.

    Article  Google Scholar 

  2. Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, et al. American society of clinical oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24:2917–31.

    Article  PubMed  Google Scholar 

  3. Loren AW, Mangu PB, Lindsay NB, 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;31:2500–11.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Carter J, Raviv L, Applegarth L, Ford JS, Josephs L, Grill E, et al. A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance. J Cancer Surviv. 2010;4:236–46.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, et al. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2012;118:1710–7.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Mersereau JE, Goodman LR, Deal AM, Gorman JR, Whitcomb BW, Su HI. To preserve or not to preserve. Cancer. 2013;119:4044–50.

    Article  PubMed Central  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. Sobota A, Ozakinci G. Fertility and parenthood issues in young female cancer patients-a systematic review. J Cancer Surviv. 2014;8:707–21.

    Article  PubMed  Google Scholar 

  10. Linkeviciute A, Boniolo G, Chiavari L, Peccatori FA. Fertility preservation in cancer patients: the global framework. Cancer Treat Rev. 2014;40:1019–27.

    Article  PubMed  Google Scholar 

  11. Bastings L, Baysal O, Beerendonk CCM, Braat DDM, Nelen WLDM. Referral for fertility preservation counselling in female cancer patients. Hum Reprod. 2014;29:2228–37.

    Article  CAS  PubMed  Google Scholar 

  12. Rosen MP, Letourneau JM, Cedars MI, Melisko ME. A changing perspective: improving access to fertility preservation. Nat Rev Clin Oncol. 2011;8:56–60.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Tschudin S, Bitzer J. Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod Update. 2009;15:587–97.

    Article  PubMed  Google Scholar 

  14. Goossens J, Delbaere I, Van Lancker A, Beeckman D, Verhaeghe S, Van Hecke A. Cancer patients' and professional caregivers' needs, preferences and factors associated with receiving and providing fertility-related information: a mixed-methods systematic review. Int J Nurs Stud. 2014;51:300–19.

    Article  PubMed  Google Scholar 

  15. 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 Adolescent Health. 2014;54:527–35.

    Article  Google Scholar 

  16. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Partridge AH, Gelber S, Peppercorn J, Sampson E, Knudsen K, Laufer M, et al. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol. 2004;22:4174–83.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Peate M, Meiser B, Cheah BC, Saunders C, Butow P, Thewes B, et al. Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer. Br J Cancer. 2012;106:1053–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Degner LF, Sloan JA, Venkatesh P. The control preferences scale. Can J Nurs Res. 1997;29:21–43.

    CAS  PubMed  Google Scholar 

  21. Stalmeier PFM, Roosmalen MS, Verhoef LCG, Hoekstra-Weebers J, Oosterwijk JC, Moog U, et al. The decision evaluation scales. Patient Educ Couns. 2005;57:286–93.

    Article  PubMed  Google Scholar 

  22. Holmes-Rovner M, Kroll J, Schmitt N, Rovner DR, Breer ML, Rothert ML, et al. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Making. 1996;16:58–64.

    Article  CAS  PubMed  Google Scholar 

  23. Brehaut JC, O'Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, et al. Validation of a decision regret scale. Med Decis Making. 2003;23:281–92.

    Article  PubMed  Google Scholar 

  24. Cousson-Gélie F, Cosnefroy O, Christophe V, Segrestan-Crouzet C, Merckaert I, Fournier E, et al. The Ways of Coping Checklist (WCC). J Health Psychol. 2010;15:1246–56.

    Article  PubMed  Google Scholar 

  25. Gorman JR, Usita PM, Madlensky L, Pierce JP. Young breast cancer survivors: their perspectives on treatment decisions and fertility concerns. Cancer Nurs. 2011;34:32–40.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Gorman JR, Bailey S, Pierce JP, Su HI. How do you feel about fertility and parenthood? The voices of young female cancer survivors. J Cancer Surviv. 2012;6:200–9.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  28. Penrose R, Beatty L, Mattiske J, Koczwara B. Fertility and cancer—a qualitative study of Australian cancer survivors. Support Care Cancer. 2012;20:1259–65.

    Article  PubMed  Google Scholar 

  29. Hill KA, Nadler T, Mandel R, Burlein-Hall S, Librach C, Glass K, et al. Experience of young women diagnosed with breast cancer who undergo fertility preservation consultation. Clin Breast Cancer. 2012;12:127.

    Article  PubMed  Google Scholar 

  30. Tschudin S, Bunting L, Abraham J, Gallop-Evans E, Fiander A, Boivin J. Correlates of fertility issues in an internet survey of cancer survivors. J Psychosom Obstet Gynaecol. 2010;31:150–7.

    Article  PubMed  Google Scholar 

  31. Wilkes S, Coulson S, Crosland A, Rubin G, Stewart J. Experience of fertility preservation among younger people diagnosed with cancer. Hum Fertil. 2010;13:151–8.

    Article  Google Scholar 

  32. Vadaparampil ST, Christie J, Quinn GP, Fleming P, Stowe C, Bower B, et al. A pilot study to examine patient awareness and provider discussion of the impact of cancer treatment on fertility in a registry-based sample of African American women with breast cancer. Support Care Cancer. 2012;20:2559–64.

    Article  PubMed  Google Scholar 

  33. Garvelink MM, ter Kuile MM, Fischer MJ, Louwé LA, Hilders CGJM, Kroep JR, et al. Development of a decision aid about fertility preservation for women with breast cancer in the netherlands. J Psychosom Obstet Gynaecol. 2013;34:170–8.

    Article  PubMed  Google Scholar 

  34. Gorman JR, Malcarne VL, Roesch SC, Madlensky L, Pierce JP. Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat. 2010;123:477–85.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Woodruff TK, Clayman ML, Waimey KE. Oncofertility communication: Sharing information and building relationships across disciplines. New York:Springer;2014

  36. Nisker J. Socially based discrimination against clinically appropriate care. CMAJ. 2009;181:764.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Nisker J. Letter to the editor: a national study of the provision of oncofertility services to female patients in Canada. JOGC. 2013;35:21.

    PubMed  Google Scholar 

  38. Snyder KA, Tate A. In: Woodruff TK, Clayman M, Waimey KE, editors.Oncofertility communication: Sharing information and building relationships across disciplines. New York: Springer; 2014. pp.49-60.

  39. Yee S, Fuller-Thomson E, Lau A, Greenblatt EM. Fertility preservation practices among Ontario oncologists. J Cancer Educ. 2012;27:362–8.

    Article  PubMed  Google Scholar 

  40. Mersereau J. Communication between oncofertility providers and patients. In: Gracia C, Woodruff TK, editors. Oncofertility medical practice: clinical issues and implementation. New York: Springer; 2012. p. 149–60.

    Chapter  Google Scholar 

  41. Lee S, Heytens E, Moy F, Ozkavukcu S, Oktay K. Determinants of access to fertility preservation in women with breast cancer. Fertil Steril. 2011;95:1932–6.

    Article  PubMed Central  PubMed  Google Scholar 

  42. 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.

    Article  PubMed  Google Scholar 

  43. Thewes B, Meiser B, Taylor A, Phillips KA, Pendlebury S, Capp A, et al. Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol. 2005;23:5155–65.

    Article  CAS  PubMed  Google Scholar 

  44. Lee RJ, Wakefield A, Foy S, Howell SJ, Wardley AM, Armstrong AC. Facilitating reproductive choices: the impact of health services on the experiences of young women with breast cancer. Psycho-Oncology. 2011;20:1044–52.

    Article  PubMed  Google Scholar 

  45. Chapple A, Salinas M, Ziebland S, McPherson A, Macfarlane A. Fertility issues: the perceptions and experiences of young men recently diagnosed and treated for cancer. J Adolescent Health. 2007;40:69–75.

    Article  Google Scholar 

  46. Connell S, Patterson C, Newman B. A qualitative analysis of reproductive issues raised by young Australian women with breast cancer. Health Care Women Int. 2006;27:94–110.

    Article  PubMed  Google Scholar 

  47. Scanlon M, Blaes A, Geller M, Majhail NS, Lindgren B, Haddad T. Patient satisfaction with physician discussions of treatment impact on fertility, menopause and sexual health among pre-menopausal women with cancer. J Cancer. 2012;3:217–25.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Yeomanson DJ, Morgan S, Pacey AA. Discussing fertility preservation at the time of cancer diagnosis: dissatisfaction of young females. Pediatr Blood Cancer. 2013;60:1996–2000.

    CAS  PubMed  Google Scholar 

  49. 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. Psycho-Oncology. 2014;23:20–6.

    Article  PubMed  Google Scholar 

  50. Peddie VL, Porter MA, Barbour R, Culligan D, MacDonald G, King D, et al. Factors affecting decision making about fertility preservation after cancer diagnosis: a qualitative study. BJOG. 2012;119:1049–57.

    Article  CAS  PubMed  Google Scholar 

  51. 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.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Society for Assisted Reproductive Technology & Practice Committees of American Society for Reproductive Medicine [ASRM]. Mature oocyte cryopreservation: A guideline. Fertil Steril. 2013;99:37–43.

  53. Bastings L, Baysal Ö, Beerendonk CCM, IntHout J, Traas MAF, Verhaak CM, et al. Deciding about fertility preservation after specialist counselling. Hum Reprod. 2014;29:1721–9.

    Article  CAS  PubMed  Google Scholar 

  54. Klock SC, Zhang JX, Kazer RR. Fertility preservation for female cancer patients: early clinical experience. Fertil Steril. 2010;94:149–55.

    Article  PubMed  Google Scholar 

  55. Armuand GM, Rodriguez-Wallberg K, 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.

    Article  PubMed  Google Scholar 

  56. Peate M, Meiser B, Friedlander M, Zorbas H, Rovelli S, Rovelli S, et al. It's now or never: Fertility-related knowledge, decision-making preferences, and treatment intentions in young women with breast Cancer—an Australian fertility decision aid collaborative group study. J Clin Oncol. 2011;29:1670–7.

    Article  PubMed  Google Scholar 

  57. Mersereau JE, Sandbulte JT. Fertility preservation in young women with breast cancer. Curr Obstet Gynecol Rep. 2013;2:59–64.

    Article  Google Scholar 

  58. Blank T, Graves K, Sepucha K, Llewellyn-Thomas H. Understanding treatment decision making: contexts, commonalities, complexities, and challenges. Ann Behav Med. 2006;32:211–7.

    Article  PubMed  Google Scholar 

  59. Noyes N, Melzer K, Druckenmiller S, Fino ME, Smith M, Knopman JM. Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors. J Assist Reprod Genet. 2013;30:1263–70.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Quinn GP, Vadaparampil ST, Fertility Preservation RG. Fertility preservation and adolescent/young adult cancer patients: physician communication challenges. J Adolescent Health. 2009;44:394–400.

    Article  Google Scholar 

  61. Lee S, Ozkavukcu S, Heytens E, Moy F, Oktay K. Value of early referral to fertility preservation in young women with breast cancer. J Clin Oncol. 2010;28:4683–6.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Balthazar U, Deal AM, Fritz MA, Kondapalli LA, Kim JY, Mersereau JE. The current fertility preservation consultation model: are we adequately informing cancer patients of their options? Hum Reprod. 2012;27:2413–9.

    Article  PubMed  Google Scholar 

  63. Quinn GP, Vadaparampil ST, Sehovic I, Clayman ML. In: Woodruff TK, Clayman M, Waimey KE, editors. Oncofertility communication: Sharing information and building relationships across disciplines. New York: Springer; 2014. pp.35-48

  64. Blough K, Mansfield C, Kondapalli LA. Seamless integration of clinical care and research in an innovative fertility preservation program: the Colorado oncofertility program model. J Cancer Surviv. 2014;8:533–8.

    Article  PubMed  Google Scholar 

  65. Zebrack BJ, Mills J, Weitzman TS. Health and supportive care needs of young adult cancer patients and survivors. J Cancer Surviv. 2007;1:137–45.

    Article  PubMed  Google Scholar 

  66. Elizur SE, Tulandi T, Meterissian S, Huang JYJ, Levin D, Tan SL. Fertility preservation for young women with rectal cancer—a combined approach from one referral center. J Gastrointest Surgery. 2009;13:1111–5.

    Article  Google Scholar 

  67. King L, Quinn GP, Vadaparampil ST, Miree CA, Wilson C, Clayton H, et al. Oncology social workers' perceptions of barriers to discussing fertility preservation with cancer patients. Soc Work Health Care. 2008;47:479–501.

    Article  PubMed  Google Scholar 

  68. Balthazar U, Fritz MA, Mersereau JE. Fertility preservation: a pilot study to assess previsit patient knowledge quantitatively. Fertil Steril. 2011;95:1913–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

The author gratefully appreciated the mentorship of Esme Fuller-Thomson PhD (supervisor), Marilyn Crawshaw PhD, Shelley L. Craig PhD, and Terry Cheng PhD from the Doctoral Thesis Committee to supervise this doctoral research study. The author was also grateful to Bradley Zebrack PhD and David Brennan PhD for their critical review of the dissertation.

The author would like to acknowledge the help from Young Adult Cancer Canada and Rethink Breast Cancer for recruiting 9 young cancer survivors to pilot test the study survey. Sincere thanks are given to the following 53 Canadian cancer groups for disseminating the recruitment flyers through their networks: Abreast of ‘bridge Cancer Survivor Dragon Boat Club Lethbridge Alberta, Bikinis for Breast Cancer, Bladder Cancer Canada, Bladder Cancer Support Group, Breast Cancer Action Kingston, Breast Cancer Action Montreal, Breast Cancer Action Nova Scotia, Breast Cancer Support Network, Breast Cancer Support Services, Breast Friends Dragon Boat Racing Team Edmonton, British Columbia Cancer Agency, Canadian Breast Cancer Foundation, Canadian Cancer Society, North West Territories Division Alberta, Canadian Cancer Society, Nova Scotia Division, Canadian Cancer Survivor Network, Canadian Partnership Against Cancer, Canadian Skin Cancer Foundation, Cancer Care Manitoba, Cancer Care Nova Scotia, Cancer Chat Canada, Cancer Fight Club, Cancer Insight Ltd, Cancer Knowledge Network, Cancerview, Colorectal Cancer Association of Canada, Compassionate Beauty, David Cornfield Melanoma Fund, Ellicsr: Health, Wellness & Cancer Survivorship Centre, Gilda’s Club Great Toronto, Gilda’s Club Simcoe Muskoka, Heart - Hope Eternal Areola Reconstructive Tattooing, Hearth Place Cancer Support Centre, Hereditary Breast & Ovarian Cancer Society of Alberta, Hereditary Breast & Ovarian Cancer Society of Montreal, Hope Spring Cancer Support Centre, Knot a Breast, Mastectomy Wear for Fighters and Survivors, Melanoma Network of Canada, Nanny Angel Network, Ovarian Cancer Canada, Peterborough’s Breast Cancer Survivor Team, Princess Margaret Hospital, Rethink Breast Cancer, Sarcoma Cancer Foundation of Canada, Sunnybrook Odette Cancer Centre, Survive and Thrive Expedition, Surviving Beautifully, Think Pink Direct, Thrive: Physical Activity for Cancer Survivors, Thunder Bay Breast Cancer Support Group, Willow Breast Cancer Support Canada, Women’s College Hospital, and Young Adult Cancer Canada.

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Authors and Affiliations

  1. Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada

    Samantha Yee

  2. CReATe Fertility Centre, 790 Bay Street, Suite 1002, Toronto, Ontario, M5G 1N8, Canada

    Samantha Yee

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  1. Samantha Yee
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Correspondence to Samantha Yee.

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Ethical approval

This study was approved by the University of Toronto’s Office of Research Ethics (#27879).

Funding

This doctoral research project was generously funded by the Ontario Graduate Scholarship, the University of Toronto Fellowship Award, and the University of Toronto Factor-Inwentash Faculty of Social Work Doctoral Completion Award.

Additional information

Conference presentations

The findings from this study were presented in part at the Annual Meetings of the Canadian Fertility and Andrology Society (CFAS) in September 2013 and September 2014, and at the Annual Meeting of the American Society of Reproductive Medicine in October 2013. The presentations received the CFAS Best Psychosocial Paper 2013, the CFAS Travel Award 2013, and the Canadian Institutes of Health Research Travel Award 2014.

Capsule

Oncologists play a pivotal role in the provision of oncofertility serivces along the decision-making pathway in young female cancer patients.

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Yee, S. Factors associated with the receipt of fertility preservation services along the decision-making pathway in young Canadian female cancer patients. J Assist Reprod Genet 33, 265–280 (2016). https://doi.org/10.1007/s10815-015-0608-x

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