Some breast cancer treatments, including chemotherapy and hormonal therapy, can cause temporary or permanent infertility. The study reviewed here found that doctors don't give patients enough information about fertility problems that may happen because of cancer treatments. Most doctors also didn't refer cancer patients to fertility specialists for counseling before treatment started. The results were presented at the 2009 American Society of Clinical Oncology (ASCO) Annual Meeting.
More than 600 oncologists were asked about their knowledge of treatment-related infertility, as well as what they actually do about infertility issues when caring for patients:
If you're a pre-menopausal woman diagnosed with breast cancer, the ability to have children after breast cancer treatment may be important to you. Still, it's very likely that a breast cancer diagnosis and the need to start treatment as soon as possible may push thoughts about future fertility (and many other things) to the back of your mind.
But while you and your doctor are planning your treatment is the best time to figure out how specific treatments might affect your fertility and learn about steps you can take to improve your chances of having a child in the future. For example, eggs from your ovaries can be extracted and stored until your treatment is completed. Other techniques include removing and storing a portion of ovarian tissue that is then put back in the body after treatment.
If you're about to start breast cancer treatment and being able to have a child in the future is important to you, be sure to tell your doctor. Ask your doctor how any treatments being considered could affect your future fertility. If the treatments that are best for you could cause fertility problems, ask your doctor about steps you can take to preserve your fertility. You also may want to ask for a referral to an infertility specialist.
You can learn more about breast cancer treatment and infertility issues in the Breastcancer.org Fertility, Pregnancy, Adoption section.
ORLANDO, June 2 (MedPage Today) -- Oncologists may talk about preserving fertility but they don't do much about it.
That's the bottom line of a national survey of doctors about their attitudes and knowledge of fertility preservation guidelines, as well as what they actually do, according to Gwendolyn Quinn, Ph.D., of the H. Lee Moffitt Cancer Center and Research Institute in Miami.
The survey found that 70% of oncologists said they discuss the issue with newly diagnosed patients, but less than 25% refer patients to fertility specialists, Dr. Quinn said at the annual meeting of the American Society of Clinical Oncology.
She and her colleagues mailed the survey to a random sample of 1,979 oncologists, of whom 613 -- or 33% -- responded. The physicians were quizzed on their knowledge of the 2006 ASCO guidelines, as well as what they do about them.
Of the respondents, 38% said they had no knowledge of the guidelines, Dr. Quinn said, although, overall, seven out of 10 said they make a habit of discussing fertility with patients.
But the depth of that talk could vary considerably, she said. "It might be as simple as saying 'you could become sterile as a result of your treatment' to a lengthy discussion," Dr. Quinn said.
Less than 25% of the doctors said they distributed educational materials on the subject to patients.
Dr. Quinn said about 450,000 people every year could be in need of fertility counseling after a diagnosis of cancer. It's unlikely that an information campaign aimed at patients would give them the knowledge they need, she said.
"This is definitely a physician responsibility," Dr. Quinn said.
One reason doctors give for not talking about the issue is that the nature of the patient's disease is so pressing there's no time for fertility preservation, Dr. Quinn said.
So they simply don't discuss the option, she said.
Another issue is the cost of fertility preservation, which is not covered by any insurance plan in the U.S., she said.
The information gap is understandable, according to Jennifer Obel, M.D., of the NorthShore University HealthSystem in Evanston, Ill., who moderated a press conference at which the research was represented.
"Caring for a cancer patient is very complex at the moment of diagnosis," Dr. Obel said. "Fertility preservation can run down to a less important priority."
And patients are often "dumbstruck at the diagnosis," she said. "They're not thinking about it."
But she said it's important to "re-prioritize" the issue.
"Our patients lack the concrete information that may help them preserve their fertility," she said.
Noting that the theme of this meeting is personalized care, Dr. Obel said, "we need to personalize care across the continuum of a patient's life."
The study was supported by the American Cancer Society. The researchers said they had no disclosures to report.
Dr. Obel said she had financial links with Onyx Pharmaceuticals.
Primary source: Journal of Clinical Oncology Source reference: Quinn G, et al "National survey of physicians practice patterns: Fertility preservation and cancer patients" J Clin Oncol 2009; 27(15S): Abstract CRA9508.
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