Radiologists and Medical Oncologists Attend to Fertility Issues in Younger Survivors

Contemporary treatment options have improved survival in cancer patients, making it more important than ever to focus on quality-of-life issues such as fertility in survivors of childbearing age. The majority of radiologists and medical oncologists appear to appreciate the need for attention to fertility in age-appropriate patients, according to a study published online ahead of print in Practical Radiation Oncology (Gwede C, et al. 2012). The survey found that more than 80% of radiation oncologists and medical oncologists discuss the impact of treatment on fertility with patients of childbearing age.

“These findings are particularly important for radiation oncologists, who may have a unique role in communicating fertility preservation options to their patients, since their patients have daily interaction with staff and weekly treatment exams with the radiation oncology physician and nurse,” stated senior author of this paper, Gwendolyn P. Quinn, PhD, Moffitt Cancer Center, Tampa, Florida.

As the authors point out, with successful treatment, survival is increased. In the past, the clinical focus was on keeping patients alive, but now attention has shifted to survival with good quality of life. Chemotherapy, radiotherapy, and surgery can impact fertility. Thus, options for preserving fertility should be discussed prior to initiation of cancer treatment with patients who may want to have a first child or an additional child.

Unfortunately, previous studies suggested that less than 50% of adult cancer patients of childbearing age are given adequate information about fertility-preserving options prior to cancer treatment, and less than 35% of women stated that they discussed risk of infertility during or after cancer treatment.

The present study sought to examine patterns of discussion of fertility preservation and referrals among medical oncologists, radiation oncologists, and surgical oncologists. These professionals were surveyed about whether they “always/often,” “sometimes,” or “rarely/never” initiated discussions on the impact of treatment on future fertility.

Radiation and medical oncologists were more proactive than surgical oncologists in having fertility discussions with patients; 83% of radiation oncologists and 84% of medical oncologists discussed fertility options with patients “always/often,” compared with only 51% of surgical oncologists. None of the radiation oncologists, 4% of medical oncologists, and 20% of surgical oncologists said they “never” discussed it with their patients.

Surprisingly, in view of the fertility discussion rates, referral rates for fertility preservation among the 3 specialties were similar: 40% of radiologists, 45% of medical oncologists, and 46% of surgical oncologists reported referring patients of childbearing age to fertility specialists “always/often.”