Women of childbearing age with cancer may lose their fertility through treatments
Only half of young women with cancer are referred to a gynaecologist for a discussion about preserving her fertility, for example by freezing eggs. This care leads to a better quality of life and less choice stress and regret, according to research by Radboudumc. The situation can be improved through a decision aid for patients, training for care providers, greater awareness and clear agreements.
Women of reproductive age with cancer can lose their fertility due to treatments such as chemotherapy, radiation, or surgery on the reproductive organs. They often want to have the opportunity to have children in the future, once they have recovered from cancer. For example, a gynecologist can often freeze eggs or move the ovaries before starting cancer treatments, so that fertility is preserved. But by no means all women receive information about these options.
‘It has improved in recent years, but by no means all women receive information about this and only half of the women are referred to a gynaecologist,’ explains PhD candidate Michelle van den Berg of Radboudumc. ‘In my dissertation I show that women who do receive this care have a higher quality of life after their recovery from cancer, experience less stress from their decision and have fewer regrets. Even if they did not opt for a treatment to preserve fertility.’
Why is it that not all young women with cancer receive this care? Gynecologist Ina Beerendonk explains: ‘It is a combination of factors. Sometimes there is a lack of awareness and knowledge of this subject. It is also a matter of time, logistics and attitude. Sometimes good information is not available in a hospital, or it is unclear who is responsible. The surgeon performing the surgery? Or the oncologist who gives the chemotherapy?’
The Radboudumc research team makes concrete recommendations for improving fertility care for young women with cancer. For example, they developed an online decision aid that supports women in their decision. This decision aid has been developed for 23 different types of cancer, because both the disorders and the associated treatments have different effects on fertility.
Not all hospitals use the decision aid yet. Training of care providers is important in this regard. Another challenge is availability. ‘There are many good decision aids in the Netherlands, but these often end up on the shelf after completion of a project in which they have been developed and tested,’ says professor of Personal Oncological Care Rosella Hermens. ‘That is partly because hosting and maintenance costs money. Fortunately, the parties from the Outline Agreement are now working nationally on a plan for maintenance, control, payment and a location for good and reliable decision aids.’
A second recommendation is the deployment of specialized nurses in the reproductive medicine department. They form a permanent point of contact during the fertility process in cancer, so that a patient sees fewer different faces. Van den Berg: ‘This care is available in most IVF centers in the Netherlands. It would be good if all centers had one or two nurses who specialize in this subject and thus provide continuity of care.’
Finally, the researchers mention the importance of awareness and clarity about responsibilities. Beerendonk: ‘We would like fertility care for cancer to receive more attention and become part of the care process. We can achieve this by, for example, a reminder in electronic patient files. In addition, fertility should be a permanent item on the agenda of the multidisciplinary oncological consultation. Each hospital must also have clear agreements about who informs the young women and who refers them. This subject deserves a permanent place in healthcare.’
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