Patient perceptions of reproductive health counseling at the time of cancer diagnosis: A qualitative study of female California cancer survivors

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA 94115, USA.
Journal of Cancer Survivorship (Impact Factor: 3.3). 07/2012; 6(3):324-32. DOI: 10.1007/s11764-012-0227-9
Source: PubMed


We sought to determine what women recall about reproductive health risks (RHR) from cancer therapy at the time of cancer diagnosis in order to identify barriers to reproductive health counseling (RHC) and fertility preservation (FP).
Data were obtained by surveying 1,041 female cancer survivors from the California Cancer Registry. Inclusion criteria included women age 18-40 with a diagnosis of leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, breast or GI cancer diagnosed between 1993 and 2007. Women were asked to respond to an open-ended question: "what did your doctor tell you about how cancer treatment could affect your ability to get pregnant?" Framework analysis was used to identify themes surrounding patient perceptions of RHC.
Of the patients, 51.8 % (361 out of 697) recalled receiving reproductive health counseling and 12.2 % (85 out of 697) recalled receiving FP counseling. Of the patients, 45.3 % (277 out of 612) reported that uncertain prognosis, risk of recurrence or vertical transmission, age, parity, or uncertain desire may have prevented them from receiving timely and essential information on RHRs. Communication barriers included omission of information, failure to disclose RHRs, and presentation of incorrect information on FP.
In a sample of women diagnosed with cancer of reproductive age, almost half did not recall counseling on RHRs and few recalled FP counseling. Communication barriers between physicians and patients regarding fertility may lead to uninformed (reproductive health) RH decisions.
Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.

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    • "Improvement of survival rates after certain types of cancer (Belot et al., 2008), and particularly breast cancer (Shigematsu et al., 2011) with a survival rate of 74% at 10 years (Jooste et al., 2013), chronic lymphoid leukaemia (Maynadié et al., 2013) and Hodgkin lymphoma with survival rates exceeding 80% (Gatta et al., 2009), has led to increased consideration of quality of life after cancer. The preservation of female fertility is thus a question that oncologists and reproduction specialists need to address (Niemasik et al., 2012). There are many indications for fertility preservation, including the most gonadotoxic treatments, such as chemotherapy with alkylating agents, the myeloablative treatments administered before bone marrow transplantation or haematopoietic stem cell transplantation and high-dose abdominal/pelvic radiotherapy (Sonmezer and Oktay, 2004). "
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