What's worse than a diagnosis of cancer?

Cancer therapy can make male and female patients infertile, which is why the American Society of Clinical Oncology (ASCO) makes the following recommendations:

RECOMMENDATIONS: As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise.

But according to an ASCO conference presentation, fewer than 25 percent of oncologists surveyed report referring patients to fertility specialists. From MedPage Today (ASCO: Fertility Preservation Not a Top Priority for Oncologists)

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, [Gwendolyn Quinn, Ph.D., of the H. Lee Moffitt Cancer Center and Research Institute] 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.

I agree that it’s the responsibility of oncologists to initiate the discussion, but since it doesn’t seem to be happening it’s up to patients, families and friends need to take the initiative.

As hard as it may be to bring up, if you or someone you know of reproductive age gets a cancer diagnosis, you might want to consider being the one to say something.

June 8, 2009

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