Infertility is often an adverse event associated with cancer treatment and discussion of fertility preservation can impact patients’ treatment choices. However, many oncologists may feel unprepared to discuss fertility issues with young women with cancer, despite knowing that this should be discussed, according to a study published in JAMA Network Open.
This qualitative study used purposeful, maximum variation, and snowball sampling strategies to recruit clinicians from cancer centers and community hospitals in five Canadian provinces, five practice areas, and 12 practice sites. The study included clinicians who regularly treated young women with cancer who might need fertility preservation.
Clinicians participated in 30- to 75-minute telephone interviews conducted between May and November 2014 using a semi-structured interview guide. Thematic analysis was used to identify barriers.
The researchers interviewed 22 clinicians, including eight medical oncologists, four surgical oncologists, four fertility specialists, three hematology/oncology specialists, and three nurse practitioners or clinician nurse specialists. Most clinicians (n=17) were women, and the median time in practice was 10 years (range, 0.67-37.0 years).
Reasons for not discussing fertility
The following factors influenced clinicians’ fertility discussion practices:
- Unfamiliarity with infertility risks
- Fertility preservation technologies
- Referral processes and procedures
- Environmental factors
- Perceptions of fertility preservation
“Multiple strategies are needed to address these challenges to improve overall care of young women with cancer,” the researchers concluded.
The study is limited because the interviews were completed five years ago, and since then, fertility education has been more widely emphasized in the medical community.