Armstrong Foundation has similar resources tailored to the needs of male and female patients.30,31
Despite these readily available patient
education resources, a 2009 survey of US oncologists showed that fewer than 35% routinely provide patients with any fertility preservation educational materials.25
Several single-institution studies have identified the costs associated with fertility preservation as a barrier to the discussion. Schover’s 2002 study at a Texas institution and the Quinn et al. 2007 study of an institution in Florida found the financial costs associated with fertility preservation served as barriers to the discussion.24,27
The physician’s perception of a patient’s insurance status, availability of cryopreservation resources, and cost of procedures may also serve as barriers.24,26
qualitative study of pediatric oncologists in the state of Florida, physicians perceived the costs of preservation and lack of insurance coverage as a primary barrier for the majority of patients.26
Financial Costs Associated with Fertility Preservation The average national cost of sperm banking is approximately $350–600/year. Embryo cryopreservation may cost up to $500 for the necessary ovarian stimulation drugs, between $5,000 and $10,000 for egg harvesting, and an additional $10,000 for each attempt at embryo transfer.28
To date, the majority of insurance companies do not cover fertility preservation for the newly diagnosed cancer patient.32
Quinn et al. in 2009 examined codified state policies related to infertility and assessed their relevance for cancer patients.32
In fact, the majority
of cancer patients do not meet the legal definition of ‘infertile’ as defined by most state laws. Fifteen states (29.4%) had laws relating to
1. Jemal A, Siegel R, Ward E, et al., Cancer statistics, 2007, CA Cancer J Clin, 2007;57:43–66.
2. American Cancer Society. Cancer Facts and Figures 2005. Atlanta: American Cancer Society; 2005. Available at: www.cancer.org
/acs/groups/content/@nho/documents/document/caff2005f4pwse curedpdf.pdf (accessed February 16, 2011).
3. American Cancer Society, Cancer Facts and Figures 2008, ACS, 2008. Available at: www.188.8.131.52/downloads/STT/ 2008CAFFfinalsecured.pdf (accessed February 16, 2011).
4. Lee SJ, Schover LR, Partridge AH, et al., American society of clinical oncology recommendations on fertility preservation in cancer patients, J Clin Oncol, 2006;24:2917–31.
5. Zebrack BJ, Casillas J, Nohr L, et al., Fertility issues for young adult survivors of childhood cancer, Psychooncology, 2004;13:689–99.
6. Oktay K, Cil AP, Bang H, Efficiency of oocyte cryopreservation: a meta-analysis, Fertil Steril, 2006;86:70–80.
7. Wallace WH, Anderson RA, Irvine DS, Fertility preservation for young patients with cancer: who is at risk and what can be offered? Lancet Oncol, 2005;6:209–18.
8. Sonmezer M, Oktay K, Fertility preservation in female patients, Hum Reprod Update, 2004;10:251–66.
9. Deimling GT, Kahana B, Bowman KF, et al., Cancer survivorship and psychological distress in later life, Psychooncology, 2002;11:479–94.
10. Schover LR, Rybicki LA, Martin BA, et al., Having children after cancer. A pilot survey of survivors’ attitudes and experiences, Cancer, 1999;86:697–709.
11. Wenzel L, Donnelly J, Fowler J, et al., Resilience, reflection, and residual stress in ovarian cancer survivorship: a gynecologic oncology group study, Psychooncology, 2002;11:142–53.
insurance coverage for infertility or in vitro fertilization (IVF) procedures and two states (California and Illinois) specifically excluded IVF from a mandatory offer of coverage. The majority of states define infertility as the inability to conceive a child after one year of unprotected sexual intercourse. This definition was developed for the general infertile population and is not responsive to the unique circumstances of cancer patients or survivors.20,32
Infertility may be a side effect of cancer treatment for many cancer survivors. Despite both established and experimental options available for cancer survivors prior to the start of cancer treatment, discussion of fertility preservation options, use of educational materials, and referrals to REIS by healthcare providers remains low. Moderate to low rates of discussion and referral can be attributed to patient factors, such as the inability of the patient to delay treatment or the patient’s resistance to addressing the issue at the time of diagnosis. Physician factors can also play a role, as in the case where the physician elects not to discuss the topic due to a patient’s poor prognosis or a personal discomfort with ethical issues, such as posthumous parenting. Finally, system factors may also serve as obstacles, with lack of distribution of education materials, financial constraints, and third-party payor limitations.
Cancer survivors who experience infertility are at increased risk for emotional distress and reduced quality of life.10
By providing survivors
with timely relevant information related to their fertility preservation options, it may be possible to reduce emotional distress and improve quality of life as they transition from cancer patient to survivor. n
12. Canada AL, Schover LR, Research promoting better patient education on reproductive health after cancer, J Natl Cancer Inst Monogr, 2005;34:98–100.
13. Rosen A, Third-party reproduction and adoption in cancer patients, J Natl Cancer Inst Monogr, 2005:91–3.
14. Cope D, Patients’ and physicians’ experiences with sperm banking and infertility issues related to cancer treatment, Clin J Oncol Nurs, 2002;6:293–4.
15. Bodurka-Bevers D, Basen-Engquist K, Carmack CL, et al., Depression, anxiety, and quality of life in patients with epithelial ovarian cancer, Gynecol Oncol, 2000;78:302–8.
16. Gotay CC, Muraoka MY, Quality of life in long-term survivors of adult-onset cancers, J Natl Cancer Inst, 1998;90:656–67.
17. King BR, Subfecundity and anxiety in a nationally representative sample, Soc Sci Med, 2003;56:739–51.
18. King L, Quinn GP, Vadaparampil ST, et al., Oncology nurses’ perceptions of barriers to discussion of fertility preservation with patients with cancer, Clin J Oncol Nurs, 2008;12:467–76.
19. Glaser A, Wilkey O, Greenberg M, Sperm and ova conservation: existing standards of practice in North America, Med Pediatr Oncol, 2000;35:114–8.
20. Ethics Committee of the American Society for Reproductive Medicine, Fertility preservation and reproduction in cancer patients, Fertil Steril, 2005;83:1622–8.
21. Quinn GP, Vadaparampil ST, Bell-Ellison BA, et al., Patient- physician communication barriers regarding fertility preservation among newly diagnosed cancer patients, Soc Sci Med, 2008;66:784–9.
22. Schover LR, Brey K, Lichtin A, et al., Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors, J Clin Oncol, 2002;20:1880–9.
23. Duffy CM, Allen SM, Clark MA, Discussions regarding reproductive health in young women with breast cancer undergoing chemotherapy, J Clin Oncol, 2005;23:766–73.
24. Quinn G, Vadaparampil S, Gwede C, et al., Discussion of fertility preservation with newly diagnosed patients: oncologists’ views, J Cancer Surviv, 2007;1:146–55.
25. Quinn G, Vadaparampil S, Lee JH, et al., Physician referral for fertility preservation with oncology patients: a national study of practice behaviors, J Clin Oncol, 2009;27:5952–7.
26. Vadaparampil S, Quinn G, King L, et al., Barriers to fertility preservation among florida pediatric oncologists, Patient Educ Couns, 2008;72:402–10.
27. Schover LR, Brey K, Lichtin A, et al., Oncologists’ attitudes and practices regarding banking sperm before cancer treatment, J Clin Oncol, 2002;20:1890–7.
28. FertileHope, Parenthood Options, FertileHope, 2006. Available at: www.fertilehope.org/learn-more/cancer-and-fertility-
m (accessed February 16, 2011).
29. FertileHope, Statistics, FertileHope, 2006. Available at: www.fertilehope.org/learn-more/index.cfm
(accessed February 16, 2011).
30. Adler NE, Page A, eds, Institute of Medicine, Committee on Psychosocial Services to Cancer Patients/Families in a Community S, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, Washington DC, National Academies Press, 2008.
31. National Cancer Institute, The Nation’s Investment in Cancer Research: Connecting the Cancer Community, 2008. Available at: plan.cancer.gov/pdf/nci_2009_plan.pdf
32. Vadaparampil ST, Lowrey KM, Miree CA, et al., State laws and regulations covering fertility preservation for cancer patients, J Clin Oncol, 2009;27(15S): abstract 9509.
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