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Background

Individuals who have received treatment for gynecologic malignancy often have reduced fertility options. However, there is a paucity of data on patient experience about this aspect of their treatment. The primary objective of this study was to quantify individual patient wishes about fertility preservation and perceived barriers they may have faced in pursuing fertility preservation, if desired.

Methods

An online survey of 21 questions was distributed to 228 patients ages 18-40 at the time of diagnosis with ovarian cancer, endometrial cancer, or cervical cancer at a single, large academic hospital. The survey questions prompted individuals to reflect on the time when they found out they had cancer to evaluate how their diagnosis changed their fertility goals, whether respondents felt they had received adequate counseling on potential harm to their fertility due to treatment, and whether they felt they were supported if they had plans to become pregnant in the future.

Results

A total of 53 patients completed the survey. Although 37 of the 53 patients (69.8%) knew cancer treatment impacted their fertility, 27 out of 53 (50.9%) respondents did not feel they received adequate counseling at the time of diagnosis. The most frequent types of counseling patients received was verbal information from their oncologist (60.4% of patients) and researching independently (56.5% of patients). 18.9% of patients did not recall receiving any counseling.

Looking at the types of fertility preservation patients underwent, 11 out of 53 (20.8%) had fertility sparing surgery and six (11.3%) tried various methods consisting of either oocyte preservation, ovarian tissue cryopreservation, ovarian transposition, or embryo cryopreservation. 35 patients (66.0%) did not undergo any fertility preservation. Patients who had children at the time of diagnosis were 75% less likely to undergo fertility preservation than patients who did not already have children at the time of diagnosis (OR 0.25, 95% CI 0.059-0.88).

Patients who did not choose to undergo fertility preservation were prompted to evaluate various reasons preventing them from accessing fertility care. The most common barriers included not wanting to delay treatment (50% of respondents), not wanting to have children (21% of respondents), feeling too emotionally burdened by their diagnosis (19% of respondents), and lack of adequate counseling from their provider (15%).

Conclusions

Though most patients received some counseling about the impact of treatment on their fertility, the majority of patients did not feel this counseling was adequate. More work needs to be done to understand how best to support patients in their fertility preservation wishes, if applicable, while planning treatment for gynecologic malignancies.

Read an interview about the study here.