Chemotherapy infertility risk more likely discussed with female patients

Clinicians are more likely to discuss reproductive risks associated with chemotherapy with female than male patients, according to a new American study.

The researchers from John Hopkins University, University of Miami Miller School of Medicine, and the University of Manitoba, Canada, assessed whether reproductive risk was discussed with patients prior to treatment initiation. Data for the study was collected biannually between January 2015 and June 2019 from the American Society of Clinical Oncology Quality Oncology Practice Initiative, a quality assessment programme that surveys around 400 oncology practices.

'The findings suggest that the American Society of Clinical Oncology (ASCO) quality measures should be better disseminated for patients of reproductive age regarding discussion of infertility risk and fertility preservation and appropriate referral to fertility specialists before the onset of chemotherapy', the authors state in their JAMA Network Open study.

Of the 6976 patients of reproductive age (18-40 years for women; 18-50 years for men) it was found that 44 percent (3036 patients) received counselling regarding the fertility risks associated with chemotherapy. Of these patients, 56 percent of female patients were informed of the risk of infertility, compared with only 32 percent of male patients.

Factors associated with increased likelihood of fertility preservation counselling included: the patient having breast, haematopoietic or lymphatic cancers, participating in multiple study years, and receiving care in either an academic clinic or a practice offering clinical trial enrolment. Factors associated with a reduced chance of fertility counselling including being male sex, older and treated in a private practice setting.

A number of US states now legally mandate insurance coverage of fertility preservation for patients undergoing treatments that may have deleterious effects on reproduction, including surgery, chemotherapy and radiation. These states were found to have significantly higher rates of fertility discussion than those without this mandate.

ASCO 2006 guidelines recommend that clinicians discuss fertility preservation with all adult and paediatric patients prior to the onset of cancer treatment. However a study carried out between 2006 and 2010 showed that only six percent of US patients were counselled with regards to fertility risk prior to treatment initiation.

In this latest study, the authors suggest that the ASCO quality measures require better dissemination to all patients within reproductive age ranges, with potential referral to fertility specialists prior to onset of cancer treatment.

'Further awareness and implementation of ASCO guidelines appear to be needed to improve rates of fertility risk discussion and referrals to fertility specialists before chemotherapy,' the authors argued.