Advances in cancer care and delayed childbearing have yielded increasing numbers of cancer patients for whom fertility-preserving treatment options are a priority. Communicating the fertility implications of radiation therapy and other cancer treatments should be standard practice at the time of diagnosis.
Advances in cancer treatment and reproductive technology have expanded the options for young women with cancer who wish to preserve their childbearing options, and young women with cancer are now routinely counseled about the fertility implications of cancer and its treatment. More than 80% of children with cancer and 85% of those who are adolescents or young adults (AYA) during their cancer journey will survive.
Of the anticipated 110,070 American women with new gynecologic cancer diagnoses this year, approximately 21% of them will be premenopausal at the time of diagnosis — younger than 40 years, typically.
Gynecologic cancer treatment paradigms
“Looking at cervical cancer specifically, 43% are younger than 45 years old,” said Nathalie D. McKenzie, MD, MSPH, an award-winning gynecologic oncologist at Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, in Orlando, Florida. “These women are also typically diagnosed at younger age — during those reproductive years.”
Those figures, combined with increasing numbers of women who opt to wait until later in adulthood to have children, mean that a growing number of women receive a cancer diagnosis before they have had children, Dr McKenzie noted.
But treatment strategies can profoundly diminish survivors' opportunities for childbearing and young women survivors have lower birth rates than do other women. Radiotherapy is associated with lower rates of female AYA cancer survivors who give birth (10%) than those who receive chemotherapy alone (18%) or surgery alone (44%).
These trends forced changes in gynecologic cancer treatment paradigms, which traditionally had involved sterilizing treatments such as radiation fields that involved ovaries or the uterus, potentially inducing premature menopause. Patients value fertility counseling and there is evidence that it can reduce patients' later levels of regret and dissatisfaction, improving quality of life.
There are not yet widely used, validated questionnaires to guide oncofertility discussions but the American Society of Clinical Oncology (ASCO) and other national organizations recommend such patient/clinician discussions as well as fertility referrals and consultations for patients of reproductive age at the time of diagnosis, “when all potential options can be discussed with the patient,” Dr McKenzie said.