Familienplanung junger onkologischer Patienten

Medical consultations about fertility preservation with haematological patients of childbearing age: A qualitative study

PURPOSE

Oncological treatments can cause serious long-term consequences, including effects on patients' fertility. Communication about possible fertility impairment is essential for cancer patients who want to have children. When oncologists initiate this discussion in a timely manner, patients can be referred to fertility specialists and avail themselves of fertility preservation methods. The oncologist plays a key role in this context.

METHODS

30 cancer patients of childbearing age (21-43 years) took part in semi-structured interviews between March 2011 and April 2012 about fertility and their desire to have children. Interview transcripts were thematically analyzed.

RESULTS

Physician-patient consultations broached the issue as a central theme in almost all patients. A few consultations were patient initiated, and the majority took place before the beginning of treatment. Almost half of the patients were satisfied with their consultations and were referred to a fertility specialist. The ideal setting for these conversations is in the presence of the patient's partner, in a private space, before the beginning of treatment.

CONCLUSIONS

All patients should be informed about the possibility of their fertility being impaired due to treatments, even if they have not explicitly expressed wanting children. The oncologist is the first and most important contact for the patient and, hence, should bring up the issue of family planning and fertility. An interdisciplinary communication and collaboration between oncologists and fertility specialists can improve patient care.

The desire for children and fertility issues among young German cancer survivors

PURPOSE

For young cancer patients, family planning is not always completed at the time of cancer diagnosis. This study investigated young cancer patients' desire to have children, its intensity, and their discussion with oncologists and fertility specialists about fertility. Furthermore, gender differences, differences between childless patients and patients with children, and correlations with psychological distress were analyzed.

METHODS

A total of 149 cancer patients (range, 18-45 years of age) answered a self-developed questionnaire. Psychological distress was measured with the Patient Health Questionnaire.

RESULTS

Seventy-four percent of patients had a desire to have children at the time of diagnosis. Whereas the intensity of the desire for children increased pre- to post-treatment in childless patients, it decreased in patients who already had children. A total of 55 patients who wanted a child (50%) needed supportive care concerning this issue; 60% of the total sample had discussed fertility aspects with their oncologists and 20% with fertility specialists. Patients reported higher levels of satisfaction with their discussions with fertility specialists than with their discussions with oncologists. Men (56%) underwent fertility preservation more often than did women (31%). Female sex was the only variable predicting psychological distress, whereas parenthood, fertility preservation, and desire for children had no significant impact.

CONCLUSIONS

The desire to have children and the fertility issues involved are important for young cancer patients. Reasons for not discussing fertility aspects with oncologists and the cause of low referral rates to fertility specialists should be explored in future studies. The implementation of structured psychosocial supportive care might address the needs of highly fertility-distressed patients.