Cancer and Fertility - Young Women Speak Up

Introduction

Main Item

Young female cancer survivors are concerned about their future fertility and parenthood options and want better information and guidance early on, according to a new study by Jessica Gorman and her team from the University of California in the US. Their paper, which presents in-depth information on young survivors' experiences navigating decisions about fertility and parenthood, is published online in Springer's Journal of Cancer Survivorship.

Many more adolescents and young adults are surviving their disease, resulting in a substantial and growing number of female cancer survivors of reproductive age. Young cancer survivors are less likely to have biological children than non-cancer survivors, mainly due to the effects of cancer treatments on future fertility. However, many are unaware of the impact of their treatment on their fertility, and understanding these young ladies' concerns is a first step towards developing effective, targeted interventions that will meet the needs of those who want to become parents.

The researchers explored the fertility and parenthood concerns of 22 American female cancer survivors, aged between 18 and 34 years. The young women, recruited from both clinics and community-based outreach projects, took part in focus groups.

The authors identified six themes from the discussions:

• 1. A hopeful but worried approach to fertility and parenthood: While participants expressed hope about having a family, many also felt anxious that they would be unable to have their own children.
• 2. Frustration with lack of choice or control over fertility: Even though the young women acknowledged that a discussion about fertility at the time of diagnosis would have been overwhelming, they felt strongly that they (or their parents) should have been told about both the impact of treatment on their fertility, and the options available before treatment to preserve fertility e.g. freezing eggs.
• 3. Young survivors want information about their fertility: Several women reported with regret that their doctors had not talked to them about fertility and they felt that a young woman was old enough to have this discussion anytime after puberty.
• 4. Young survivors want better continuity of care in survivorship: Many were frustrated with the poor coordination of care between their multiple medical providers, including care related to fertility and pregnancy planning. They felt that each practitioner focused on his or her specialist issue, rather than the bigger picture.
• 5. Cancer diagnosis and related fertility problems introduce relationship challenges: Young women were concerned about this both in the early stages of a relationship and in a more stable relationship.
• 6. Decisions about parenthood are complicated: Participants listed both emotional (worry about their personal health and life expectancy, as well as worry about their potential child's health) and practical (mainly financial) barriers to parenthood.

Gorman and team conclude; "It's critical for both researchers and clinicians to understand young female survivors' concerns about fertility and parenthood in order to address them adequately. Our results suggest that these young women would benefit from improved information regarding their options, through discussions initiated by their healthcare providers, better coordination of care in survivorship, and guidance and support in navigating both emotional and practical issues that arise when considering fertility and future parenthood."

Reference:

Gorman JR et al (2011). How do you feel about fertility and parenthood? The voices of young female cancer survivors. Journal of Cancer Survivorship. DOI 10.1007/s11764-011-0211-9