Advertisement

Supportive oncofertility care, psychological health and reproductive concerns: a qualitative study

Abstract

Purpose

Impaired fertility in cancer patients and survivors of reproductive age (15–45 years) may lead to psychological distress and poor mental health outcomes, and may negatively impact quality of life. Limited research has focused on the fertility experiences of those who have had access to supportive oncofertility care. This study aims to explore the fertility-care experiences and reproductive concerns of reproductive age cancer patients at the time of their cancer diagnosis who have had access to oncofertility care.

Methods

The qualitative data from a larger mixed method study is presented, comprising 30 semi-structured telephone interviews with newly diagnosed cancer patients across Australia and New Zealand, undertaken between April 2016 and April 2018.

Results

Interviews were undertaken with 9 male patients and 21 female patients aged between 15 and 44 years. All patients recalled a discussion about fertility and majority underwent some form of fertility preservation. Thematic analysis identified five main themes: (i) satisfaction with oncofertility care, (ii) a need for individualised treatment and support, (iii) desire for parenthood, (iv) fertility treatment can be challenging, and (v) fertility preservation provides a safety net for the future.

Conclusions

Participants who access supportive oncofertility care report low emotional impact of threatened future infertility at the time of cancer diagnosis. These results suggest that such services may assist in lowering the emotional burden of potential infertility in survivors. Long-term research is needed to assess the longitudinal benefits for different models of care.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1

References

  1. 1.

    Welfare AIoHa (2012) Cancer in Australia: an overview 2012. AIHW, Canberra

  2. 2.

    Dohle GR (2010) Male infertility in cancer patients: review of the literature. Int J Urol 17(4):327–331. https://doi.org/10.1111/j.1442-2042.2010.02484.x

  3. 3.

    Levine JM, Kelvin JF, Quinn GP, Gracia CR (2015) Infertility in reproductive-age female cancer survivors. Cancer 121(10):1532–1539. https://doi.org/10.1002/cncr.29181

  4. 4.

    Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK (2018) Oncofertility-an emerging discipline rather than a special consideration. Pediatr Blood Cancer 65(11):e27297. https://doi.org/10.1002/pbc.27297

  5. 5.

    Kenney LB, Cohen LE, Shnorhavorian M, Metzger ML, Lockart B, Hijiya N, Duffey-Lind E, Constine L, Green D, Meacham L (2012) Male reproductive health after childhood, adolescent, and young adult cancers: a report from the Children's Oncology Group. J Clin Oncol 30(27):3408–3416. https://doi.org/10.1200/jco.2011.38.6938

  6. 6.

    Jayasinghe YL, Wallace WHB, Anderson RA (2018) Ovarian function, fertility and reproductive lifespan in cancer patients. Expert Rev Endocrinol Metab 13(3):125–136. https://doi.org/10.1080/17446651.2018.1455498

  7. 7.

    Gnaneswaran S, Deans R, Cohn RJ (2012) Reproductive late effects in female survivors of childhood cancer. Obstet Gynecol Int 2012:564794. doi:https://doi.org/10.1155/2012/564794, 1, 7

  8. 8.

    Upponi SS, Ahmad F, Whitaker IS, Purushotham AD (2003) Pregnancy after breast cancer. Eur J Cancer 39(6):736–741. https://doi.org/10.1016/S0959-8049(02)00870-5

  9. 9.

    Yasmin E, Balachandren N, Davies MC, Jones GL, Lane S, Mathur R, Webber L, Anderson RA (2018) Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline. Human Fertil (Camb) 21(1):3–26. https://doi.org/10.1080/14647273.2017.1422297

  10. 10.

    Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K (2013) Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(19):2500–2510. https://doi.org/10.1200/JCO.2013.49.2678

  11. 11.

    Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, Wallace WH, Wang ET, Loren AW (2018) Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 36(19):1994–2001. https://doi.org/10.1200/jco.2018.78.1914

  12. 12.

    Ho WLC, Bourne H, Gook D, Clarke G, Kemertzis M, Stern K, Agresta F, Heloury Y, Clark H, Orme L, Jayasinghe Y, Zacharin MR (2017) A short report on current fertility preservation strategies for boys. Clin Endocrinol 87(3):279–285. https://doi.org/10.1111/cen.13377

  13. 13.

    Partridge AH, Gelber S, Peppercorn J, Sampson E, Knudsen K, Laufer M, Rosenberg R, Przypyszny M, Rein A, Winer EP (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22(20):4174–4183. https://doi.org/10.1200/jco.2004.01.159

  14. 14.

    Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR (2014) Prospective study of depression and anxiety in female fertility preservation and infertility patients. Fertil Steril 102(5):1377–1384. https://doi.org/10.1016/j.fertnstert.2014.07.765

  15. 15.

    Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR (2015) Psychological counseling of female fertility preservation patients. J Psychosoc Oncol 33(4):333–353. https://doi.org/10.1080/07347332.2015.1045677

  16. 16.

    Gorman JR, Malcarne VL, Roesch SC, Madlensky L, Pierce JP (2010) Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat 123(2):477–485. https://doi.org/10.1007/s10549-010-0768-4

  17. 17.

    Gorman JR, Su HI, Roberts SC, Dominick SA, Malcarne VL (2015) Experiencing reproductive concerns as a female cancer survivor is associated with depression. Cancer 121(6):935–942. https://doi.org/10.1002/cncr.29133

  18. 18.

    Canada AL, Schover LR (2012) The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology 21(2):134–143. https://doi.org/10.1002/pon.1875

  19. 19.

    Armuand GM, Wettergren L, Rodriguez-Wallberg KA, Lampic C (2014) Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis. Support Ccare Cancer : Off J Multinatl Assoc Support Care Cancer 22(10):2805–2812. https://doi.org/10.1007/s00520-014-2279-z

  20. 20.

    Ussher JM, Perz J (2019) Infertility-related distress following cancer for women and men: a mixed method study. Psychooncology 28(3):607–614. https://doi.org/10.1002/pon.4990

  21. 21.

    Ussher JM, Parton C, Perz J (2018) Need for information, honesty and respect: patient perspectives on health care professionals communication about cancer and fertility. Reprod Health 15:2. https://doi.org/10.1186/s12978-017-0441-z

  22. 22.

    Ussher JM, Perz J, Miller A, Patterson P, Wain G, Hobbs K, Mason C, Kirsten L, Weisberg E, Butt A, Cummings J, Nattress K, Parton C, Cancer TA, Team FS (2018) Threat of biographical disruption: the gendered construction and experience of infertility following cancer for women and men. BMC Cancer 18(1):250. https://doi.org/10.1186/s12885-018-4172-5

  23. 23.

    Deshpande NA, Braun IM, Meyer FL (2015) Impact of fertility preservation counseling and treatment on psychological outcomes among women with cancer: a systematic review. Cancer 121(22):3938–3947. https://doi.org/10.1002/cncr.29637

  24. 24.

    Crawshaw MA, Crawshaw MA, Glaser AW, Hale JP, Sloper P (2008) Young males’ experiences of sperm banking following a cancer diagnosis – a qualitative study. Hum Fertil 11(4):238–245. https://doi.org/10.1080/14647270802132752

  25. 25.

    Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, Melisko ME, Cedars MI, Rosen MP (2012) Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer 118(6):1710–1717. https://doi.org/10.1002/cncr.26459

  26. 26.

    Anazodo A, Logan S, Wakefield CE, Cohn RJ, Stern K, Agresta F, Jayasinghe Y, Deans R, Segelov E, McLachlan RI, Gerstl B, Ledger W (2018) Reproductive concerns, psychological distress and satisfaction in young cancer patients at diagnosis and 12 months later. Supportive Care in Cancer [Under Review]

  27. 27.

    Anazodo AC, Stern CJ, McLachlan RI, Gerstl B, Agresta F, Cohn RJ, Jayasinghe Y, Wakefield CE, Daly G, Chan D, Gilbert L, Kemertzis M, Orme LM, Wand H, Viney R, Gillam L, Deans R, Jetti M, Wu J, Chapman M, Ledger W, Sullivan EA (2016) A study protocol for the Australasian Oncofertility Registry: monitoring referral patterns and the uptake, quality, and complications of fertility preservation strategies in Australia and New Zealand. J Adolesc Young Adult Oncol 5(3):215–225. https://doi.org/10.1089/jayao.2015.0062

  28. 28.

    Sturges JE, Hanrahan KJ (2004) Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res 4(1):107–118. https://doi.org/10.1177/1468794104041110

  29. 29.

    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. https://doi.org/10.1191/1478088706qp063oa

  30. 30.

    Duffy CM, Allen SM, Clark MA (2005) Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol 23(4):766–773. https://doi.org/10.1200/jco.2005.01.134

  31. 31.

    Thewes B, Meiser B, Taylor A, Phillips KA, Pendlebury S, Capp A, Dalley D, Goldstein D, Baber R, Friedlander ML (2005) Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 23(22):5155–5165. https://doi.org/10.1200/jco.2005.07.773

  32. 32.

    Ruddy KJ, Gelber SI, Tamimi RM, Ginsburg ES, Schapira L, Come SE, Borges VF, Meyer ME, Partridge AH (2014) Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol 32(11):1151–1156. https://doi.org/10.1200/JCO.2013.52.8877

  33. 33.

    Logan S, Perz J, Ussher JM, Peate M, Anazodo A (2017) A systematic review of patient fertility support needs in reproductive cancer patients aged 14 to 45 years of age. Psychooncology. 27:401–409. https://doi.org/10.1002/pon.4502

  34. 34.

    Armuand GM, Wettergren L, Rodriguez-Wallberg KA, Lampic C (2015) Women more vulnerable than men when facing risk for treatment-induced infertility: a qualitative study of young adults newly diagnosed with cancer. Acta Oncol 54(2):243–252. https://doi.org/10.3109/0284186x.2014.948573

  35. 35.

    Benedict C, Shuk E, Ford JS (2016) Fertility issues in adolescent and young adult cancer survivors. J Adolesc Young Adult Oncol 5(1):48–57. https://doi.org/10.1089/jayao.2015.0024

  36. 36.

    Crawshaw MA, Glaser AW, Hale JP, Sloper P (2009) Male and female experiences of having fertility matters raised alongside a cancer diagnosis during the teenage and young adult years. Eur J Cancer Care 18(4):381–390. https://doi.org/10.1111/j.1365-2354.2008.01003.x

  37. 37.

    Carter J, Sonoda Y, Abu-Rustum NR (2007) Reproductive concerns of women treated with radical trachelectomy for cervical cancer. Gynecol Oncol 105(1):13–16. https://doi.org/10.1016/j.ygyno.2006.10.059

  38. 38.

    Dryden A, Ussher JM, Perz J (2014) Young women’s construction of their post-cancer fertility. Psychol Health 29(11):1341–1360. https://doi.org/10.1080/08870446.2014.932790

  39. 39.

    Ruddy KJ, Gelber S, Ginsburg ES, Schapira L, Abusief ME, Meyer ME, Partridge AH (2011) Menopausal symptoms and fertility concerns in premenopausal breast cancer survivors: a comparison to age- and gravidity-matched controls. Menopause 18(1):105–108. https://doi.org/10.1097/gme.0b013e3181ef39f8

  40. 40.

    Logan S, Anazodo A (2019) The psychological importance of fertility preservation counseling and support for cancer patients. Acta Obstet Gynecol Scand 0 (0). doi:https://doi.org/10.1111/aogs.13562, 98, 583, 597

  41. 41.

    Parton C, Ussher JM, Perz J (2019) Hope, burden or risk: a discourse analytic study of the construction and experience of fertility preservation in the context of cancer. Psychol Health 34:1–22. https://doi.org/10.1080/08870446.2018.1543764

  42. 42.

    Logan S, Perz J, Ussher J, Peate M, Anazodo A (2018) Systematic review of fertility-related psychological distress in cancer patients: informing on an improved model of care. Psychooncology. 28:22–30. https://doi.org/10.1002/pon.4927

  43. 43.

    Connell S, Patterson C, Newman B (2006) A qualitative analysis of reproductive issues raised by young Australian women with breast cancer. Health Care Women Int 27(1):94–110. https://doi.org/10.1080/07399330500377580

Download references

Acknowledgements

We are grateful to all the patients and family members who took part in this study sharing personal experiences so that we can improve oncofertility care.

Funding

This work is supported by funding from a Prince of Wales Foundation Champion’s Grant, CanTeen, and ANZCHOG joint funding for Concept Validation.

AA is supported by funding from the Kids Cancer Alliance (KCA) and CanTeen funding from the Federal Health Department.

CW is supported by a Career Development Fellowship from the NHMRC of Australia (APP1143767).

Author information

Correspondence to Shanna Logan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Logan, S., Stern, K. et al. Supportive oncofertility care, psychological health and reproductive concerns: a qualitative study. Support Care Cancer 28, 809–817 (2020). https://doi.org/10.1007/s00520-019-04883-1

Download citation

Keywords

  • Oncology
  • Fertility
  • Fertility preservation
  • Oncofertility
  • Emotional well-being
  • Psychological health