This study explores the attitudes, knowledge, and referring behaviors in fertility preservation among Ontario physicians providing adult cancer care. Ontario physicians with specialties in medical oncology, radiation oncology, gynaecologic oncology, and urology were invited to complete a 48-item questionnaire. A total of 152 questionnaires were available for analysis with a response rate of 23.7%. Seventy-four percent of the physicians indicated that they rarely or never modified cancer treatment due to concern about future fertility. Differences were found in fertility preservation knowledge among respondents in different medical specialties (p < 0.01) and clinical settings (p < 0.05). The frequency of initiating a referral was strongly associated with knowing where to refer patients (p < 0.001). The odds of knowing where to refer cancer patients was higher for physicians who work in a teaching hospital (p < 0.01) and a cancer centre (p < 0.01) compared with those who primarily work in a community setting. About 45% did not know where to refer female patients, and 69.7% rarely ever made a fertility preservation consultation referral for their female patients. The majority of respondents had positive attitudes despite their lack of current knowledge in cryopreservation services and fertility preservation options through assisted reproductive technologies. Our findings provide further insights of the relevance of considering physicians’ medical backgrounds and practice settings when designing training modules to raise their awareness in fertility preservation issues.
Oncology Fertility preservation Oncologists Cancer patients Assisted reproductive technology
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The co-authors would like to express appreciation to Abha Gupta MD, David Hodgson MD, Keith Jarvi MD, Kirk Lo MD, Orla McArdle MD, Joan Murphy MD, and Barry Rosen MD for providing feedback on the questionnaire for validity purpose.
Mount Sinai Hospital Rose Torno Bursary 2009 awarded to the first author.
The findings were presented at the Canadian Fertility and Andrology Society’s 56th Annual Meeting in Vancouver (29 Sept–2 Oct 2010), and the presentation received the Best Psychosocial Paper award.
Canadian Cancer Society’s Steering Committee (2011) Canadian Cancer Statistics 2011. Available at: http://www.cancer.ca. Accessed 5 December 2010
Crha I, Ventruba P, Zakova J et al (2009) Survival and infertility treatment in male cancer patients after sperm banking. Fertil Steril 91:2344–2348PubMedCrossRefGoogle Scholar
Hickey M, Peate M, Saunders CM et al (2009) Breast cancer in young women and its impact on reproductive function. Hum Reprod Update 15:323–339PubMedCrossRefGoogle Scholar
Partridge AH, Gelber S, Peppercorn J et al (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22:4174–4183PubMedCrossRefGoogle Scholar
Chapple A, Salinas M, Ziebland S et al (2007) Fertility issues: the perceptions and experiences of young men recently diagnosed and treated for cancer. J Adolesc Health 40:69–75PubMedCrossRefGoogle Scholar
Duffy C, Allen S, Clark M (2005) Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol 23:766–773PubMedCrossRefGoogle Scholar
Quinn GP, Vadaparampil ST, Bell-Ellison BA et al (2008) Patient–physician communication barriers regarding fertility preservation among newly diagnosed cancer patients. Soc Sci Med 66:784–789PubMedCrossRefGoogle Scholar
Zapzalka DM, Redmon JB, Pryor JL (1999) A survey of oncologists regarding sperm cryopreservation and assisted reproductive techniques for male cancer patients. Cancer 86:1812–1817PubMedCrossRefGoogle Scholar
Schover LR, Brey K, Lichtin A et al (2002) Oncologists’ attitudes and practices regarding banking sperm before cancer treatment. J Clin Oncol 20:1890–1897PubMedCrossRefGoogle Scholar
Quinn GP, Vadaparampil ST, Gwede CK et al (2007) Discussion of fertility preservation with newly diagnosed patients: oncologists’ views. J Cancer Surviv 1:146–155PubMedCrossRefGoogle Scholar
Quinn GP, Vadaparampil ST, Lee JH et al (2009) Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol 27:5952–5957PubMedCrossRefGoogle Scholar
Anderson RA, Weddell A, Spoudeas HA et al (2008) Do doctors discuss fertility issues before they treat young patients with cancer? Hum Reprod 23:2246–2251PubMedCrossRefGoogle Scholar
Schover LR, Brey K, Lichtin A et al (2002) Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. J Clin Oncol 20:1880–1889PubMedCrossRefGoogle Scholar
Achille MA, Rosberger Z, Robitaille R et al (2006) Facilitators and obstacles to sperm banking in young men receiving gonadotoxic chemotherapy for cancer: the perspective of survivors and health care professionals. Hum Reprod 21:3206–3216PubMedCrossRefGoogle Scholar
Nagel K, Neal M (2008) Discussions regarding sperm banking with adolescent and young adult males who have cancer. J Pediatr Oncol Nurs 25:102–106PubMedCrossRefGoogle Scholar
Yee S, Fuller-Thomson E, Dwyer C et al (2011) “Just what the doctor ordered”: factors associated with oncology patients’ decision to bank sperm. Can Urol Assoc J. doi:10.5489/cuaj.10084
Vadaparampil ST, Clayton H, Quinn GP et al (2007) Pediatric oncology nurses’ attitudes related to discussing fertility preservation with pediatric cancer patients and their families. J Pediatr Oncol Nurs 24:255–263PubMedCrossRefGoogle Scholar
Vadaparampil ST, Quinn GP, King LM (2008) Institutional availability of fertility preservation. Clin Pediatr 47:302–305CrossRefGoogle Scholar
Selk A, Belej-Rak T, Shapiro H, Greenblatt E (2009) Use of an oncology sperm bank: a Canadian experience. Can Urol Assoc J 3:219–222PubMedGoogle Scholar
Lee SJ, Schover LR, Partridge AH et al (2006) American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24:2917–2931PubMedCrossRefGoogle Scholar
Ethics Committee of the American Society for Reproductive Medicine (2005) Fertility preservation and reproduction in cancer patients. Fertil Steril 83:1622–1628CrossRefGoogle Scholar
British Fertility Society (2003) A strategy for fertility services for survivors of childhood cancer. Hum Fertil 6:A1–A40CrossRefGoogle Scholar
Forman EJ, Anders CK, Behera MA (2010) A nationwide survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. Fertil Steril 94:1652–1656PubMedCrossRefGoogle Scholar
Köhler T, Kondapalli LA, Shah A et al (2011) Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer. J Assist Reprod Genet 28:269–277PubMedCrossRefGoogle Scholar