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Fertility preservation in reproductive-aged female patients with colorectal cancer: a scoping review

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Abstract

Background

Colorectal cancer (CRC) incidence in adults younger than 50 years is steadily increasing in the USA, and treatment for CRC can impact future fertility. However, fertility decision-making in female patients with CRC can be complex, with fertility preservation (FP) counseling occurring inconsistently.

Purpose

The goal of this scoping review was to assess the literature regarding the frequency and quality of fertility preservation (FP) discussions taking place among oncology clinicians and their reproductive-age female patients with colorectal cancer (CRC) in order to identify existing gaps in care and inform future research, interventions, or potential changes in practice.

Methods

A comprehensive literature search was conducted using the Ovid Medline, PsycInfo, and Scopus databases in order to identify studies pertaining to FP counseling in reproductive-age female patients with CRC. We used Covidence to screen studies for relevance and to extract data. Findings of interest included rate of fertility and/or FP discussions, patient characteristics associated with fertility discussions, initiators of discussions, rate of referrals to fertility specialists, patient utilization of FP services, and unmet fertility needs. We performed both quantitative and qualitative data synthesis.

Results

We identified five studies that met our inclusion criteria, all published between 2007 and 2022. Frequency of fertility counseling discussions was low across studies, with a range of 15 to 52.5% of female patients with CRC receiving counseling. Patient characteristics which may be associated with likelihood of fertility discussion included age, parity, number of children, cancer location and stage, treatment type, and quality of life. The literature suggested that fertility discussions were initiated by clinicians about two-thirds of the time, and medical oncologists were the clinicians most likely to initiate. Studies did capture unmet fertility-related patient needs; participants who did not receive counseling often expressed desire for these discussions and regret that they did not occur.

Conclusion

Despite increasing incidence of CRC in patients at younger ages, this scoping review found a dearth of research conducted on young female CRC patients’ experiences with fertility counseling and referrals. Notably, the existing research reveals that relatively few of these patients are receiving appropriate counseling. Additional research is needed to clarify current FP counseling practices, patient and clinician perceptions about FP, and ways to improve the quantity and quality of FP counseling in this patient population.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Sophia L. Landay

  2. Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA

    Jamie A. Burns

  3. OU Health Stephenson Cancer Center, University of Oklahoma College of Medicine, Oklahoma City, OK, USA

    Madison L. Bickle & Ryan D. Nipp

  4. University of Massachusetts Chan Medical School, Worcester, MA, USA

    Becky Baltich Nelson

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Contributions

SL and RN contributed to review conception and design. Search strategy was devised by SL and BBN. Literature search, data collection, and analysis were performed by SL, JB, and MB. The first draft of the manuscript was written by SL. RN, JB, and MB critically revised previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sophia L. Landay.

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The original version of this article was revised. The author name Becky Baltich Nelson, though correctly appeared in the PDF version, were incorrectly displayed in indexing sites. The correct name should be Baltich Nelson, B.

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Landay, S.L., Burns, J.A., Bickle, M.L. et al. Fertility preservation in reproductive-aged female patients with colorectal cancer: a scoping review. Support Care Cancer 31, 612 (2023). https://doi.org/10.1007/s00520-023-08081-y

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