Factors associated with the receipt of fertility preservation services along the decision-making pathway in young Canadian female cancer patients
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This study investigated the factors associated with the receipt of fertility preservation (FP) services along the decision-making pathway in young Canadian female cancer patients. The roles of the oncologists were examined.
A total of 188 women who were diagnosed with cancer between the ages of 18–39 after the year 2000 and had finished active cancer treatment by the time of the survey (2012–2013) participated in the study. Logistic regression models and Pearson χ 2 tests were used for analyses.
The mean ages of participants at diagnosis and at survey time were 30.2 (SD = 3.7) and 33.9 (SD = 5.9). One quarter (n = 45, 23.9 %) did not recall having a fertility discussion with their oncologists. Of the three quarters who had a fertility discussion (n = 143, 76.1 %), discussions were equally initiated by oncologists (n = 71) and patients (n = 72). Of the 49 women (26 %) who consulted a fertility specialist, 17 (9 %) underwent a FP procedure. Fertility concern at diagnosis was the driving force of the receipt of FP services at all decision points. Our findings suggest that not only was the proactive approach of oncologists in initiating a fertility discussion important, the quality of the discussion was equally critical in the decision-making pathway.
Oncologists play a pivotal role in the provision of fertility services in that they are not only gate keepers, knowledge brokers, and referral initiators of FP consultation, but also they are catalysts in supporting cancer patients making important FP decision in conjunction with the consultation provided by a fertility specialist.
KeywordsFertility preservation Cryopreservation Oncofertility Oncologist-patient communication Female cancer patients Decision-making
The author gratefully appreciated the mentorship of Esme Fuller-Thomson PhD (supervisor), Marilyn Crawshaw PhD, Shelley L. Craig PhD, and Terry Cheng PhD from the Doctoral Thesis Committee to supervise this doctoral research study. The author was also grateful to Bradley Zebrack PhD and David Brennan PhD for their critical review of the dissertation.
The author would like to acknowledge the help from Young Adult Cancer Canada and Rethink Breast Cancer for recruiting 9 young cancer survivors to pilot test the study survey. Sincere thanks are given to the following 53 Canadian cancer groups for disseminating the recruitment flyers through their networks: Abreast of ‘bridge Cancer Survivor Dragon Boat Club Lethbridge Alberta, Bikinis for Breast Cancer, Bladder Cancer Canada, Bladder Cancer Support Group, Breast Cancer Action Kingston, Breast Cancer Action Montreal, Breast Cancer Action Nova Scotia, Breast Cancer Support Network, Breast Cancer Support Services, Breast Friends Dragon Boat Racing Team Edmonton, British Columbia Cancer Agency, Canadian Breast Cancer Foundation, Canadian Cancer Society, North West Territories Division Alberta, Canadian Cancer Society, Nova Scotia Division, Canadian Cancer Survivor Network, Canadian Partnership Against Cancer, Canadian Skin Cancer Foundation, Cancer Care Manitoba, Cancer Care Nova Scotia, Cancer Chat Canada, Cancer Fight Club, Cancer Insight Ltd, Cancer Knowledge Network, Cancerview, Colorectal Cancer Association of Canada, Compassionate Beauty, David Cornfield Melanoma Fund, Ellicsr: Health, Wellness & Cancer Survivorship Centre, Gilda’s Club Great Toronto, Gilda’s Club Simcoe Muskoka, Heart - Hope Eternal Areola Reconstructive Tattooing, Hearth Place Cancer Support Centre, Hereditary Breast & Ovarian Cancer Society of Alberta, Hereditary Breast & Ovarian Cancer Society of Montreal, Hope Spring Cancer Support Centre, Knot a Breast, Mastectomy Wear for Fighters and Survivors, Melanoma Network of Canada, Nanny Angel Network, Ovarian Cancer Canada, Peterborough’s Breast Cancer Survivor Team, Princess Margaret Hospital, Rethink Breast Cancer, Sarcoma Cancer Foundation of Canada, Sunnybrook Odette Cancer Centre, Survive and Thrive Expedition, Surviving Beautifully, Think Pink Direct, Thrive: Physical Activity for Cancer Survivors, Thunder Bay Breast Cancer Support Group, Willow Breast Cancer Support Canada, Women’s College Hospital, and Young Adult Cancer Canada.
Compliance with ethical standards
This study was approved by the University of Toronto’s Office of Research Ethics (#27879).
This doctoral research project was generously funded by the Ontario Graduate Scholarship, the University of Toronto Fellowship Award, and the University of Toronto Factor-Inwentash Faculty of Social Work Doctoral Completion Award.
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