Fertility Discussions Before Treatment Starts Can Mitigate Decisional Regret in Cancer Survivors

It is important that young adult patients with cancer — especially women — discuss their future family-building plans with their health care team before starting treatment. In doing so, individuals may be able to mitigate feelings of regret down the line, according to Donna Herrera Bell, a nurse practitioner at The University of Texas MD Anderson Cancer Center in Houston.

“For women, it can be a little bit more complex (than it is for men). Fertility preservation for women is invasive,” Bell said in an interview with CURE®’s sister publication, Oncology Nursing News®, explaining that fertility preservation for women with cancer is similar to an in-vitro fertilization (IVF) cycle, where drugs are administered to stimulate the ovaries, which will produce oophytes (mature eggs) that will be retrieved.

That whole process can take 14 days or longer, so the sooner it is completed, the sooner the patient can start their cancer treatment.

However, some patients have cancer that is more advanced and delaying treatment for a few weeks can negatively impact outcomes. In this case, it is vital to know how much treatment may impact fertility.

“Fertility risk for women is related to what kind of chemotherapy they’re going to receive. If they are receiving radiation — and if the ovary is going to be included in that field of radiation. The pituitary (gland) can affect (fertility) as well, (along with) what kind of surgery they are having,” Bell said. “It’s multifactorial, (and patients should consider) what is their age?”

Since women are born with all their eggs and do not make more throughout their life, older women may have a more sensitive fertility risk because they have fewer eggs than someone who only recently started menstruating.

Knowing fertility risks — and what can be done to improve future chances of getting pregnant — can help young women with cancer feel empowered, according to Bell.

“Many of the young adults who I talked to feel like fertility is yet one more thing that cancer has taken away from them,” Bell said. “So being able to have those discussion, being able to feel informed about their risks, fertility preservation procedures … I think is really key in decreasing the amount of decisional regret that survivors may feel, empowering them to be able to know that those decisions have been made.”

While patients may feel uncomfortable discussing sexual intimacy with health care providers, though that’s an important topic, too, fertility conversations do not typically delve into an individual’s sexual life.

“Fertility is obviously associated with sex,” Bell said. “When I started having these conversations, I would say, ‘The good news is that we’re not going to talk about sex. We’re just going to talk about fertility. We’re talking about if you want to have children in the future.’”

Bell explained that cancer survivorship research has shown that women who do not have discussions on fertility have increased decisional regret after treatment ends. Not to mention, fertility issues can also be a source of stress in the survivor’s relationships, Bell said.

Thankfully, these conversations are happening more frequently, even in the wake of an overwhelming cancer diagnosis.

“Many times, patients are devastated or focused on their diagnosis, and maybe they have a family member who brings it up and says, ‘Have they talked about fertility?’… We’re not quite there yet (in terms of always addressing it with patients), I think we’ve come a long way in the past few years, having these discussions and increasing the amount of awareness,” Bell said.

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