Identifying barriers to fertility preservation in adolescent and young adult cancer patients

Meagan Harrison, Cynthia Lando, Sarah Smith, Katherine Harrison, Jeremy Rosenblum, Lila M. Pereira

Abstract


The adolescent and young adult (AYA) oncology population faces unique issues relating to cancer treatment, psychological symptoms, and access to appropriate care. Many patients receive gonadotoxic treatment, leading to impacts on fertility. Despite this, a large portion of the population does not pursue fertility preservation, negatively impacting both short- and long-term quality of life. AYA patients aged 14–39 years at a suburban academic medical center being treated for a cancer diagnosis consented to a larger registry study. Participants were contacted by phone, and a semi-structured interview regarding experiences with fertility preservation was conducted and transcribed. Interviews were coded for themes using a codebook based on previous literature. Of 57 eligible patients, 23 completed the interview. The most frequently coded themes were treatment urgency (20.6%) and length of reproductive material preservation (14.7%). Additional themes included cost of initial treatment (8.8%), patient/parents not being informed of the risk (8.8%), and perceived lower risk of gonadotoxicity (8.8%). Contrary to physician cited reasoning for their logic behind not offering preservation, patients didn’t cite lack of desire for children (0%) or already having children (2.9%) as reasons for not participating. Facilitators included a strong desire for children (26.1%) and timely provider communication (21.7%). Fertility preservation is an underutilized resource in the AYA population due to many factors. Despite increases in systemic patient education and in mandated insurance coverages, AYA populations still demonstrate reluctance to pursue FP treatment. The research findings continue to encourage consistent and timely discussions about fertility to promote shared decision-making and address factors influencing treatment utilization. 

Keywords: cancer, adolescent young adult, fertility preservation

https://doi.org/10.5737/23688076362228


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