Fertility concerns of cancer survivors inadequately addressed, study finds

Professor Bogda Koczwara from Flinders Medical Centre in Adelaide said that fertility concerns among cancer survivors was a growing problem, due to a combination of improved cancer treatment outcomes in young cancer survivors and the trend for people to delay having children.

Millions of people worldwide are living after treatment for cancer, many of them still of reproductive age, Prof Koczwara said. To evaluate the range of fertility and sexuality concerns among these patients, she and her colleagues interviewed 25 cancer survivors --19 women and 6 men.

"Respondents perceived fertility as an important concern that was often inadequately addressed by healthcare providers," Prof Koczwara said.

"The most intriguing finding was that fertility concerns were also identified by women who have already completed their family, and fertility was an important issue even for those women who had no plans for further children."

The researchers found that fertility was important for these patients' sense of identity and body image. "That is important, as doctors may not raise these issues with patients who claim not to have plans for further children. As our study points out, maybe we should."

Sexuality and fertility can be affected by cancer and its treatment in a variety of ways. For some cancers, treatment may involve removal of reproductive organs. For others, the chemotherapy or radiotherapy may affect reproductive organs function either temporarily or permanently. For most patients, cancer treatment, delays reproduction and by making the patient unwell may impact on sexual desire.

In this study, sexual concerns seemed to be related to changes in body image and sexual identity, and the often discrepant sexual needs of patient and their partner. For single people, changes in sexual function resulted in anxiety about entering into future relationships.

"The lack of desire attributed to cancer treatment was associated with feelings of guilt about not supporting the partner among the participants in our study," Prof Koczwara said. With time, many respondents accepted fertility loss but struggled with ongoing impact of changes in sexual function and its impact on their relationships.

Prof Koczwara said there are some good resources available for patients to help them with concerns about fertility and sexuality, but patients in the study indicated interest in more information and resources."

"There appears to be a need for raising awareness of these concerns among cancer professionals and providing them with information and training regarding these concerns," she said.

Prof Ian Olver, CEO of Cancer Council Australia, commented that the presentation by Prof Koczwara highlights a major issue that impacts on the quality of life of people who survive cancer.

"Up to 65% patients diagnosed with cancer are still alive in 5 years, and survival is increasing with better treatments. Until recently the emphasis was on treating the cancer but it is being increasingly recognized that a variety of psychosocial problems and late effects of treatment persist and need to be addressed in this population," Prof Olver said.

"Perhaps the most surprising aspect of Prof Koczwara's study is that issues of fertility are important even to those who have completed their families, which highlights the importance of fertility to a person's identity. The call for greater awareness amongst cancer professionals of sexual and fertility issues should be translated as the need to provide the opportunity for patients to discuss these issues and then have the appropriate support to help in their resolution."