By Brittany Speller, Corinne Daly, and Nancy Baxter
Cancer Treatment and Fertility
More young people are surviving cancer due to improvements in cancer treatments. Some cancer treatments however, including chemotherapy, radiation or surgery may temporarily or permanently impact the natural ability of women to conceive or carry a pregnancy to term. Future fertility and the ability to have biological children are common concerns among women of reproductive age who are diagnosed with cancer. While there are options available to preserve eggs or embryos (fertilized eggs), women report a lack of awareness of the fertility options and costs associated with fertility treatments.
Individuals are often shocked when confronted with a diagnosis of cancer and it may be difficult for them to make urgent decisions about future fertility in an informed way. Research has shown, that generally, younger women and those who express a desire to have children before cancer treatment are more likely to receive information on fertility matters whereas older (aged 35 – 40) women are less likely to be informed of fertility risks. Women who are able to attend fertility counseling prior to the start of cancer treatment have reduced long-term decisional regret, reductions in anxiety and depression, and greater overall satisfaction with life.
Providing women with information on the fertility risks and options prior to cancer treatment is essential for informed decision-making with health care providers. Not-for- profit organizations such as Willow provide a community of support, resources, and information on fertility for breast cancer patients. Tools are also used in practice to inform patients on the medical options and associated outcomes, and help clarify personal values. In Australia and the Netherlands, formal decision support tools with customized exercises (referred to as decision aids) have been developed to help young women diagnosed with breast cancer make value-based fertility decisions. Evaluation of these aids has shown that patients have improved fertility-related knowledge and reduced uncertainty in decisions thus promoting informed decision-making.
Fertility Decision-Making in Canada
While fertility decision aids in Australia and the Netherlands have shown promising results, the information and resources in the tools are not directly relevant to the Canadian setting. Currently, there is no decision aid specifically designed to assist Canadian breast cancer patients with fertility decision-making at the time of cancer diagnosis. Our multi-disciplinary research team at St. Michael’s Hospital in Toronto, Ontario is conducting a study to determine what information health care providers and breast cancer survivors feel is useful when discussing and considering fertility preservation. We plan to use the results of the study to help in the design of a Canadian decision aid that will be available to breast cancer patients and help in making value-based fertility preservation decisions before cancer treatment.
If you are a breast cancer survivor who was 18-45 years of age when diagnosed and completed active treatment less than 5 years ago, you may be eligible for this study. If you are interested in participating in a short one-time interview please contact, Brittany Speller, at 647-407-8557 or by email at firstname.lastname@example.org.
Dr. Nancy Baxter is a General Surgeon and Chief of the General Surgery Department at St. Michael’s Hospital. She is a Professor of Surgery at the University of Toronto, and an Associate Professor in the Institute of Health Policy, Management and Evaluation. Dr. Baxter is a full member of both the Institute of Medical Sciences and School of Graduate Studies. She holds a Senior Scientist role in the Cancer Theme Group at the Institute for Clinical Evaluative Sciences and is an Scientist with the Li Ka Shing Knowledge Institute.