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| |  Fertile Cancer Patients Could Benefit From Collaboration Between Oncologists and Reproductive Endocrinologists: Presented at ASRM By Crina Frincu-Mallos, PhD Washington, DC -- October 18, 2007 -- The use of chemotherapeutics on female cancer patients of child-bearing age can result in permanent impairment of fertility, a group of researchers reported here at the 63rd Annual Meeting of the American Society for Reproductive Medicine (ASRM). Ninety-one oncologists at Duke University Medical Center were sent a survey to determine the extent of their knowledge when it comes to fertility preservation and whether they apply this knowledge to premenopausal women. Data from 36 participants (40%) were collected using SurveyMonkey (www.surveymonkey.com). Although most of the oncologists stated that they recognize the importance of discussing fertility-preservation options, the survey shows that 6% of responders said they "always" refer their patients to reproductive endocrinologists, while 15% "routinely" (yet not always) do so. "Most [respondents] had heard of fertility-preservation options, but they were not routinely referring women to reproductive specialists," stated Eric Forman, MD, Resident Physician, Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, North Carolina, United States. "Almost half of them have never done that before, for any of their patients," he added. "Most of the ones that have been [referring their patients to reproductive endocrinologists] 'rarely' [or] 'only sometimes' do it." About 61% of the survey participants reported that they "usually" talk about the impact cancer treatment will have on fertility. "When it comes to adjusting the kind of treatment that they [give], a large proportion [of oncologists] would not be willing to give a regimen that would be less toxic to a woman's ovaries, even if she was willing to undergo that risk to preserve her fertility," noted Dr. Forman. There are guidelines from the American Society of Clinical Oncology (ASCO) recommending that oncologists routinely have discussions related to fertility and suggest options for fertility preservation in this patient population, prior to cancer treatment. "Everyone that responded agreed that they have a responsibility to do that, but it seems that they are not doing it yet," noted Dr. Forman. Interestingly, 77% (10/13) of the oncologists surveyed who treat more than 50 women a year have referred their patients to reproductive specialists, versus 43% (9/21) of the oncologists treating less than 50 women a year, said the researchers. Most oncologists were familiar with techniques such as in vitro fertilisation with embryo cryopreservation (97%), oocyte cryopreservation (97%), or ovarian-tissue cryopreservation (85%), according to the survey. In addition, alkylating agents were correctly identified by 72% of oncologists as the most gonadotoxic among chemotherapeutics. The data collected, however, indicate that the physicians surveyed are not necessarily keen on changing the way they treat their patients. There are definitely obstacles to referring patients, explained the researchers, such as the need to treat a patient immediately, or having a patient that is not interested in fertility preservation. The survey in this study -- an Institutional Review Board exempted survey -- although limited to a single academic institution, shows that there is a need for more education and cooperation between oncologists and reproductive specialists, and that more counseling should be offered to patients, explained Dr. Forman. One way to achieve greater cooperation between the two disciplines would be to have educational Grand Rounds for oncologists, said Dr. Forman. Physicians that attended Fertile Hope seminars at Duke University were "more likely to be willing to prescribe a less aggressive regimen to treat cancer, compared to those that did not attend the Grand Rounds," said Dr. Forman. David Adamson, MD, President-Elect of the American Society for Reproductive Medicine, noted, "Our field has made a great deal of progress in freezing eggs and ovarian tissue in the last 2 decades, and it is encouraging to see that oncologists recognise the need to inform cancer patients of the ways treatment will affect their fertility and the options they have to preserve fertility. Women with cancer, however, are not getting all the information they want on these topics. Reproductive specialists and oncologists both must make greater efforts to increase awareness." A new survey is being designed to target oncologists nationwide who are treating female cancer patients at reproductive age with no fertility problems, said Dr. Forman.
[Presentation title: A Survey of Oncologists Regarding Treatment-related Infertility Preservation in Female Cancer Patients. Abstract 690]
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