Reproductive concerns

What are the reproductive concerns and information needs of people diagnosed with cancer and their families?

Future fertility is a significant concern for people diagnosed with cancer.^[1] Patients desiring children at the time of diagnosis and people with post-treatment infertility are more vulnerable to reproductive concerns, independent of age.^[2] These concerns may result in distress, with infertility-related distress recognised as a long-term effect of a cancer diagnosis. There have been attempts to examine predictors of distress, but there are inconsistency in the findings. Infertility distress has been positively correlated with psychological distress, and negatively correlated with quality of life, relationship satisfaction, and acceptance of cancer. This is seen across gender, cancer type and stage, relationship status, and age.^[3]

Women with cancer report significantly higher infertility distress than men, while childlessness and relationship dissatisfaction are unique predictors of distress for men with cancer.^[4] Despite the importance of fertility for people diagnosed with cancer, unsurprisingly survival and good health are also a priority. Adolescent males diagnosed with cancer rank having children as an important life goal, however having good health is more important. ^[5] Fertility concerns of adolescent and young adult patients with cancer focus on health risks for the patient and their potential children, what infertility would mean for their future, and partner reactions to potential fertility problems.^[6][2]

Few studies have explored the fertility information needs of patients with cancer.^[7] Young women with breast cancer require information regarding the likelihood of specific treatments affecting their fertility, as this may influence their treatment decisions.^[8] Many men with cancer are concerned they will pass on cancer to their children. Informing men of the low likelihood of this risk may encourage more men to preserve sperm ^[9]. Women with cancer also have fears about cancer recurrence due to pregnancy^[10][8] and the impact of inherited cancer predisposition on any future children.

A systematic review found that young patients with cancer wish to be more adequately informed about fertility.^[11] While many parents and young people make shared decisions around fertility, parents and adolescents may have different priorities regarding future fertility and fertility preservation. Parents and health professionals need to consider this when counselling a child.^[5] When discussions are held with a child’s parents the preference for the child to be present depends on the child’s level of emotional and mental development and independence. Some children are too young or feel overly burdened to participate in these discussions.^[12] Embarrassment when discussing fertility can lead to rejection of fertility preservation which may later be regretted.^[11]

Most young people living with a history of cancer are sexually active and confusion about their fertility status may lead to risk taking behaviour and unplanned pregnancy. It is important to inform young patients with cancer of the likely uncertainty of their fertility status and the need for contraception despite any risk of infertility.^[11]

Evidence summary	Level	References
Future fertility and the opportunity to have a family are among the most important concerns of people with cancer. Receiving appropriate and accessible information is regarded as a high priority by patients and their families.	IV	[13], [6], [2], [5], [10], [9], [11], [8], [12], [14]

Evidence-based recommendation	Grade
All patients with cancer, regardless of age or relationship status, should receive age-appropriate information and support regarding the impact of specific cancer treatments on their future fertility.	C

Practice point

Where possible, the desire of the person with cancer for future fertility should be taken into account when choosing systemic and local cancer treatments.