Increasing interest has recently been shown in quality-of-life issues for cancer survivors, including fertility preservation (FP).1-12 Following the publication of the American Society of Reproductive Medicine’s guidelines on FP,13 in 2006 ASCO published FP guidelines, stating that oncologists should be prepared to discuss risks to patients’ fertility and make appropriate referrals.14 Despite these professional guidelines, current evidence indicates that numerous barriers exist to patients’ receipt of information about fertility options and referrals to appropriate clinical resources.8,11,15
The Competing Demands Model,16 which examines the offer of preventive services in a clinical setting, provides an excellent framework for examining discussions and offering FP. Because oncologists have multiple roles and must prioritize demands, such as adherence to guidelines and regulations and time required for patient visits, it has been argued that “rational physicians could be forgiven for despairing over yet another demand.”17 The Competing Demands Model explicitly considers these tensions.18 As noted by Williams,17 “the model describes 3 domains that directly influence the outcome of each clinical encounter: the clinician, the patient, and the practice ecosystem. The services delivered are the result of the competition between these demands. The model is useful because it highlights the need to consider all 3 factors in any attempt to improve care.” However, to date, the examination of barriers has only been conducted within patient populations or physician groups. Because no research to date has reviewed the institutional setting or practice ecosystem, this article potentially contributes novel information that will help advance health services research to improve FP communication.
At the time of this study, 39 NCI-designated comprehensive cancer centers (CCC) throughout the United States were treating adult patients. For a cancer center to achieve the “comprehensive” designation, it must demonstrate “reasonable depth and breadth of research activities in each of three major areas: laboratory, clinical, and population-based research.”19 Furthermore, NCI documents express an expectation for these CCCs to be leaders in progress against cancer and its sequelae.20 Because of their leadership in many areas of cancer treatment and survivorship, the authors expected these institutions would also be at the vanguard of addressing patients’ FP needs.
Notably, only 8 CCCs mentioned fertility and/or FP among their own survivorship activities in the 2006 report of the Cancer Center Directors Working Group.21 Although some may not consider FP a survivorship activity, the NCI uses the definition of survivor that begins at the time of diagnosis. Given the evolving landscape of basic and clinical science regarding FP22 and the interest in survivorship for young adults with cancer,23-25 the goal of this study was to examine institutional policies related to the provision of clinical FP resources and the availability of these services.
Proceedings of the 10th International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer. Niagara-on-the-Lake, Ontario, Canada. June 6-7, 2008. Pediatr Blood Cancer2009;53:248–302.
CarpentierMYFortenberryJD. Romantic and sexual relationships, body image, and fertility in adolescent and young adult testicular cancer survivors: a review of the literature. J Adolesc Health2010;47:115–125.
KingLQuinnGPVadaparampilST. Oncology nurses’ perceptions of barriers to discussion of fertility preservation with patients with cancer. Clin J Oncol Nurs2008;12:467–476.
QuinnGPMurphyDKnappC. Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature. J Adolesc Health2011;49:337–346.
QuinnGPVadaparampilSTBell-EllisonBA. Patient-physician communication barriers regarding fertility preservation among newly diagnosed cancer patients. Soc Sci Med2008;66:784–789.
Ethics Committee of the American Society for Reproductive Medicine. Fertility preservation and reproduction in cancer patients. Fertil Steril2005;83:1622–1628.
LeeSJSchoverLRPartridgeAH. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol2006;24:2917–2931.
QuinnGPVadaparampilSTGwedeCK. Discussion of fertility preservation with newly diagnosed patients: oncologists’ views. J Cancer Surviv2007;1:146–155.
JaenCRStangeKCNuttingPA. Competing demands model of primary care: a model for the delivery of clinical preventive services. J Fam Pract1994;38:166–171.
KlinkmanM. Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry1997;19:98–111.
National Cancer Institute. NCI-designated cancer centers. Available at: http://www.cancer.gov/researchandfunding/extramural/cancercenters. Accessed August 17 2012.
National Cancer Institute Office of Cancer Centers. Our History. Available at: http://cancercenters.cancer.gov/about/our-history.html. Accessed August 7 2012.
Recommendations from the NCI-Designated Cancer Center Directors: Accelerating Successes Against Cancer. Publication number T081 NIH number 06-6080. Available at: https://pubs.cancer.gov/ncipl/detail.aspx?prodid=T081. Accessed November 25 2013.
National Coalition for Cancer Survivorship. Our History. Available at: http://www.canceradvocacy.org/about-us/our-history.html. Accessed August 13 2012.
Lance Armstrong Foundation Centers for Disease Control and Prevention. A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies. Available at: http://www.cdc.gov/cancer/survivorship/pdf/plan.pdf. Accessed November 22 2013.
ReineckeJDKelvinJFArveySR. Implementing a systematic approach to meeting patients’ cancer and fertility needs: a review of the Fertile Hope Centers Of Excellence program. J Oncol Pract2012;8:303–308.
LorenAWManguPBBeckLN. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol2013;31:2500–2510.
QuinnGPVadaparampilSTLeeJH. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol2009;27:5952–5957.
QuinnGPVadaparampilSTGwedeCK. Developing a referral system for fertility preservation among patients with newly diagnosed cancer. J Natl Compr Canc Netw2011;9:1219–1225.
HuygheESuiDOdenskyESchoverLR. Needs assessment survey to justify establishing a reproductive health clinic at a comprehensive cancer center. J Sex Med2009;6:149–163.
KelvinJFReineckeJ. Institutional approaches to implementing fertility preservation for cancer patients. Adv Exp Med Biol2012;732:165–173.
CanadaALSchoverLR. The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology2012;21:134–143.
ClaytonHQuinnGPLeeJH. Trends in clinical practice and nurses’ attitudes about fertility preservation for pediatric patients with cancer. Oncol Nurs Forum2008;35:249–255.
QuinnGPVadaparampilSTKingL. Impact of physicians’ personal discomfort and patient prognosis on discussion of fertility preservation with young cancer patients. Patient Educ Couns2009;77:338–343.
QuinnGPVadaparampilST. Fertility preservation and adolescent/young adult cancer patients: physician communication challenges. J Adolesc Health2009;44:394–400.