In the United States, more than 72,000 adolescents and young adults (ages 15-39 years) are diagnosed with cancer each year.1 Fortunately, advancements in early detection and treatment mean many young patients with cancer will live well beyond their cancer diagnosis. As higher rates of cancer survivorship are reached, the clinical focus has shifted from survival alone to include long-term quality-of-life issues.2 One important quality-of-life issue in young patients is the potential infertility caused by some cancer treatments.3,4 The likelihood of infertility varies according to age at diagnosis, cancer site, treatment modality, treatment agent, and other factors5; however, sustained infertility is estimated to develop in 50% to 95% of cancer survivors treated during their reproductive years.5-8
The issue of fertility subsequent to cancer treatment is a primary concern for most patients of childbearing age.9,10 Even in the face of a life-threatening illness, patients report that the loss of fertility is almost as distressing as the actual battle with cancer.11,12 Several studies have found that most cancer survivors (∼ 76%), men and women alike, are interested in having children, especially if they were childless at diagnosis.10,13-15 In fact, many patients report that their cancer experience increased the value they placed on parenthood and family ties.16,17
The long-term negative impact of infertility has also been shown among young male and female cancer survivors.18,19 More-recent studies suggest that among young women in particular, cancer-related infertility is associated with a greater risk for emotional distress and poorer quality of life.20,21 However, options are available that may preserve the ability to have biological children in the future.
WareJEJr. Methodology in behavioral and psychological cancer research. Conceptualizing disease impact and treatment outcomes. Cancer1984;15(Suppl 10):2316-2323.
Centers for Disease Control and Prevention. A national action plan for cancer survivorship: advancing public health strategies. Available at www.cdc.gov/cancer/survivorship/pdf/plan.pdf. Accessed October 13 2011.
PadronOFSharmaRKThomasAJJrAgarwalA. Effects of cancer on spermatozoa quality after cryopreservation: a 12-year experience. Fertil Steril1997;67:326-331.
LeeSJSchoverLRPartridgeAH. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol2006;24:2917-2931.
LassAAkagbosuFBrinsdenP. Sperm banking and assisted reproduction treatment for couples following cancer treatment of the male partner. Hum Reprod Update2001;7:370-377.
KnobfMT. The influence of endocrine effects of adjuvant therapy on quality of life outcomes in younger breast cancer survivors. Oncologist2006;11:96-110.
SchoverLRRybickiLAMartinBABringelsenKA. Having children after cancer. A pilot survey of survivors' attitudes and experiences. Cancer1999;86:697-709.
SchoverLRBreyKLichtinA. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. J Clin Oncol2002;20:1880-1889.
SchoverLRBreyKLichtinA. Oncologists' attitudes and practices regarding banking sperm before cancer treatment. J Clin Oncol2002;20:1890-1897.
PartridgeAHGelberSPeppercornJ. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol2004;22:4174-4183.
HammondCAbramsJRSyrjalaKL. Fertility and risk factors for elevated infertility concern in 10-year hematopoietic cell transplant survivors and case-matched controls. J Clin Oncol2007;25:3511-3517.
GreenDGalvinHHorneB. The psycho-social impact of infertility on young male cancer survivors: a qualitative investigation. Psychooncology2003;12:141-152.
GanzPAGreendaleGAPetersenL. Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol2003;21:4184-4193.
GanzPARowlandJHDesmondK. Life after breast cancer: understanding women's health-related quality of life and sexual functioning. J Clin Oncol1998;16:501-514.
SchoverLR. Psychosocial aspects of infertility and decisions about reproduction in young cancer survivors: a review. Med Pediatr Oncol1999;33:53-59.
McPhersonCJHigginsonIJHearnJ. Effective methods of giving information in cancer: a systematic literature review of randomized controlled trials. J Public Health2001;23:227-234.
KoithanMBellIRCaspiO. Patients' experiences and perceptions of a consultative model integrative medicine clinic: a qualitative study. Integr Cancer Ther2007;6:174-184.
QuinnGPVadaparampilSTLeeJH. Physician referral for fertility preservation with oncology patients: a national study of practice behaviors. J Clin Oncol2009;27:5952-5957.
GoodwinTOosterhuisBKiernanM. Attitudes and practices of pediatric oncology providers regarding fertility issues. Pediatr Blood Cancer2007;48:80-85.
WebbCKevernJ. Focus groups as a research method: a critique of some aspects of their use in nursing research. J Adv Nurs2001;33:798-805.
McGrathPHolewaH. Missed opportunities: nursing insights on end-of-life care for haematology patients. Int J Nurs Pract2006;12:295-301.
QuinnGPVadaparampilSTGwedeCK. Discussion of fertility preservation with newly diagnosed patients: oncologists' views. J Cancer Survivorship2007;1:146-155.
WallaceWHAndersonRAIrvineDS. Fertility preservation for young patients with cancer: who is at risk and what can be offered?Lancet Oncol2005;6:209-218.