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.
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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.
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Schover LR, Brey K, Lichtin A. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. J Clin Oncol 2002;20:1880-1889.
Schover LR, Brey K, Lichtin A. Oncologists' attitudes and practices regarding banking sperm before cancer treatment. J Clin Oncol 2002;20:1890-1897.
Partridge AH, Gelber S, Peppercorn J. Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 2004;22:4174-4183.
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Hammond C, Abrams JR, Syrjala KL. Fertility and risk factors for elevated infertility concern in 10-year hematopoietic cell transplant survivors and case-matched controls. J Clin Oncol 2007;25:3511-3517.
Green D, Galvin H, Horne B. The psycho-social impact of infertility on young male cancer survivors: a qualitative investigation. Psychooncology 2003;12:141-152.
Ganz PA, Greendale GA, Petersen L. Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 2003;21:4184-4193.
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Schover LR. Psychosocial aspects of infertility and decisions about reproduction in young cancer survivors: a review. Med Pediatr Oncol 1999;33:53-59.
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Koithan M, Bell IR, Caspi O. Patients' experiences and perceptions of a consultative model integrative medicine clinic: a qualitative study. Integr Cancer Ther 2007;6:174-184.
Quinn GP, Vadaparampil ST, Lee JH. Physician referral for fertility preservation with oncology patients: a national study of practice behaviors. J Clin Oncol 2009;27:5952-5957.
Goodwin T, Oosterhuis B, Kiernan M. Attitudes and practices of pediatric oncology providers regarding fertility issues. Pediatr Blood Cancer 2007;48:80-85.
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Andersen MR, Bowen DJ, Morea J. Involvement in decision-making and breast cancer survivor quality of life. Health Psychol 2009;28:29-37.
Klock S, Zhang J, Kazer R. Fertility preservation for female cancer patients: early clinical experience. Fertil Steril 2010;94:149-155.
Quinn GP, Vadaparampil ST, Gwede CK. Discussion of fertility preservation with newly diagnosed patients: oncologists' views. J Cancer Survivorship 2007;1:146-155.
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