Difficult Conversations: Fertility after Cancer

Cancer can be a challenging thing to discuss, even with your doctors and loved ones. Discussing the often sensitive topic of your fertility before, during or after cancer treatment can prove even more challenging. A study published December 2014 in the Journal of Oncology Practice looked at how often clinicians documented having fertility discussions with their adolescent and young adult (AYA) patients. Lead author Gwendolyn Quinn and colleagues report results from a group 231 AYA cancer patients who were in treatment in 2011. Their findings left a lot of room for better communication: 

  • In 26% of the cases, there was documented discussions of fertility risk
  • In 24% of the cases, there was documented discussions of fertility preservation
  • In 13% of the cases, clinicians had documented referral to a fertility specialists  

Even more concerning was that AYAs with cancer rated fertility preservation as their top priority. Since 2011, there have been some positive efforts to correct this lack of communication about fertility topics. In 2013, American Society of Clinical Oncology (ASCO) updated guidelines on how to discuss fertility with cancer treatments and these guidelines now encourage clinicians to have this conversation as soon as possible. Furthermore, researchers continue to study fertility after cancer treatment and they’ve found some optimistic results

But what can patients do to ensure that they get answers to their important questions? One of the goals of the AYA Clinic at Tufts Medical Center is to help patients advocate for themselves in all medical settings, to ensure that, regardless of the situation your needs are met as best as possible. So what can you do if your healthcare provider isn’t giving you information about something like your fertility?

Here are some tips from our team:

1. Don’t feel embarrassed to ask! While this is easier said than done, your clinicians are a resource for all of your health-related questions. If there is a question they can’t answer, they should be able to refer you to someone who can.

2. Don’t be afraid to find a new clinician if you just can’t talk to your current one about your important questions.

3. If you are nervous, you might forget! Bring a list of questions that you want to ask and write down the answers. If you want more support, bring a family member or a friend whom you trust to be supportive without dominating your appointment. Ask him or her to take notes and remind you to bring up any questions

4. It is O.K. to tell your providers if they aren’t explaining something well and you should definitely ask follow-up questions. Your understanding is most important and sometimes clinicians forget to speak clearly or they use medical jargon instead of explaining concepts. Have confidence to ask for clarification, or even for them to just slow down, whenever you feel you need it!

This study is further evidence that there needs to be more, and better, conversations about the risk of and options for fertility during the cancer treatment process. It is also important that clinicians document these important conversations as part of complete, quality care. Learn more about the study here.

Do you have other suggestions on how best to talk about difficult topics with your doctors? Share in the comment section if you do!

If you should have any questions about how cancer and treatment can affect fertility, please contact us at ayaprogram@tuftsmedicalcenter.org.

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