Fertility and Family Planning: Supportive Conversations With Cancer Patients
A family discusses fertility options with a clinician.
A multitude of questions come to mind when nurses ask themselves “How can we best support patients with cancer?” Given the sense of urgency that often accompanies a cancer diagnosis, supporting a patient's fertility or family planning options is often not at the top of the list. However, the more important question nurses should ask themselves is “How can I support the whole patient?” The answer to this question often involves going beyond the cancer and examining aspects of patients' lives outside of the cancer that will likely be impacted as a result.
Although no one can foresee a patient's outcome or what their future holds, we can do our best to ensure patients live a full life — one with many of the same options those without cancer would have. One way to do this is by providing patients, or the parents or legal guardians of pediatric patients, with information that empowers them to make educated and insightful decisions.
But when it comes to a patient's fertility or family planning options, when is the best time to have these discussions? Whether these decisions are in the patient's near or even distant future, the time to broach this topic is: as soon as possible. In fact, according to Kutluk Oktay, MD, PhD, of Yale University School of Medicine, and colleagues, the American Society of Clinical Oncology (ASCO) issued a clinical practice guideline update addressing fertility preservation in adults and children with cancer.1 These guidelines encourage health care teams caring for adult and pediatric patients with cancer to address the possible impact on fertility as soon as possible. Similarly, they encourage medical teams to refer patients who have expressed interest in preserving their fertility to reproductive specialists, and to document these discussions in the patient's medical records.
FAMILY PLANNING DISCUSSION POINTS
When nurses speak to patients about fertility and family planning options, there are several goals to keep in mind:
Preserve patients' choice Patients often struggle with not knowing if they want a family. This is especially challenging for pediatric patients and their parents. However, whether patients want to have a family is not the question they have to answer now. Instead, the question patients must ask themselves is, “Do I want the choice to have the family later on?”
Working toward preserving fertility provides patients with more options should they decide they want a family down the road. With all the uncertainty that comes along with a cancer diagnosis, many patients find it particularly empowering to preserve the option to have a family, even if they may later decide not to do so.