A systematic review found that fertility and parenthood were important and affected quality of life for young patients with gynecologic cancers; however, counseling and referral to fertility services is suboptimal. These findings were published in The Oncologist.
Investigators at the University of Coimbra in Portugal searched publication databases through July 2020 for studies on fertility in women with gynecologic cancers. A total of 13 studies comprising 910 patients with cervical cancer (428), ovarian cancer (217), endometrial or uterine cancer (147), and other cancers (118) were included.
Gynecologic cancers are heterogenous but have similar risk for potential loss of fertility, which can have important implications for the patient’s future quality of life.
In general, women expressed positive attitudes toward parenthood as well as fears about fertility postcancer. One-quarter of survivors considered their fertility when making treatment decisions.
Reproductive concerns were associated with poorer quality of life, increased cancer-specific distress, reduced sexual functioning, and greater gynecologic pain.
In one study, fewer than half of women (206/470 [46%]) recalled receiving pretreatment fertility counseling and fewer than half of those who did receive counseling (47%) were satisfied. A second study (39 participants) found a similar rate of pretreatment fertility counselling (46%), but this patient group was more satisfied with their counseling (89%).
Receiving fertility counseling was associated with reduced regret about fertility decisions.
One study of 660 women who received counseling found low referral rates to a fertility specialist (12.9%). Low referral rates also were reported by 3 other studies, with rates ranging from 15% to 33%.
A potential limitation of this study was that most studies were retrospective which could have included recall bias.
This review found that patient perspective regarding fertility concerns in gynecologic cancer is often overlooked and should be researched further.
Gonçalves V, Ferreira PL, Saleh M, Tamargo C, Quinn GP. Perspectives of young women with gynecologic cancers on fertility and fertility preservation: a systematic review. Oncologist. 2022;27(3):e251-e264. doi:10.1093/oncolo/oyab051