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01/23/2015

The Need for Patient Navigators for Fertility Preservation

Although life-saving, cancer treatments (e.g. radiation, chemotherapy, and surgery) can also lead to infertility in both women and men. Established reproductive technologies for women and men like gamete freezing and embryo freezing allow cancer patients to preserve their fertility in case they want to become biological parents in the future. 

Unfortunately, patients are frequently not adequately informed and sometimes not informed at all about fertility preservation. Some oncologists don’t consider fertility preservation to be an important issue, as they are more focused on saving the patients’ lives and see fertility preservation as a secondary consideration. Research has shown that even when oncologists refer their patients for fertility preservation they often do so based on social factors (they are more likely to refer wealthy, white, heterosexual, married patients) rather than purely on medical indications. Even when health care providers discuss fertility preservation with patients, many patients say that once they heard the word “cancer” as a diagnosis, they didn’t absorb much else from their initial conversation with their provider. 

This finding has lead some places to schedule a follow-up visit for newly diagnosed patients with a health care provider specializing in fertility preservation. However, having a fertility preservation patient navigator is expensive and the vast majority of hospitals don’t have someone dedicated to that position. Northwestern University’s Oncofertilty Consortium is one of the few places where there is a full time person devoted solely to providing patient navigation for fertility preservation. This navigator is also available as a resource for providers and patients outside of the Northwestern system; more information can be found here. There are some pilot programs at various institutions to train nurses and other health care providers to be able to counsel newly diagnosed cancer patients about their fertility preservation options and to encourage oncologists to refer all newly diagnosed cancer patients to these trained providers.  

While not all institutions will be able to provide the same degree of patient navigation regarding fertility preservation, it is imperative that some sort of system is in place to make sure patients are educated about fertility preservation. Many women find the diagnosis of potential iatrogenic (treatment-induced) infertility to be more devastating than the cancer diagnosis.  Research has shown that some women are willing to delay their cancer treatment in order to preserve their fertility and that some women choose less effective cancer treatment methods if these methods are more likely to spare their fertility. Given how important fertility preservation is to cancer patients, healthcare providers and institutions should strive to ensure that all cancer patients are made aware of fertility preservation technologies.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website. 

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