According to a 2009 survey of 249 oncologists who practice at academic medical centers, 95% reported routinely discussing a cancer treatment’s impact on fertility (Fertil. Steril. 2010;94:1652-6). Only 39% said they routinely referred female cancer patients to a reproductive endocrinologist or ob.gyn. who specializes in fertility, however, while 18% said they never refer their patients. Reasons most commonly cited for not referring included lack of patient interest in fertility preservation (38%), lack of time because of emergent need to start therapy (28%), and poor prognosis for future fertility (6%).
Three key factors contribute to a lack of referrals by oncologists, according to Dr. Loren: a lack of time, a lack of access to reproductive endocrinologists in the oncologist’s network/institution, and a lack of baseline knowledge about fertility preservation options.
"Many oncologists don’t know a lot about this; so they worry if they bring this up, patients are going to start asking, ‘What are my options?’ " Dr. Loren said.
"We have studied this issue specifically among clinicians who provide bone marrow transplantation to cancer patients. Lack of knowledge and lack of access to a provider are the biggest reasons that people don’t refer patients for fertility preservation," she added.
Dr. Loren advises gynecology specialists to make networking inroads with oncologists by offering to be their referral source for patients with questions about fertility preservation. This may include speaking at grand rounds and at occasional meetings of oncology faculty and staff – anything to increase awareness of options for patients. "A key to this is good communication," she said.
In a year-long pilot study carried out at the Tampa, Fla.–based Lee Moffitt Cancer Center to develop a referral system for fertility preservation in patients with newly diagnosed cancer, measures that included placement of informational brochures in the waiting room and establishment of a dedicated telephone line for referrals led to a ninefold increase in the number of calls received (J. Natl. Compr. Canc. Netw. 2011;9:1219-25). The researchers concluded that such a referral system "allows oncologists to fulfill their obligation and make informed decisions about fertility preservation, thereby improving the full cancer care continuum."
Dr. Chung, Dr. Loren, Dr. Noyes and Dr. Gracia said that they had no relevant financial disclosures.