Dr. Woodruff’s article “Reproductive endocrinology: fertility in female survivors of childhood cancer” was recently listed as one of the top 20 articles in the field of reproduction and endocrinology since 2013. This article was listed at the 8th most influential in the list of 20. Dr. Woodruff’s impact in the field of reproduction and endocrinology remains clear and she joins of the likes of other highly influential scholars on the list. Congratulations to Dr. Woodruff for this honor!
Gonadotoxic therapies, such as chemotherapy, used to treat breast cancer can have harmful effects on fertility- they destroy ovarian follicles, or women’s reserve of ova, resulting in amenorrhea and/or early menopause. Additionally, many endocrine therapies used to treat breast cancer have indirect effects on fertility, often impairing ovulatory and endometrial function.
Approximately 11% of women diagnosed with breast cancer are under age 45, and one of the largest predictors of infertility after cancer treatment in women is age: 5% of women diagnosed with cancer at age 30, 32% of women diagnosed at age 35, and 80% of women diagnosed at age 40 are infertile after cancer treatment. Women under age 45 have unique survivorship concerns- including the risk of infertility due to cancer treatment.
Current guidelines from both the American Society of Clinical Oncology (ASCO) and the American Society for Reproductive Medicine (ASRM) recommend discussing the impact of cancer treatment on fertility and fertility preservation options with all reproductive-aged patients. These discussions need to take place as early as possible following a cancer diagnosis so there is time to consider all fertility preservation options.
It is unknown how many women in the United States are at risk for loss of fertility following breast cancer treatment. A recently published article by Trivers et al. (2014) in The Oncologist, estimated the number of breast cancer survivors in the U.S. at risk of infertility for whom fertility preservation education is necessary. Trivers et al. (2014) also estimated the number of at-risk survivors who may desire pregnancy and therefore may benefit from a more in-depth fertility preservation consultation as well.
The study combined data from several different sources:
- National Program of Cancer Registries (NPCR)
- National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) program
- NPCR’s 2004 Breast and Prostate Cancer Data Quality and Patterns of Care (PoC) study
- 2006-2010 National Survey of Family Growth (NSFG)
In the cancer registry data, an average of 20,308 women with breast cancer aged <45 years were diagnosed annually. Based on estimates from PoC data, almost all of these survivors (97%, 19,416 women) were hormone receptor positive or received chemotherapy and would be at risk for infertility. These women should receive information about the impact of treatments on fertility. Estimates based on NSFG data suggest approximately half of these survivors (9,569 women) might want children and could benefit from fertility counseling and fertility preservation.
Trivers et al. (2014) conducted the first study determining that nearly all young women diagnosed with early stage breast cancer will receive therapy and treatment that puts them at risk for infertility, and approximately half of at-risk survivors may be interested in having children in the future. Therefore health care providers should discuss the potential impact of cancer treatment on fertility with all reproductive-aged patients diagnosed with cancer and refer them to a fertility specialist before cancer treatment begins.
Unfortunately, barriers exist which prevent young women diagnosed with early stage breast cancer from receiving the needed information regarding their future fertility. Many survivors have reported not receiving information about how cancer treatment effects fertility and/or available fertility preservation options. Nevertheless, health care providers have a critical role in discussing potential risk of infertility in the context of treatment decision making and determining the patient’s interest in having children. Additionally, financial constraints make it difficult for women to proceed with fertility preservation procedures. Cancer survivors should have access to and coverage for fertility preservation services given the risk of potential infertility and the subsequent quality-of-life implications. The American Medical Association (AMA) recently released a policy supporting coverage by all insurance companies of fertility preservation techniques for cancer patients requiring treatment that may result in infertility.
In conclusion, Trivers et al. (2014) data showed the importance of and the need for fertility preservation consultations and access to oncofertility specialists among almost all young women diagnosed with breast cancer.
Estimates of Young Breast Cancer Survivors at Risk for Infertility in the U.S.
Katrina F. Trivers, Aliza K. Fink, Ann H. Partridge, Kutluk Oktay, Elizabeth S. Ginsburg, Chunyu Li and Lori A. Pollack
The Oncologist published online June 20, 2014
Read the full article, along with updated information and services, at: http://theoncologist.alphamedpress.org/content/early/2014/06/20/theoncologist.2014-0016
A variety of patient education materials have been created for providers to use in the oncofertility care setting- materials that describe fertility preservation options in easy-to-understand language and have been designed in multiple platforms ranging from informational fact sheets to internet videos. The Oncofertility Decision Tool Web Portal.has gathered the existing oncofertility patient aids and organized them within our
An entire section of the portal is devoted to patient education. We have done this so providers can quickly access materials when reproductive age patients whose fertility is threatened by their disease or treatment are on their clinic schedule.
Every patient has a unique learning style and therefore the following types of oncofertility educational materials are available for patients:
- American Society for Reproductive Medicine (ASRM) one-page fact sheet with short summaries of the available fertility preservation options available to men and women diagnosed with cancer
- Personal Accounts of Cancer and Infertility provided by Fertile Hope
- An interactive web-based video designed for patients who may not have access to a full fertility preservation consultation with a reproductive endocrinologist
- Interactive and informational websites, such as:
- The Livestrong Foundation
- Fertile Action
- The 24-hour fertility preservation hotline: FERTline
- An electronic booklet on adolescent and young adult cancer issues created by the National Comprehensive Cancer Network (NCCN)
- The Moving Forward video series created by the American Society of Clinical Oncologists (ASCO)
If you would like the oncofertility patient education materials your clinic provides to patients included in the Oncofertility Decision Tool Web Portal, please email us at firstname.lastname@example.org or comment below.
Need to stay up to date on the latest clinical guidelines, recommendations, and opinions? Our Oncofertility Decision Tool Web Portal has an entire section devoted to bringing you ALL of the clinical guidelines affecting fertility preservation and oncology care. We designed it this way so the resources you need are at your fingertips- organized in one easy to access online location. Check out our Clinical Recommendations, Guidelines, and Opinions section of the Oncofertility Web Portal today!
The resources are listed in reverse chronological order and directly link to the clinical recommendations in PDF format making them easy to download to your desktop or print. We have also summarized each guideline explaining how health care providers may benefit from each resource.
Our Clinical Recommendations, Guidelines, and Opinions are pulled from the following organizations:
- American Society for Reproductive Medicine (ASRM)
- American Society of Clinical Oncology (ASCO)
- British Fertility Society
- Children’s Oncology Group
- National Comprehensive Cancer Network (NCCN)
- Society for Assisted Reproductive Technology (SART)
Check out our NEW Oncofertility Decision Tool Web Portal section on Clinical Guidelines, Recommendations, and Opinions. We want your feedback!
Yesterday we announced our NEW Oncofertility Decision Tool Web Portal. This online portal serves as a one-stop-shop for health care providers in need of tools to facilitate fertility preservation conversations with their patients whose disease, or its treatment, threatens fertility. In addition to decision tools and aids, we have collected and organized the existing literature discussing oncofertility communication strategies and provided online access to the publications in our web portal. Many of the publications come directly from Dr. Woodruff’s various Oncofertility books- the same books you may have read chapter summaries about in this very blog. The web portal has taken all of those book chapters, along with journal articles, and compiled them for health care providers. They are organized by publication year and patient population. Each Decision-Making Publication also includes a short summary describing how health care providers may find the reading beneficial in their clinical practice.
The Decision-Making Publications address many issues, including:
- Fertility preservation communication strategies for: pre-pubertal (pediatric), adolescent, and adult oncology patients
- Hereditary cancer predisposition syndromes (e.g. HBOC due to mutations in BRCA1 and BRCA2) and fertility preservation
- Family history of cancer and fertility preservation
- Non-malignant conditions and treatments associated with infertility
- Including partners in fertility preservation discussions
- Including families in fertility preservation discussions (e.g. family decision making)
- Psychosocial screening and loss of fertility
- Bioethics and Oncofertility: Arguments and Insights from Religious Traditions
Please check out our brand new Decision Tool Web Portal and browse the communication literature YOU can use to help discuss fertility preservation options with your patients. We would greatly appreciate feedback in the comments section.
Have you written or read a piece of fertility preservation communication not currently accessible through the Decision Tool Web Portal? Email the Oncofertility Consortium at email@example.com if you would like it to be included!
The Decision Tool Web Portal for health care providers who care for patients diagnosed with malignant and non-malignant conditions which may impair fertility (or treatment may impair fertility).has created a
Decision Tools are designed to enable oncofertility stakeholders to take action. They provide information to help health care providers guide patients through their fertility preservation options and help them make the best decision based on their treatment, lifestyle, values, and future fertility goals. We collected existing decision tools from oncofertility stakeholders around the globe and organized them in one easy-to-access web portal. Each decision tool links to the tool itself, the original research article or book chapter (if applicable), a description of the patient population the tool targets (e.g. adolescents), and a short summary of how health care providers can use the tool in clinical practice.
Please check out our brand new Decision Tool Web Portal and find a tool that YOU can use to help discuss fertility preservation options with your patients. We would appreciate your feedback (leave a comment below).
Do you use fertility preservation decision tools or aids in your practice that are not currently accessible through the Decision Tool Web Portal? Email the firstname.lastname@example.org if you would like your decision tool/aid to be included!at
Thank you to Drs. Woodruff and Kibbe on their tireless work to promote the inclusion of females in all research, from cells to humans and we congratulate them on a wonderful interview.
Dr. Teresa Woodruff, Director of the Oncofertility Consortium and Northwestern’s Women’s Health Research Institute will be featured on Chicago Tonight on WTTW, Channel 11, tonight at 7pm CST. Dr. Woodruff, along with Dr. Melina Kibbe from Northwestern Medicine, were driving forces behind the push for the NIH to require females in all preclinical research studies; from cells to animals. Tune in if you can!
Registration is now open for the 2014 Oncofertility Conference, Bench to Bedside: Oncofertility Advances in Males and Females which takes place September 22-23, 2014 in Chicago, IL.
This year’s conference will attract more than 150 researchers, clinicians, advocates and trainees from around the globe who are dedicated to ensuring reproductive health for cancer survivors whose disease or treatment may impair fertility.
This year, we are excited to expand the number and scope of training courses offered in conjunction with the 2014 Oncofertility Conference, Bench to Bedside: Oncofertility Advances in Males and Females. In addition to our exciting Day 1 agenda full of presentations and case studies by Oncofertility leaders, we have elected to have 2 clinical-based training courses and 2 lab-based training courses on Day 2 with a shared luncheon to allow for additional networking and communication between researchers and clinicians.
The Robert H. Lurie Comprehensive Cancer Center of Northwestern University is proud to host a Cancer Survivors’ Celebration Walk & 5K on Sunday, June 1st in Chicago’s Grant Park. No pledges are required to participate and registration is open until May 30th.
This wonderful event includes a non-competitive walk along the lakefront or a chip-timed 5K race, picnic, family entertainment, Dedication wall, and more. Join survivors, families, friends, physicians, scientists, and health professionals to celebrate our survivors! The celebration begins at 7:30am and we hope to see you there.