Cancer and fertility preservation
A scoping report that highlights why fertility preservation is an important consideration for cancer patients. It includes a comparison of CCG/STP fertility preservation policies in London and a checklist for system wishing to reducing variation in fertility preservation and support for patients.
During 2019/20, TCST undertook a scoping exercise regarding fertility preservation for people affected by cancer. The aim of the Fertility and Cancer Scoping Report is to provide CCGs/STPs/ICSs, cancer alliances, clinicians and management teams with a greater understanding of the fertility preservation services and support offered to people aged 16 and over affected by cancer in London. This includes both Teenage and Young Adult and Adult Cancer Services for both men and women.
Cancer and Fertility Preservation – the case for change
At the time of diagnosis, The National Institute for Health and Care Excellence (NICE) clinical guidance 156 recommends that: ‘the impact of the cancer and its treatment on future fertility should be discussed between the person diagnosed with cancer and their cancer team.’ It is also important to note that the NICE guidance mentioned in Section 1.3.1 does not mention specific age limits for fertility preservation treatments. NICE guidance mentions ‘women of reproductive age (including adolescent girls)’ and ‘men and adolescent boys,’ but no age cut off for eligibility.
Whilst NICE recommends the above, London’s Clinical Commissioning Groups (CCGs) dictate the fertility preservation treatment available to patients and the length of time sperm, oocytes, embryos can be stored for patients residing within their geographies. This means that fertility preservation treatment varies at a CCG level or Integrated Care System level or borough level (depending on location in London).
In a survey of London’s cancer healthcare professionals:
- 98% of respondents mentioning they refer patients for fertility preservation
- Only 37% of HCPs indicated that they were either extremely confident or very confident discussing the impact cancer and/or cancer treatment has on fertility,
- Approximately 30% of HCPs felt confident about discussing fertility preservation options with cancer patients
- Almost 75% reported that they had not received any training/education in the last 5 years on the impact of cancer treatment on fertility and fertility preservation options available to patients.
In the survey, respondents also also identified a range of obstacles to referring patients to fertility preservation services/support, including:
- concerns that waiting times for fertility treatment may delay cancer treatment and time delays if a patient chooses to go through with fertility preservation.
- lack of communication and complicated referral pathways between cancer and fertility services, making it difficult to refer patients in the first place.
- lack of knowledge/guidance, including not understanding eligibility criteria for fertility preservation or not knowing where to refer to as a barrier to referring
- fertility service being on a different site to the cancer service, making it far for some patients to travel
- Concerns around psychological impact for the patient — receiving bad news about cancer and then having to quickly think about family planning.
It is important to note that this work ended prematurely due to the Covid-19 outbreak in March 2020 when NHS England declared a level four incident due to the pandemic. This meant project work unrelated to Covid-19 was halted in the top down command and control structure where NHS England determined local activity and priorities.
Read the report: Cancer and Fertility Preservation Scoping Report (2020)