Currently, oncofertility guidelines recommend fertility counselling at the time of cancer diagnosis to assist in fertility preservation decision-making.1,2 A systematic review was conducted to assess the level of fertility-related psychological distress experienced by cancer patients of reproductive age (<45 years) across oncological treatment time points: diagnosis, treatment, and survivorship. This review was able to inform on a model of longitudinal care having assessed the fertility-related psychological impact that may persist into survivorship.
Results indicated both a prevalence and persistence of fertility-related psychological distress and reproductive concerns that are associated with negative emotional responses. Reproductive concerns and impacted fertility affect the sense of self and life narrative of cancer survivors, leading to a life with reduced meaning and purpose. Heightened anxiety, depression, and trauma reported at diagnosis appear to remit throughout oncological treatment, while reproductive concerns persist. However, an increased prevalence of mental health disorders was noted in cancer survivors; namely, depression in male and female survivors (22–30%), and trauma commensurate with post-traumatic stress disorder experienced by female survivors (20–72%). Findings highlight that there are risk factors for the experience of mood disorders in survivorship, including reproductive concerns, being childless, expressing an unfulfilled desire for a child, sexual dysfunction, and ovarian failure.
Discussions brought forward at the European Society of Human Reproduction and Embryology (ESHRE) 2018 Annual Meeting pertained to the clinical implications of these findings. Although there is variance in the level of distress that patients experience, the increased prevalence of clinically significant distress in survivorship highlights the need for ongoing psychological care. As such, it is recommended that all patients continue to have access to fertility counselling throughout cancer treatment and survivorship. Ongoing access to fertility information and supportive care, which form part of fertility counselling, may serve to reduce levels of psychological distress and may mitigate the likelihood of mental health disorders developing in survivorship.
Moreover, it is recommended that the provision of specialised mental health treatment be available to those patients that report significant levels of distress. Currently, models of care vary worldwide in both the availability and utilisation of fertility counselling.3,4 At times, fertility counselling is undertaken by medical fertility specialists,5 while, in other locations, counselling is undertaken by mental health clinicians.6 As such, the content discussed and the training of clinicians in delivering counselling may vary widely. Results indicate the necessity of an experienced clinician being available to undertake the assessment and treatment of psychological distress and mental health disorders. As such, fertility treating centres should ensure they are able to access or refer to appropriate psychological services for those patients who report additional fertility-related psychological distress.
In addition, it is useful to consider that the experience of fertility occurs within a family system. In this sense, fertility-related distress may be experienced by family members of cancer patients, including parents and partners, or others involved in direct patient care and fertility treatment decision-making. It is advisable that when fertility-related psychological distress occurs in cancer patients or those family members involved in patient care, that fertility counselling would be beneficial to all parties.7 As such, psychological support should be delivered to those individuals who necessitate additional care when fertility distress is identified and is not contingent on a cancer patient’s specific age.