Only half of people with early-onset cancers reported discussing fertility preservation options prior to their oncology treatments, according to results of a cross-sectional study published Nov. 12 in JAMA Network Open.
The questionnaire was administered by investigators with the Reproductive Health After Cancer Diagnosis and Treatment (REACT) study, an initiative led by Andreana Holowatyj, PhD, MSCI, assistant professor of Medicine at Vanderbilt-Ingram Cancer Center, in partnership with 23 community organizations and several patient advocacy colleagues. REACT aims to improve clinicians’ and researchers’ understanding of the unmet care needs of adults younger than 50 with a cancer diagnosis, including fertility, sexual health, body esteem, physical activity and personal relationships.
“From an early-onset cancer diagnosis through to surveillance and survivorship, we know there are unique care needs for patients and their families that must be considered,” said Holowatyj, the study’s senior author. “That said, we do not yet have the ‘best’ strategies to deliver comprehensive oncology care to all young patients, regardless of age, geographic location, access to care, self-identified race and ethnicity, sex or gender identity. The REACT study was developed in partnership with patients to capture some of these important insights into what young patients experience, feel and discuss with their cancer care provider — so that we can work to effectively address these unmet needs moving forward.”
Young patients with thyroid, lung, ovarian and colorectal cancers reported the lowest prevalence of a fertility preservation discussion with a health care professional involved in their cancer care. Only 21.4% of patients with ovarian cancer reported a discussion about fertility preservation. The percentages reporting a discussion were 44.2% for patients with colorectal cancer, 21% for lung cancer, and 3.6% for thyroid cancer. The patient population represented 30 types of early-onset cancers.
This study included 473 patients between the ages of 18 and 49 who participated in REACT worldwide. The patients were diagnosed between 2013 and 2021. Holowatyj then established the Preserving Fertility After Colorectal Cancer (PREFACE) study in late 2021.
“We want all young patients diagnosed with cancer to get comprehensive, high-quality oncology care, which includes reproductive health care, like we deliver here at Vanderbilt,” Holowatyj said. “Our discovery that 1 in every 2 patients in REACT reported not having had a discussion on fertility preservation options with their health care professional before starting early-onset cancer treatment is alarming. Notwithstanding the potential drawback that not all patients may have remembered this conversation, our clinically significant findings shed light on the crucial need to tailor strategies that will deliver concordant reproductive health care to this growing patient population.”
This study is the first set of data and results released by REACT. Holowatyj has received the National Cancer Institute’s Method to Extend Research in Time (MERIT) Award to study how cancer treatments impact reproductive health (R37CA273318). REACT was also supported by the American Cancer Society, National Cancer Institute (P50CA236733), National Institute of Child Health and Human Development (K12HD043483), National Center for Advancing Translational Sciences (UL1TR002243), and the Drs. Sidney and Becca Fleischer Undergraduate Summer Research Fund.
The study’s lead author is a recent Vanderbilt University alumna and former trainee in the Holowatyj Laboratory, Samantha Keller. Other Vanderbilt authors who contributed to the study include Rebecca Babyak, Fei Ye, PhD, MSPH, Rajiv Agarwal, MD, Kristen Ciombor, MD, Timothy Geiger, MD, MMHC, Cathy Eng, MD, Michelle Roach, MD, and Digna Velez Edwards, PhD.
