The progress made in cancer diagnosis and treatment has radically improved patient outcomes. More than 50% of people diagnosed with cancer can expect to achieve long-term survival in countries with well-developed healthcare systems. That steady and continuing improvement brings with it the requirement that we focus on the quality of life of cancer survivors. Cancer professionals and patients need to plan carefully together to manage any long-term consequences of cancer and its treatment that they may encounter. Such “Survivorship Care Plans” are widely recommended but not yet comprehensively taken up in all healthcare systems.
Increasing cancer survival rates and the trend towards a later parental age for childbirth mean that there is an increasing chance of a person being diagnosed with cancer before their family is complete. There are increasing numbers of patients for whom fertility following their cancer and its treatment has to be considered carefully; this is a central issue for these patients and professionals. The Association of Cancer Physicians (ACP) has worked with specialists in fertility on Problem Solving in Cancer and Fertility, bringing together the extensive and ever-increasing body of information about the way that cancer and its treatment can affect fertility, the way that fertility can be protected in many patients, and the important aspects of communication and a patient-centred approach which must underpin the provision of cancer care in this most important and sensitive area. The book will discuss exciting technological developments in the preservation and promotion of fertility in cancer patients, which has become a fast-moving field of research and innovation.
Patient concerns about their future fertility are well documented. For example, studies show that over 50% of women diagnosed with breast cancer and ovarian cancer express substantial concerns about impacts on fertility; young men diagnosed with cancer place the retention of fertility as a high priority. However, good quality discussions about fertility do not always occur between cancer patients and healthcare providers. Under some circumstances the cancer care team may prioritise the treatment on curing a cancer; some cancer professionals may lack knowledge of modern fertility preservation. There will be concerns about any risks of delay in treatment, or about increasing emotional distress if fertility is discussed in detail. However, these fertility discussions are central to high-quality survivorship for cancer patients in future. The best cancer care is delivered through a multidisciplinary team; all team members need to be aware of fertility issues for their patients, and some team members should take specific responsibilities to constantly review and audit team practice in this challenging area. The wider multidisciplinary team should involve specialists in fertility, and there need to be clear protocols to involve fertility specialists appropriately when this is needed.
This text on cancer and fertility includes a wide spectrum of issues which are illustrated as chapters and case histories. The perspective chapters cover fertility issues in women and men, including fertility preservation at the time of diagnosis; management, including drugs used during pregnancy; and survivorship issues such as conceiving after treatment, premature ovarian insufficiency, and surrogacy. There are also chapters on issues related to counselling, genetics and ethics. The case histories follow the same pathway as the chapters, but using sometimes complex histories to illustrate the principles and dilemmas.
The case histories are complementary to the chapters, and there are themes linking clinical scenarios as follows:
Female fertility and fertility preservation:
Chapters 1, 2 and Case histories 1, 2, 4, 5, 6, 21, 22
Male fertility and fertility preservation:
Chapters 3, 7 and Case histories 3, 7, 23
Chapters 4, 5 and Case histories 4, 8, 9, 10,11,
Pregnancy after cancer in women and men:
Chapters 6, 9 and Case histories 4, 9, 12, 13, 14, 15, 18, 20, 21, 22, 23
Chapter 11 and Case histories 5, 19, 22
Premature ovarian insufficiency:
Chapters 8, 10 and Case histories 14, 15, 16, 17
Counselling and ethical issues:
Chapters 9, 12, 13 and throughout many of the case histories
The decision by the Association of Cancer Physicians to focus a workshop and Problem Solving publication on the fertility of cancer patients is a reflection of the progress and success in cancer treatment which we all welcome. However, it also illustrates very well the challenges which we have to face to ensure the best quality of cancer survivorship and the long-term wellbeing of cancer patients.
Peter Selby, President, Association of Cancer Physicians
Eleni Karapanagiotou, Julia Kopeika, Ruth Board, Caroline Archer, Melanie Davies, Janine Mansi, Editors
David Cunningham, Chair, Association of Cancer Physicians