For younger cancer patients, fertility counseling at the time of diagnosis is important for making family planning decisions, according to Ranjith Ramasamy, M.D., a clinician and researcher at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
Chemotherapy and radiation treatment can affect reproductive health temporarily or permanently. Along with discussing a cancer diagnosis and treatment options, oncologists should also talk about long-term issues, including fertility counseling."
Dr. Ranjith Ramasamy, Associate Professor of Urology and Director of the Male Reproductive Medicine and Surgery Program
Dr. Ramasamy was the lead author of a new collaborative study, "Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey," published July 17 in the journal, JAMA Network Open. The first author was Premal Patel, M.D., a former Miller School fellow now on the faculty at the University of Manitoba in Canada; other co-authors were from Johns Hopkins University School of Medicine in Baltimore.
The study, which was funded by the Miller School's Department of Urology, used data from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveyed 400 oncology practices biannually from 2015 to 2019.
Altogether, 6,976 patients of reproductive age were included in the study, and 43.5 percent were counseled about reproductive risks before initiation of chemotherapy. Discussions on fertility preservation were more likely to occur at academic medical centers in states with mandated laws for counseling.
"Clinicians are more likely to counsel younger patients and female patients about reproductive risks before initiation of chemotherapy," said Dr. Ramasamy. "There was an increase in the percentage of oncologists who had these patient discussions during the study period, however, more awareness is needed about the importance of this issue."
Sylvester patients like Kevin Dwyer, and his wife Nancy, understand the importance of fertility counseling. "Nancy and I were married in September 2017 and a month later I started experiencing pain in the right testicle," said Dwyer, a 30-year-old serving at the U.S. Coast Guard Air Station in Opa-Locka. "I was referred to Dr. Ramasamy who diagnosed the cancer and spoke with us about our family planning goals. I went ahead and made a sperm preservation contribution on that initial visit."
To treat Dwyer's cancer, Dr. Ramasamy surgically removed the testicle. Meanwhile, the Dwyers learned that Nancy was pregnant, and they were grateful to now experience the excitement of expecting their first child. However, when Nancy was 7-months pregnant, the Dwyers learned that Kevin's cancer had returned. He began nine weeks of chemotherapy guided by Pasquale W. Benedetto, M.D., professor of medicine.
"It frightened me to think that I may not be able to be there for the birth of our son and what it would be like for us as a family to manage cancer treatment and a newborn," said Dwyer.
Nancy and Kevin's son, Trey, arrived a month earlier than anticipated. Just two weeks after the birth of his son, Kevin endured chemo and a follow-on surgery to remove a mass that had grown in his abdomen.
In November of 2018, Kevin and Nancy learned that Kevin was cancer free and in remission.
"We knew we wanted kids, and Dr. Ramasamy made sure to give us that option," said Nancy. "While we are now trying to have another child naturally, we also have Kevin's frozen sperm, thanks to Dr. Ramasamy. He is a wonderful physician who has become an important part of our family."
Patel, P., et al. (2020) Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2020.10806.