Give cancer patients a choice about fertility
SUMMARY
Every year around 5,600 women aged 45 and under are diagnosed with breast cancer in the UK. Breast Cancer Care runs tailored services for these women called Our Younger Women Together – events that offer a safe, supportive environment to learn more about breast cancer and share experiences. Younger women with cancer may be concerned about how treatment will affect their fertility. To address these concerns, we decided to update our standards of care offered for those with breast cancer. We used two surveys to inform the development of our standards: one involved younger women with breast cancer and the other with healthcare professionals. The most shocking finding was that the majority (88 per cent) of younger women reported they had not been offered a referral to a specialist to discuss the option of preserving fertility. This means up to 5,000 younger women a year may be missing out on discussing fertility options ahead of their treatment, including freezing eggs or embryos. Consequently, they are left with a real sense of loss.
ISTOCKPHOTO
Nurses need to discuss the available options with women at diagnosis, says Grete Breuton-Smith
before starting breast cancer treatment. We know fertility preservation will not always be appropriate, but younger women deserve to have this discussion with specialists. In 2013, the National Institute for Health and Care Excellence issued guidelines addressing the need for cancer patients to have access to fertility preservation. These state that the impact of the cancer should be discussed at initial diagnosis. Women should be offered egg and embryo freezing if they are healthy enough, there is enough time and it will not worsen their condition.
Prompt referrals
Patients should be referred to a fertility specialist before embarking on treatment
Surveys by Breast Cancer Care suggest that younger women with breast cancer can be denied the chance to preserve their fertility. Treatments, including chemotherapy, can cause infertility, so healthcare professionals should discuss options such as egg freezing beforehand. Author Grete Breuton-Smith is a clinical nurse specialist with Breast Cancer Care
A total of 176 younger women responded to the Breast Cancer Care survey, along with 50 healthcare professionals (breast cancer oncologists, surgeons and nurses). Notably, more than a third (35 per cent) of healthcare professionals are not telling younger breast cancer patients at diagnosis how treatment could affect their fertility. Most young women with breast cancer will need chemotherapy and possibly up to ten years of hormone treatment. Chemotherapy can affect the way the ovaries work, reducing the number and quality of eggs. It sometimes causes permanent infertility and often brings on an early menopause. Women are also advised not to get pregnant while taking hormone treatment and we know fertility declines with advancing age. It is therefore important for younger women to be informed
Our final ten standards of care for younger women include: 4 Every younger woman should be offered a prompt referral to a fertility specialist – even if they have no partner – to discuss their fertility options before starting chemotherapy or hormone treatment. 4 Every breast oncology service should have processes in place for prompt referral to a fertility specialist who can provide assisted conception. The referral should not depend on local in vitro fertilisation funding arrangements. 4 Women should be given information about the success rate of a fertility option and the possible impact of delaying breast cancer treatment. 4 All younger women with breast cancer should be offered a referral to a fertility expert at diagnosis. This ensures that they can make informed choices about their future fertility. 4 We need all healthcare professionals – including nurses – to have open discussions about fertility, and to offer these patients referrals to experts NS For more information on Breast Cancer Care’s new standards of care for younger women visit www.breastcancercare.org.uk
NURSING march 18 other :: vol uses 29 no 29 :: permission. 2015 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Dec 02, 2015. For personal use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
SUMMARY
Every year around 5,600 women aged 45 and under are diagnosed with breast cancer in the UK. Breast Cancer Care runs tailored services for these women called Our Younger Women Together – events that offer a safe, supportive environment to learn more about breast cancer and share experiences. Younger women with cancer may be concerned about how treatment will affect their fertility. To address these concerns, we decided to update our standards of care offered for those with breast cancer. We used two surveys to inform the development of our standards: one involved younger women with breast cancer and the other with healthcare professionals. The most shocking finding was that the majority (88 per cent) of younger women reported they had not been offered a referral to a specialist to discuss the option of preserving fertility. This means up to 5,000 younger women a year may be missing out on discussing fertility options ahead of their treatment, including freezing eggs or embryos. Consequently, they are left with a real sense of loss.
ISTOCKPHOTO
Nurses need to discuss the available options with women at diagnosis, says Grete Breuton-Smith
before starting breast cancer treatment. We know fertility preservation will not always be appropriate, but younger women deserve to have this discussion with specialists. In 2013, the National Institute for Health and Care Excellence issued guidelines addressing the need for cancer patients to have access to fertility preservation. These state that the impact of the cancer should be discussed at initial diagnosis. Women should be offered egg and embryo freezing if they are healthy enough, there is enough time and it will not worsen their condition.
Prompt referrals
Patients should be referred to a fertility specialist before embarking on treatment
Surveys by Breast Cancer Care suggest that younger women with breast cancer can be denied the chance to preserve their fertility. Treatments, including chemotherapy, can cause infertility, so healthcare professionals should discuss options such as egg freezing beforehand. Author Grete Breuton-Smith is a clinical nurse specialist with Breast Cancer Care
A total of 176 younger women responded to the Breast Cancer Care survey, along with 50 healthcare professionals (breast cancer oncologists, surgeons and nurses). Notably, more than a third (35 per cent) of healthcare professionals are not telling younger breast cancer patients at diagnosis how treatment could affect their fertility. Most young women with breast cancer will need chemotherapy and possibly up to ten years of hormone treatment. Chemotherapy can affect the way the ovaries work, reducing the number and quality of eggs. It sometimes causes permanent infertility and often brings on an early menopause. Women are also advised not to get pregnant while taking hormone treatment and we know fertility declines with advancing age. It is therefore important for younger women to be informed
Our final ten standards of care for younger women include: 4 Every younger woman should be offered a prompt referral to a fertility specialist – even if they have no partner – to discuss their fertility options before starting chemotherapy or hormone treatment. 4 Every breast oncology service should have processes in place for prompt referral to a fertility specialist who can provide assisted conception. The referral should not depend on local in vitro fertilisation funding arrangements. 4 Women should be given information about the success rate of a fertility option and the possible impact of delaying breast cancer treatment. 4 All younger women with breast cancer should be offered a referral to a fertility expert at diagnosis. This ensures that they can make informed choices about their future fertility. 4 We need all healthcare professionals – including nurses – to have open discussions about fertility, and to offer these patients referrals to experts NS For more information on Breast Cancer Care’s new standards of care for younger women visit www.breastcancercare.org.uk
NURSING march 18 other :: vol uses 29 no 29 :: permission. 2015 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Dec 02, 2015. For personal use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
