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Gender, Racial and Socioeconomic Fertility Treatment Disparities in Young Cancer Patients

Doctors often don't disclose the full impact on fertility to cancer patients, especially if they happen to be women with less education and women of color.

The malignant growth that is cancer does not discriminate—a person of any race, creed, color, nationality, marital status, gender, sexual orientation, disability or socioeconomic status can be affected.   

Our healthcare system, however, does discriminate between cancer patients.

When it comes to informing patients of the effects of chemotherapy and radiation on their fertility, studies conducted in Sweden and the US reveal some disturbing new findings and trends.

In a recent Swedish study published in the Journal of Clinical Oncology of nearly 500 cancer survivors (18 to 45 years old), 80 percent of men said their doctor had told them their chemotherapy could affect their reproductive capacities, but only 48 percent of women surveyed said the same.

The study went on to show that a meager 14 percent of women said they received any information on options to preserve their fertility, versus 68 percent of men.

Although this study is relatively small in size, the results and the conclusions that can be drawn from the study cannot be ignored and are disquieting at the least.

The overall trend shows that women are less likely than men to be informed of how treatment would impact their fertility. Furthermore, they aren’t given enough information once initially diagnosed to make an informed decision about their fertility preservation care.

The disparity between the sexes may be related to the fact that preserving fertility in women is a far more complicated issue than in men.

For example, although the best option for women may be to undergo egg retrieval and/ or IVF before cancer treatment begins, this is neither an easy process nor guarantee good egg quality or embryos. It also comes with drawbacks; hormonal stimulation of the ovaries raises estrogen levels, so this isn’t a safe option for women with breast or uterine cancer.

Men on the other hand can have their sperm frozen and banked prior to cancer treatment. This relatively quick and simple process is also comparatively inexpensive ($300-600) compared to female fertility preservation (costs between $12,000 and $20,000; egg freezing is $8000 per cycle and medications range from $2,500-$5,000).

Although fertility counseling figures in the US are better than in Europe, with  61 percent of women cancer patients aware of the possible risks that cancer treatment posed (in a study of 1041 women).  There are significant socioeconomic and racial disparities.

Women who hadn’t obtained a Bachelor’s degree were less likely to be counseled on their options. In fact, results revealed that women who were childless, younger, white and heterosexual were more likely to be told about the possible effects of cancer treatments on their fertility than their non-Caucasian counterparts.

Trends also suggested possible disparities in access to fertility preservation in women over the  age of 35 and those with previous children.

It doesn’t stop there- disparities in access to fertility preservation based on sexual orientation were also observed.

These lapses in treatment are simply unacceptable especially given that in the U.S. alone, nearly half a million cancer survivors are of child bearing age. And an average of 50 percent of all fertile women receiving chemotherapy will enter menopause because of cancer treatment.

In the light of these results, our healthcare system needs to take note that African Americans have the highest death rate and shortest sur­vival of any racial and ethnic group in the US for most cancers. Social and economic disparities more than biologic dif­ferences have been blamed as the cause. Outreach programs and health care reform are a must given these trends.

One particular program is the nonprofit organization Fertile Action founded by Alice Crisci. Fertile Action is dedicated to helping women cancer patients negotiate discounts for fertility preservation treatment. Born from her own struggles to become a mother in the face of cancer and its treatment, Crisci has forged a path recruiting fertility specialists to donate their services and medications pro bono to help the plight of cancer patients facing fertility issues.

This is the start, but is this enough?

Should a nonprofit such as Fertile Action have to exist to advocate for human rights such as these? Weigh in with your thoughts on why our healthcare system has failed so badly here.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Dee Baucher June 27, 2012 at 06:39 PM
Cedars and Rosen are reproductive endocrinologists who work with women with infertility, some of whom are dealing with infertility associated with cancer. Their focus is on providing reproductive technology to enhance fertility options for this group of patients. They are not oncologists, and they are not involved with diagnostic or therapeutic management of cancer. Your article, that seems to be falsely alarming people about discrimination in oncology care, should be predicated upon actual scientific studies that are performed, with critical and specific focus, upon oncology practice.
Shirley Hodges June 30, 2012 at 03:49 AM
By far the majority of Doctors today are specialists... and quite focused on their area of expertise. I think that placing the blame for not knowing the consequences of a course of treatment on the Doctor is ignoring the other side. There is nothing to prevent someone with cancer from asking questions... about treatment options, side effects, and anything else they might be concerned about. A Doctor can't answer the questions that aren't asked. "Women who hadn’t obtained a Bachelor’s degree were less likely to be counseled on their options".... Perhaps those women who are more educated simply ask more questions.
Fenella Das Gupta PhD Neuroscience, MFT June 30, 2012 at 03:28 PM
Dear Shirley Many factors have affected how health care is practiced with the rights of the patients being affected. In fact, patient rights is often the center of national attention within the practice of medicine. Often, people do not realize their specific rights at the time of their care because those rights are often not clearly defined. A patient's rights occur at many different levels, and in all specialties. The American Medical Association (AMA) outlines fundamental elements of the doctor-patient relationship in their Code of Medical Ethics. These rights include the following: The right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives The right to make decisions regarding the health care that is recommended by the physician The right to courtesy, respect, dignity, responsiveness, and timely attention to health needs The right to confidentiality The right to continuity of health care The basic right to have adequate health care Of course the patient can always ask questions, but as you can see from the above, the code of ethics set out by the AMA is that this information be adequately explained. Patients should not have to dig around to see have all the right questions.
Graham Lower July 11, 2012 at 05:06 AM
Based upon the abstract (sorry, I'm not paying for an article which I likely won't understand the technical jargon), it suggests a correlation but I see no mention that there is causal relationship. It may be plausible that those with higher education (for example) simply ask more questions which leads to greater information. Because, there tends to be disparity between socioeconomic status and some of the other demographics (e.g. nationality), this is particularly important; suppose someone from Mexico was more/less likely than someone from Saudi Arabia to receive information, it may be because one tends to be more economically well off than the other (the presumption, possible incorrect, that traveling over several continents versus intracontinental travel introduces a natural bias). I think without establishing causality, the statement "Our healthcare system, however, does discriminate between cancer patients" can only establish author bias.
Fenella Das Gupta PhD Neuroscience, MFT July 11, 2012 at 05:25 AM
Dear Graham, Certainly i don't disagree with you that those who are more educated may be inclined to ask more questions. But regardless of one's educational status, economic status, ability to articulate thought etc etc, everyone has the right to receive information on how treatment may affect their health- in this case reproductive health. This article highlights that there doesn't seem to be a standard practice in the health care system as it stands with respect to this particular issue. In addition, this article is not blaming doctors or nurses for not providing this information, but the system at large. This article is about cancer and reproductive rights, but many cancer patients have reported that there are other side effects that they experienced that they were not informed about. I believe the issue to complex, multi layered and not closed

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