On May 28, 2013, the American Society for Clinical Oncology (ASCO) released an update to its seminal 2006 Fertility Preservation Guideline. Two members of the LIVESTRONG Fertility Advisory Committee (Lindsay N. Beck and Gwenn Quinn) and a Director of the LIVESTRONG Survivorship Center of Excellence Network site at the Dana-Farber Cancer Institute (Ann Partridge) helped to co-author this new version. The guideline update reiterates the need for oncology health care providers to discuss fertility with their reproductive-age cancer patients in a timely manner, before any potentially sterilizing cancer treatment begins.
While the updated guideline does not substantially change the recommendations made in the original 2006 guideline, it does clarify certain key points and adds new topics including:
1. Expansion of Responsibility for Fertility Discussions.
Notably, the guideline authors have expanded the responsibility for fertility discussions to include not only oncologists, but “all health care providers.” In doing so, they emphasize the need to address fertility throughout the entire treatment process, and the value of providers supplying patients with referrals, psychosocial support, and financial resources in addition to medical information.
2.Egg Freezing Is No Longer Considered Experimental.
The updated guideline reflects the recent change in the medical status for egg freezing made by the American Society for Reproductive Medicine (ASRM). The standardization of this technique is an important breakthrough that will provide greater availability to fertility preservation, especially for single female cancer patients.
3. Need for Cancer and Fertility Research.
The authors attribute the lack of substantial revision of the guideline directly to a lack of high-quality research on the topic. Significant gaps in knowledge still exist, particularly around the efficacy of fertility preservation interventions as well as exact nature and extent of reproductive damage caused by newer chemotherapeutic drugs and protocols. Large, randomized control trials could allow for more definitive recommendations for fertility preservation in the future.
4. Considerations for Special Populations.
The update also includes new discussions about fertility concerns for pediatric patients, patients receiving targeted therapies, and medically underserved groups.
Importantly, the updated guideline also contains practical tools and strategies to assist providers in broaching the topic of fertility. A section addressing patient-provider communication lists talking points, and a table entitled “The Bottom Line” summarizes key recommendations. In addition, ASCO has created an online data supplement which includes the LIVESTRONG Foundation’s newly updated Fertile Hope Risks and Options charts for men and women. Additional useful tools including explanatory videos, a presentation and related articles are also available on the ASCO website.
The LIVESTRONG Foundation applauds ASCO’s continued commitment to meeting patients’ fertility needs – a critical quality of life issue that the Foundation addresses through its cancer & fertility program. For more information about LIVESTRONG’s fertility education, support and resources, please visit our website.
Joyce Reinecke, JD
Cancer & Fertility Advisor