Life after cancer: Transforming the post-treatment experience
Empowering people living with cancer to make more informed fertility decisions
The impact treatment can have on fertility is a significant concern for many who are diagnosed with cancer, especially young people who may want to have children later in life. But fertility preservation can take time, so depending on the diagnosis, delaying treatment to complete fertility preservation can conflict with the usual recommendation to start cancer treatment immediately. Deciding what to prioritize is hard. But too often, individuals aren’t being provided with timely, understandable information on fertility options before starting treatment.
In addition: 2
- Egg/sperm preservation services can be too expensive for many people, with access to financial support varying across the country.
- In rural or remote areas, there may be no specialized fertility services nearby.
- Equity-denied populations face deeper barriers related to health literacy or accessing medical appointments (e.g., transportation costs, getting time off work) that can prevent fertility discussions from happening.
By the time a person living with cancer is able to pursue fertility preservation, it may be too late — potentially affecting their quality of life.
The Partnership has supported projects that are working to ensure that people living with cancer who are in their reproductive years are aware of the potential impacts of treatment on fertility and the fertility preservation options available to them.
How Cancer Care Alberta makes fertility screening more equitable and sustainable
In 2020, Cancer Care Alberta used contributions from the Partnership to move from a paper-based screening questionnaire to one that is embedded within its electronic health record (EHR), Connect Care. In the process, they added a prompt asking about fertility preservation that is automatically generated for all individuals under 45 years of age. The prompt states: “Some cancer treatments could negatively impact fertility or reproductive health and the ability to have biological children now or in the future. I would like to speak to a healthcare professional about this”.
If an individual expresses an interest in having a conversation about fertility preservation, a best practice advisory (BPA) is populated in the person’s chart to ensure their cancer care team is aware of this request. A fertility risk classification guideline was also created to help cancer providers estimate the fertility risk associated with different cancer treatments.
Cancer Care Alberta plans to make the connection process to fertility preservation treatment more efficient for both providers and individuals receiving care in the future. This will include the ability for cancer care teams to send referrals to fertility providers directly through the EHR system rather than by paper or fax.
Working with a pan-Canadian organization like the Partnership has many benefits. Conversations span across provinces and connections can be established with much less effort.
Cancer Care Alberta
See how Alyssa navigated fertility-preserving treatment after being diagnosed with myeloma in her 30s.
Other initiatives supported by the Partnership
Making the case for fertility screening
To encourage more cancer specialists to discuss fertility preservation with people living with cancer, the Partnership led the development of a business case for fertility screening. It describes:
- the costs and funding models associated with fertility preservation;
- the level of financial coverage offered in each province and territory;
- how a fertility prompt can be integrated into existing patient-reported outcomes (PROs) screening processes;
- factors affecting access to fertility services among First Nations, Inuit and Métis;
- factors affecting access to fertility services among equity-denied populations; and
- what’s needed to improve fertility education and policy.
It makes the case that enhanced financial coverage and streamlined referral pathways will increase fertility awareness and accessibility, especially for equity-denied populations.
- Young Adult Cancer Canada. YAC Prime report: A study to incite change [Internet]. Young Adult Cancer Canada; 2023 [cited 2024 Jan 25]. Available from: https://youngadultcancer.ca/yac-prime-study.
- Canadian Partnership Against Cancer. Business case for oncofertility screening in the cancer system [Internet]. The Partnership, 2022 [cited 2024 March 05]. Available from: https://stg.partnershipagainstcancer.ca/topics/access-to-oncofertility-screening-in-canada/