Module 2 Discussion Board Response

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    It is a known fact that infertility for male patients can be a side effect of several cancer therapies.  The exact impact of cancer therapy on fertility mainly depends on the therapeutic regimen.  Yet, most cancer treatment modalities will undeniably have a detrimental effect on male reproductive potential.  Since men are living longer after having cancer due to the improvement in diagnostics and therapeutics, the option for fertility preservation must be discussed at the time of diagnosis.  Therefore, all patients should be thoroughly educated about the impact of treatment on their reproductive capacity.  Moreover, they should be provided with as many resources as possible regarding fertility preservation.  If need be, the social worker in this vignette should refer the male patient to a specialist in fertility preservation.  Also, the male patient should be allowed time and space to share his feelings/emotions regarding cancer, treatments, and consequences of treatments (such as infertility) in a safe environment so as to help build rapport and allow for catharsis and support.


    I agree.  I am an oncology nurse and have initiated these conversations wit pts in the past to help advocate their discussions/wishes they have shared with me apart from the rest of the interdisciplinary team.   I help arm them with talking points directed at their oncologist to address (knowing the recommendations from ONS like PLISSIT and BETTER).


    Its also fine to just say “sex” in additional to the “old fashioned method”


    Working with cancer patients, I find that by the time they meet with me they are scared and just want to get going on treatment. My focus with them is educating them about their disease and treatment options. By the time we start talking about fertility, they have being over saturated with information and are no longer able to process the information or they are so scared about their life and cure rates that they don’t want to discuss that but focus on treatment instead. Many of them worry about their life expectancy and don’t want to bring a child into the world with that uncertainty. I look forward to learning ways to more effectively handle these conversations.
    Paola PA-C


    I am a oncology nurse practitioner in an AYA survivorship clinic.   Most of the patients who I see have completed treatment 1-2 years prior.  Many echo what Paola describes above.  At that time of diagnosis and treatment — they feel overwhelmed by their cancer diagnosis and medical complexity and just want to move forward with treatment as soon as possible.

    In retrospect when they come to see us in Survivorship — many experience feelings of loss and remorse — they feel that they were not fully informed of the long term effects of treatment.  They did not ask enough questions or fully prepare for the possibility of infertility.

    It would be ideal for the treating oncology team and the oncology survivorship team to collaborate  on  strategies to broach these issues at the time of diagnosis and then continue the conversation through treatment and into survivorship care.


    I agree with the statements above. Both personally (with friends who have had cancer) and professionally as an OSW, I have observed the move from diagnosis to treatment happen very quickly due to the fear of progression of disease and outcomes. At my institution the risks are discussed with patients, but I am honestly not sure as to the extent because I am often not part of that conversation. Over the past 2 years, my institution has expanded AYA services and I am excited to take this course to learn more about how my role can impact patients as they make these important decisions that can affect their fertility.


    This is great to hear different viewpoints from a variety of health care professionals and institutions.  I agree with what was said about patients feeling overwhelmed and scared at the time of diagnosis and not wanting to delay treatment for another minute.  I think this calls for more responsibility of the primary oncology team to carve out dedicated time to discuss this specific topic.  Additionally, educating providers on the fertility risk and preservation methods would help them feel more comfortable and empowered to advocate for the short term and long term goals of their patients.  Another topic that I’m not sure how to handle is the ethical dilemma of fertility preservation in patients who will endure significant cognitive deficits related to treatment.  I work in pediatric neuro-oncology, which unfortunately is a field where many patients cannot go on to live independently as adults, hold a job, or care for themselves-let alone a child.  How do we reconcile this with the fundamental right to procreate and education on fertility preservation?


    The issue is very important but how do you handle the discussion when the parents must consent for this group of patients at the sickest moment and must decide between starting treatment or allowing time for fertility concerns. As an ICU nurse and having witnessed parents not wanting to delay the treatment that many cure their child this issue can sometimes add more stress to the child and the parents. The parents feel pressure to begin treatment but at the same time are forced to think about fertility at a time when they only want their son to live. The conversations work well when time is on your side but in an urgent state this only creates more discord.  Some AYA’s at the time look for the parents to help them with the decision and are not thinking about long term survival issues.


    Regina- I agree, when the child is in ICU care and initiation of treatment is dependent on survival, these discussions are the least of the providers worries. Nor do I think it is always appropriate for the provider to discuss with family at that time. However, the most important thing is that the provider circles back with the patient and family as soon as the child is medically stable. Although fertility preservation options were not obtained prior to treatment, there’s potential for this to still be obtained afterwards. Thanks for sharing your experience.


    The urgency of treatment does make the discussion of fertility preservation a tough call, that said I think it is paramount that we as the professionals try our best to provide people with the array of options so that they can make fully informed choices for themselves/their children. Even if it is to set expectations about moving forward, it is our job to guide people through the distress of the process in all its aspects and help them to see possible blind spots.


    I agree….these are all important factors to consider before initiating a conversation about fertility.    For those patients with high acuity and/or less favorable prognosis, I think we still need to provide some basic education on the potential impact of their planned treatment on fertility to all patients.  These conversations are some of the toughest!   If timing isn’t right for fertility preservation,  it’s helpful to provide the patient and family with point of contact for future conservations.   For AYA patients, knowledge is power.

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