Fertility preservation in female cancer sufferers: (only) a moral obligation?

Abstract

Purpose

Advances in cancer diagnostics and therapeutics have thankfully led to high numbers of young cancer survivors, although some interventions may sometimes threaten fertility. The authors aimed to assess how evidence-based oncofertility counselling can be adequately fulfilled for the sake of female cancer patients, in light of its complexities and multidisciplinary nature, which require thorough counselling and consent pathways.

Materials and Methods

A search has been conducted in the databases PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Google Scholar via search strings such as fertility preservation, reproductive counselling, oncofertility, cancer survivors, in order to identify relevant meaningful sources spanning the 2010–2021 period.

Results

Counselling needs to be implemented in compliance with international guidelines, so as to avoid medicolegal repercussions. Albeit fertility preservation is supported by most health care institutions, actual conditions at health care facilities often reflect several lingering difficulties in the oncofertility process. Oncofertility counselling should foster access to fertility preservation procedures. To best serve that purpose, it should be implemented in a manner consistent with ethical and legal standards, so that patients can make an informed decision based on comprehensive and relevant data.

Conclusions

Counselling needs to be rooted in a close cooperation of oncologists, reproductive endocrinologists, mental health counsellors and clinical researchers. The provision of oncofertility services is grounded in the moral obligation to uphold individual autonomy, which is essential in a free society, unless the exercise thereof could pose a risk to the children conceived or to others.

摘要

目的：尽管一些癌症诊断和治疗干预措施有时可能会威胁到生育能力, 幸运的是大量年轻的癌症患者得以生还。鉴于癌症复杂性和多学科性质, 需要全面的咨询和一致途径, 本文旨在评估如何为女性癌症患者充分实施基于证据的肿瘤生育咨询。

材料和方法：在 PubMed/MEDLINE、Web of Science、Scopus、EMBASE 和 Google Scholar 数据库中进行搜索, 通过生育力保护、生殖咨询、肿瘤生育力、癌症生还者等搜索字符串, 以确定2010-2021 年期间相关的有意义的文献。

结果：咨询需要按照国际指南实施, 以避免法医学后果。尽管大多数医疗保健机构都支持保护生育能力, 但医疗保健机构的实际情况往往反映了肿瘤在生育过程中的几个挥之不去的困难。肿瘤生育咨询应促进获得生育力保护程序。为了更好地实现这一目的, 它应该以符合道德和法律标准的方式实施, 以便患者可以根据全面和相关的数据做出明智的决定。

结论：咨询需要根植于肿瘤学家、生殖内分泌学家、心理健康顾问和临床研究人员的密切合作。提供肿瘤生育服务以维护个人自主权的道德义务为基础, 这在自由社会中是必不可少的, 除非这种行为可能对受孕的孩子或其他人构成风险。

Keywords:

• Oncofertility
• gonadal toxicity
• counselling
• reproductive autonomy
• medicolegal viability

Disclosure statement

No potential conflict of interest was reported by the author(s).