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Incorporating Partners and Spouses into Oncofertility Communication

MeganJohnsonShenby Megan Johnson Shen, Ph.D.

Regardless of their gender, patients undergoing treatment for cancer list their future fertility as an important concern (Mersereau, 2012). This issue is so important that 66% of cancer patients express a desire to have children in the future (Schover, Rybicki, Martin, & Bringelsen, 1999) and female cancer survivors rate concerns about having children in the future as second only to fears of recurrence (Connell, Patterson, & Newman, 2006). Despite the fact that fertility preservation is of great concern to most cancer patients, there is currently very little guidance on how to incorporate one’s partner into the discussion. However, it is critical to learn how to involve partners and spouses in these discussions, as patients rate discussing fertility issues with their partners as more helpful than discussing it with their oncologists (Tschudin et al., 2010). This brief article attempts to outline some of the issues and concerns that should be considered when incorporating spouses and partners into oncofertility discussions.

One thing that must be considered when involving partners and spouses in the oncofertility discussion is the stressors that potential future infertility may put on the couple’s relationship. There is extensive research on this topic, which indicates that infertility can exacerbate distress in both members of the couple (Cousineau & Domar, 2007) as well as cause marital distress. Having a diagnosis of cancer is only likely to add to the stress of this situation.

Another issue couples must deal with is the complexity of the fertility preservation options. Preservation of men’s sperm is a lot easier, less expensive, and less invasive than women’s fertility preservation. However, when a woman is considering preserving her fertility, she is often facing procedures that could delay cancer treatment for up to five weeks. Thus, both partners must face a difficult decision and negotiate whether preserving fertility is worth delaying treatment. Further complicating this process is the fact that many of the techniques designed to preserve women’s fertility are unreliable, making this decisions more difficult.

In addition to the stress and difficult decision-making that couples must face, they must also consider the ethical and legal concerns surrounding fertility preservation. Ethically, couples may not agree on the mode of fertility preservation they would like to pursue. If there is disagreement, the rights of the patient must be considered and introduced into the conversation. One such example is the ethical concern of reproducing a child when one of the parents (the cancer survivor) may be more at risk of having a shortened lifespan, leaving the other parent to raise the child alone. Additionally, couples must consider the legal rights to embryos, sperm, and other gametes if the couple splits up or has a divorce prior to reproduction. Will either or both individuals have rights to these gametes? If the cancer survivor passes away, will the surviving partner have legal rights to their gametes? These are questions that must be considered and ultimately documented legally to avoid any complications in the future.

Ultimately, this brief summary highlights the importance of involving partners and spouses into oncofertility discussions and demonstrates that there is a paucity of research on the topic. Thus, research should focus on how to understand these discussions better so that interventions can be developed to improve communication amongst couples regarding this topic. Research can borrow from the extensive couples literature to determine modes for improving communication, such as engaging in open, supportive, and mutually constructive communication.

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References

Connell, S., Patterson, C., & Newman, B. (2006). Issues and concerns of young Australian women with breast cancer. Supportive Care in Cancer, 14(5), 419–426. doi:10.1007/s00520-005-0003-8

Cousineau, T. M., & Domar, A. D. (2007). Psychological impact of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology, 21(2), 293–308. doi:10.1016/j.bpobgyn.2006.12.003

Mersereau, J. (2012). Communication between oncofertility providers and patients. In C. Gracia & T. K. Woodruff (Eds.), Oncofertility Medical Practice (pp. 149–160). Springer New York. Retrieved from http://link.springer.com/chapter/10.1007/978-1-4419-9425-7_11

Schover, L. R., Rybicki, L. A., Martin, B. A., & Bringelsen, K. A. (1999). Having children after cancer. Cancer, 86(4), 697–709. doi:10.1002/(SICI)1097-0142(19990815)86:4<697::AID-CNCR20>3.0.CO;2-J

Tschudin, S., Bunting, L., Abraham, J., Gallop-Evans, E., Fiander, A., & Boivin, J. (2010). Correlates of fertility issues in an Internet survey of cancer survivors. Journal of Psychosomatic Obstetrics & Gynecology, 31(3), 150–157. doi:10.3109/0167482X.2010.503910

 


 

Megan Johnson Shen is Chief Postdoctoral Research Fellow at Memorial Sloan Kettering Cancer Center. She is a social psychologist, and her research focuses on patient-physician communication, including how to involve family members in discussions about fertility, treatment, and end-of-life care decisions. She also specializes in the psychology of religion, studying how to incorporate patients’ religious, spiritual, and cultural beliefs into end-of-life care discussions. Finally, her work examines prejudice and stigma and the role they play in patient-physician communication.

 

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