TEALE FENNING

Nick Raine-Fenning

The RCP / RCR / RCOG Working Party have just published their Report on
The Effects of Cancer Treatment on Reproductive Functions

Professor Mike Richards, National Cancer Director says ...

Nick Raine-Fenning · Posted: Fri Feb 22, 2008 5:51 pm Post subject:

The Recommendations make a nice marking scheme for your essays:

1 All patients with reproductive potential who require anti-cancer treatment either for cancer treatment or benign indications should be fully informed about potential gonadotoxic side effects at the time of diagnosis and prior to potentially gonadotoxic treatment.

Alternative treatment strategies causing less gonadal damage should be discussed where relevant.

2 Discussion and advice given about gonadal toxicity should be carefully documented in the patient’s notes. Written information should be provided about contraception, gonadal damage and techniques to preserve fertility. Specialist psychological support and counselling should be available to all these patients.

3 Sperm banking must be considered for all males prior to treatment that carries a risk of long-term gonadal damage. Testicular sperm extraction is sometimes possible even when azoospermia is present.

4 All females should be fully informed at diagnosis of the potential for gonadal or uterine damage caused by anti-cancer treatment, together with the possibility of early menopause.

5 Embryo storage prior to treatment is possible for the minority of patients with a partner and sufficient time for IVF.

6 Egg and ovarian storage are techniques in development which are not currently funded by the National Health Service. Very few live births have been reported after either technique worldwide. It is, however, anticipated that the results will improve.

It is recommended that a research based egg and ovarian tissue storage facility be developed at a number of collaborating sites in the UK, which should be available for younger female patients likely to be sterilised by their cancer treatment.

7 The literature in the field of gonadal toxicity is very limited, with few or no randomised trials. It is imperative that a research base/evidence base be developed in this field. In particular the gonadal effects of new anti-cancer agents are very poorly validated.

8 In 2004 the National Institute for Health and Clinical Excellence (NICE) issued a report, Fertility: assessment and treatment for people with fertility problems, which considered cryopreservation of gametes and embryos in patients undergoing gonadotoxic treatment. Universal access to sperm, egg and embryo storage was recommended. There is, however, currently no national policy for funding any of the techniques which aim to preserve fertility or treat the effects of gonadal damage, demand for which will always be very limited. The Working Party strongly recommends that an agreed national policy and funded nationwide equity of access to resources be available. Furthermore, we recommend an ongoing audit of the implementation of this recommendation.

9 Provision of sex hormone replacement, where required, should be brought into line with other long-term replacement therapies and be exempt from prescription charges.

I have highligted the key points in bold.