Consequences of cancer treatments and fertility preservation: Report and propositions [Conséquences des traitements des cancers et préservation de la fertilité: état des connaissances et propositions Rapport de l'Institut national du cancer et de l'Agence de la biomédecine]

摘要

Cancer prognosis has considerably improved over recent decades and increasing numbers of young adults live with the long-term consequences of their treatment. Their quality of life is often serious compromised by the inability to conceive a child. As such the recent and rapidly evolving practice of fertility preservation needs to become a standard option in cancer care. Embryos, oocytes, spermatozoa, and germinal tissue can be cryopreserved without damage until such time that the patient, freed from their illness can envisage starting a family. Fertility can be persevered prior to initiation of gonadotoxic treatments by different methods. Some options, in particular in prepubescent boys (and even in adolescents and young adults), though a high research priority and a source of great hope, remain highly experimental. Since the available options combine both validated and experimental methods, it is necessary that care teams are multidisciplinary and that they discuss these choices with the patient and (for children) their family. Even though some patients, through choice or otherwise, are not candidates for Fertility Preservation, their decision, taken in the light of complete, correct and understandable information about the available options, must be respected in accordance with their rights to determine their own reproductive future. The current situation in France needs improvement and multidisciplinary structures are forming where cancer specialists work closely with specialists in reproductive medicine and biology to provide rapid and coordinated patient care. The national cancer institute (INCA) with the Agence de la biomédecine have co-published a report that brings the knowledge of all involved in the care of these patients up to date and makes a series of propositions to improve the situation and notably to guarantee equitable access to quality care for all concerned persons. The principal areas of improvement are: - Equitably improve cancer patients' access to fertility preservation across the country through the regional planning and establishment of multidisciplinary teams, supported by targeted funding and the authorisation of centres. - Publish and disseminate professional guidelines and verify that they are taken into account during multidisciplinary decision making. - Systematically inform patients and their families about the consequences of cancer therapy on reproductive function. - Set up longitudinal cohorts of patients. - Promote research into how to prevent or reduce the risk of the attenuation of fertility and into how to restore it.