Cancer survivors of gynecologic malignancies are at risk for decreased opportunity for fertility preservation

Background Cancer survivors rate fertility as one of the most important determinants of their quality of life in the years after cancer treatment. We seek to describe the reproductive goals of women affected by gynecologic cancers and investigate their specific challenges during fertility preservation (FP) counseling. Methods Univariate & multivariate logistic regression were used for quantitative analysis of objective FP counseling measures between women with gynecologic (GYN) and non-gynecologic (non-GYN) cancers from a cross sectional survey. Framework analysis was conducted on patient perception of physician-patient interactions. Results Of the 2537 women contacted, 1892 responded and 1686 reported treatment with potential to impact fertility. Among women with GYN cancers 52% wanted future children. Women <35 years were interested in FP (74%). Women with Gyn cancers received less FP counseling than women with non Gyn cancer (OR 0.5 95% CI 0.4-0.6). Three hundred twenty-four patients gave qualitative answers. Patient identified barriers included incomplete FP information (59%), nondisclosure (29%), a disinterest in FP (5%), and a perceived urgency to start treatment (7%). Conclusions Women with gynecologic cancers are less likely to be counseled about FP in comparison to women not affected by gynecologic cancers despite having similar fertility goals. We have identified patient perceived barriers to optimal FP counseling which may be improved upon to increase the value of FP and optimize quality of life for cancer survivors of gynecologic malignancies.