Qualitative Study of Factors Contributing to Fertility Service Use Among Cancer Survivors of Reproductive Age in the US

Cancer remains the second leading cause of death in the United States; however, there has been a decline in incidence and mortality due to advances in screening and treatment. Currently 16.9 million survivors are thriving within the United States, and the population of cancer survivors has been projected to grow to 22.2 million by 2030. Although cancer survivors report an increased surge of vitality and vigor, they often face physical, mental, psychosocial, or financial challenges that threaten their quality of life. A late treatment effect of particular concern for cancer survivors of reproductive age that has both physical and psychosocial implications is infertility. Current guidelines are in place to ensure that survivors are made aware of how treatment can impact their plans for building a family and pose viable options for preserving their fertility; however, studies indicate under-utilization of fertility preservation among cancer survivors. The aim of this study was to examine how a cancer diagnosis influenced parenthood motivation and family building strategies among individuals of reproductive age. The study identified contributors to access and use of fertility services by using a conceptual model based on Andersen’s Behavioral Model of Health Services, Lea’s model of Age-appropriate Care, and Kilbourne’s Health Services Research Framework to Advance Health Disparities. The conceptual model elucidates factors that impact cancer survivors’ use of fertility services, equitable access to services, and policy actions that assure equitable access to fertility services. A phenomenological qualitative study was conducted to allow deep exploration of these issues through the review and analysis of survivors’ stories as told through online narratives and in-depth interviews. Study findings showed a cancer diagnosis had not altered an individual’s desire to have children. Although fertility preservation was not always utilized by cancer survivors of reproductive age to conceive or sire a child, most survivors sought out some form of fertility service post treatment. Access and subsequent use of fertility services was grossly dependent on both survivor and provider factors as well as successful clinical encounters between the patient and the provider. These findings have implications for clinical care, public health policy, practice, and research