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Monday, 10 March 2008
Colleges Say NHS Should Fund Fertility Services For Cancer Patients, UK
Article Date: 15 Jan 2008 - 3:00 PST
A new working party report from the Royal Colleges of Physicians, Radiologists, and Obstetricians and Gynaecologists, including specialists in cancer and fertility, recommends that the NHS should fully fund fertility services for patients with cancer. NICE guidelines from 2004 recommend universal access to sperm, egg and embryo storage, but a survey of oncologists to accompany the report shows that these were not always widely available and funded, and certainly not universally provided.
The report 'The effects of cancer treatment on reproductive functions; guidance on management' recommends that a national policy on sperm, egg and embryo storage is needed and that funding bodies develop equitable funding protocols for patients. In addition, the report stresses the need for patients to be fully informed of the risks of treatment at the time of diagnosis, including written information, and psychological support and counselling should be available.
Eleven thousand patients under 40 years old are diagnosed with cancer every year in the UK. Cure rates have risen recently, and while effective treatment and cure is paramount, infertility following treatment can be a source of great distress. Many cancer treatments will not affect fertility at all. However, chemotherapy and some forms of radiotherapy and surgery can damage the testicles or ovaries.
While it is not usually possible to prevent this damage occurring, it is possible to anticipate it, particularly in men by banking sperm. In women it is sometimes possible (where a partner is present) to create embryos using IVF, which can then be stored, or more experimentally to freeze eggs or portions of the ovary. Once treatment is complete and infertility confirmed it is then possible to thaw the sperm, embryos or eggs and potentially restore fertility.
Sperm banking is widely available in the UK, but not always available free of charge. Embryo storage is often, although not always available and funded. There are no routine NHS facilities for banking eggs or portions of ovary, although these are often available in the private sector.
Dr Ben Mead, Chair of the working party said:
"More and more young people with cancer can now be cured with modern treatments-but this success has sometimes been achieved at a price -particularly with regard to fertility. Techniques are available, or in development, to store sperm, eggs, embryos or even parts of an ovary that can then restore fertility after treatment. What is lacking is a uniform national strategy - leaving the present arrangements as analogous to postcode prescribing. It is time for action nationally to deal with this distressing problem."
Dr Michael Williams, Vice-President of the Royal College of Radiologists, said:
"It is shocking that arguments over funding still limit patients' access to fertililty preserving treatments. Sperm freezing is well established, simple and effective. It should be available to all as recommended by three reports from NICE, and there should be a national strategy to fund other options for patients".
Professor Richard Anderson of the Royal College of Obstetricians and Gynaecologists said:
"The irreversible effects of cancer treatment on fertility will have long-term implications for men and women. Sperm banking should be routinely available to all men and funded as part of their cancer treatment and there are very promising and increasingly successful developments in new options for women.
"The joint guidelines give recommendations for improved provision of fertility preservation treatments for both men and women and should be heeded by healthcare professionals, service providers and policy makers responsible for providing good quality care to these patients."
Royal Colleges of Physicians