Current oncology training programs lack adequate education in fertility preservation counseling

Given that oncologic treatments can cause damage to reproductive organs leading to infertility, multiple national organizations recommend that all health care providers counsel patients on risk of infertility and fertility preservation options. Studies demonstrate a lack of counseling and referral to reproductive services in this population. Our aim was to develop an original survey for resident and fellow physicians in oncology subspecialties to assess their attitudes, awareness and knowledge on fertility preservation and identify barriers in training. Questionnaire-based observational study. An IRB-approved survey study was electronically distributed to all ACGME-accredited programs in gynecologic oncology (GO), radiation oncology (RO), surgical oncology (SO), hematology oncology (HO) and pediatric oncology (PO) in the United States. The survey was distributed between January and April 2019. The questionnaire assessed attitudes and knowledge about fertility counseling and preservation for the newly diagnosed oncology patient. Comparisons between groups were evaluated with chi-squared tests and pairwise comparisons with significance defined as p <0.05. Two hundred and sixty-eight surveys were completed (GO: n=25; HO: n=93; PO: n=66, RO: n=60; SO: n=6). All respondents agreed that oncologists should be responsible for disclosing treatment effects on fertility; however, only 51% (n=119) responded that they often or always personally counsel patients on the impact of treatment on fertility. GO was more likely to refer patients >50% of the time to fertility preservation counseling compared to HO (p= 0.017) or RO (p=0.022). RO was also significantly more likely than HO (p= 0.009) or PO (p=0.007) to consider a patient’s future fertility when planning treatment. Among all respondents, the most common reason infertility risk was not discussed was poor prognosis (41.6%). Furthermore, 61% of all respondents reported that there is no specific person in their office setting responsible for these discussions. Most trainees did not feel their program prepared them for counseling on fertility preservation (55.5%, n=122). When asked what materials would be helpful to increase learning, lectures (48%, n=105) and practice bulletins (43%, n=95) were the most common answers. Our study demonstrates that while all residents and fellows in oncology training programs believe that oncofertility counseling is important, they lack the adequate education and resources to do so. There is also a significant difference between subspecialties in the level of comfort in completing these discussions. Curriculum for residents and fellows should address these disparities and focus on improving patient counseling.