Addressing fertility and sexual health in cancer survivorship – Oncology Central

Report on Sexual and Reproductive Health in Cancer Survivorship and Alignment with Sustainable Development Goals

Executive Summary

This report analyzes the state of sexual and reproductive health within cancer survivorship care, based on research by Sadaf Sedaghatshoar and Karlynn BrintzenhofeSzoc of the University of Louisville (KY, USA). The findings reveal significant gaps in addressing fertility and reproductive health, which are critical components of health-related quality of life (HRQoL). Addressing these deficiencies is essential for advancing several United Nations Sustainable Development Goals (SDGs), including SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). The report outlines key research findings, urgent clinical priorities, and recommendations for healthcare providers and policymakers to create more equitable and comprehensive survivorship care programs.

Key Findings on Health-Related Quality of Life (HRQoL) Variables

A scoping review presented at the AOSW Annual Conference highlighted a significant imbalance in the focus of cancer survivorship interventions.

Alignment with SDG 3: Good Health and Well-being

The current focus of survivorship care does not fully align with the holistic approach of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. While some aspects of health are addressed, critical components are overlooked.

• Commonly Addressed Variables: Interventions frequently target sexual health functions and psychosexual factors.
  • Sexual function and behavior (e.g., erectile dysfunction, vaginal dryness).
  • Psychosexual and emotional factors (e.g., body image, sexual confidence, distress).
• Neglected Variables: Fertility and reproductive health variables are almost entirely absent from the studies reviewed. This represents a major gap in care that directly impacts survivors’ long-term well-being, contrary to the principles of SDG 3.
  • Fertility preservation outcomes.
  • Hormonal rehabilitation.
  • Family-building support.

Urgent Priorities in Fertility Preservation

The report identifies an urgent need for proactive and structured interventions focused on fertility preservation to better support cancer patients.

Contribution to SDG 3 and SDG 5: Gender Equality

Addressing fertility preservation is a direct contribution to SDG Target 3.7 (ensure universal access to sexual and reproductive health-care services) and SDG Target 5.6 (ensure universal access to sexual and reproductive health and reproductive rights). Empowering patients with information and options regarding their fertility upholds their right to plan their future and promotes gender equality.

1. Early and Proactive Counseling: Patients require timely information about fertility preservation options before cancer treatment begins to make informed decisions.
2. Integrated Medical and Psychosocial Support: Interventions must address both the medical aspects of preservation (e.g., cryopreservation) and the psychosocial dimensions, including fertility-related distress and financial barriers.
3. Multidisciplinary Models: There is a critical need for integrated care models that connect oncology with reproductive endocrinology to provide seamless support.
4. Long-Term Follow-Up: Research is needed to examine the long-term effects of preservation choices on quality of life, mental health, and relationship outcomes.

Recommendations for Healthcare Providers

To improve survivorship care programs, the report provides practical recommendations for healthcare providers.

Advancing SDG 3 and SDG 10: Reduced Inequalities

These recommendations promote the comprehensive well-being outlined in SDG 3 and advance SDG 10 by advocating for equitable access to specialized services and culturally sensitive care, thereby reducing health disparities among cancer survivors.

1. Implement Proactive Screening: Adopt universal screening for sexual and reproductive health concerns as a standard component of survivorship care.
2. Provide Foundational Education: Offer all patients basic education on common treatment side effects related to sexual and reproductive health and connect them with appropriate resources.
3. Foster Multidisciplinary Collaboration: Establish clear referral pathways to specialists, including gynecologists, urologists, reproductive endocrinologists, and mental health professionals.
4. Adopt a Holistic and Culturally Sensitive Approach: Extend care beyond physical symptoms to include intimacy, body image, and relationship quality, ensuring that care is culturally sensitive and accessible to all.

Policy and Institutional Frameworks for Improved Care

The report examines the role of policy in standardizing attention to sexual and reproductive health in cancer care.

Strengthening Institutions for Health Equity (SDG 16 and SDG 10)

While organizations like the American Society of Clinical Oncology and the National Comprehensive Cancer Network provide guidelines, their implementation is inconsistent. Moving from guidelines to mandated standards is a crucial step toward building stronger, more accountable healthcare institutions (SDG 16) and ensuring equitable access to care for all survivors (SDG 10).

• Existing Guidelines: Professional bodies have established recommendations that encourage referrals to fertility and sexual health specialists.
• Need for Stronger Policy: Current guidelines are not mandates, leading to inconsistent application. Stronger policy action is necessary to build upon existing frameworks and ensure that sexual and reproductive health services are integrated into survivorship care standards to guarantee equitable access for all patients.

Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the primary SDG addressed, as the article focuses entirely on improving the health-related quality of life (HRQoL) for cancer survivors. It discusses specific health challenges, including sexual dysfunction, fertility issues, and mental health aspects like psychosexual distress and body image, all of which are critical components of overall health and well-being.

• SDG 5: Gender Equality

  The article connects to SDG 5 by emphasizing the need for universal access to sexual and reproductive healthcare. It covers issues specific to different genders, such as vaginal dryness and premature menopause in women and erectile dysfunction in men, and advocates for comprehensive care that addresses the reproductive rights and health needs of all individuals, a cornerstone of gender equality.

• SDG 10: Reduced Inequalities

  This goal is relevant because the article highlights significant disparities in care. It points to “cultural or financial barriers to fertility preservation care” and notes that because current standards are “guidelines rather than mandates,” sexual and reproductive health is “inconsistently addressed.” The call for “stronger policy action” to “ensure equitable access for all survivors” directly targets the reduction of inequalities in healthcare access and outcomes.

What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

     The article directly supports the “promote mental health and well-being” aspect of this target. It focuses on improving the quality of life for survivors of a non-communicable disease (cancer) by addressing “psychosexual and emotional factors including body image, sexual confidence and distress” and “fertility-related distress.”

   • Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

     This target is central to the article’s recommendations. The call for “early, proactive counseling” on fertility, support for “fertility preservation,” and addressing sexual health issues like “erectile dysfunction” and “vaginal dryness” are all components of ensuring universal access to sexual and reproductive healthcare for this specific population.

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…

     The article aligns with this target by advocating for “equitable access to specialized services” and the removal of “financial barriers to fertility preservation care.” The recommendation to implement “proactive and universal screening for sexual and reproductive health concerns as part of survivorship care” is a strategy to achieve universal coverage for these essential services.

2. SDG 5: Gender Equality

   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights…

     This target is reinforced by the article’s focus on reproductive health as a critical component of survivorship care. The discussion on “fertility preservation, hormonal rehabilitation or family-building support” directly relates to ensuring individuals can exercise their reproductive rights and have access to the necessary health services after a cancer diagnosis.

3. SDG 10: Reduced Inequalities

   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by… promoting appropriate legislation, policies and action in this regard.

     The article directly addresses this target in the section on policy changes. It notes that current “guidelines rather than mandates” lead to inconsistent care and calls for “stronger policy action” to “move toward mandated standards to ensure equitable access for all survivors,” which is a clear call to reduce inequalities of outcome through policy.

Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For Targets 3.7 and 5.6 (Universal access to sexual and reproductive health-care)

   • Mentioned/Implied Indicator: The rate of implementation of “proactive and universal screening for sexual and reproductive health concerns” in survivorship care programs. The article recommends this as a key action for healthcare providers.
   • Mentioned/Implied Indicator: The proportion of at-risk cancer patients who receive “early, proactive counseling and decision-making support” regarding fertility preservation before starting treatment.
   • Mentioned/Implied Indicator: The existence and use of “clear referral pathways to gynecologists, urologists, reproductive endocrinologists, mental health professionals and social workers” within cancer care systems.

2. For Target 3.4 (Promote mental health and well-being)

   • Mentioned/Implied Indicator: Measurement of Health-Related Quality of Life (HRQoL) variables among cancer survivors, specifically those related to sexual and reproductive health. The article explicitly states that its research reviewed studies addressing “HRQoL variables.”
   • Mentioned/Implied Indicator: Prevalence of “fertility-related distress” and “psychosexual distress” among cancer survivors, which could be tracked over time to measure the impact of interventions.

3. For Target 10.3 (Reduce inequalities of outcome)

   • Mentioned/Implied Indicator: The number of healthcare systems or jurisdictions that have moved from voluntary “guidelines” to “mandated standards” for sexual and reproductive health care for cancer survivors.
   • Mentioned/Implied Indicator: Data on the reduction of “cultural or financial barriers” to fertility preservation, which could be measured through patient surveys or analysis of insurance coverage policies.

SDGs, Targets and Indicators Table

Source: oncology-central.com