Fertility Preservation Among Patients With Breast Cancer: A Qualitative Study of Patient and Healthcare Provider...

The aim of this study is to explore barriers impacting the decision about pursuing fertility preservation (FP) among women in the reproductive age group diagnosed with breast cancer before beginning cancer treatment at the patient, healthcare provider, and healthcare system levels from both patients' and healthcare providers' perspectives.

A qualitative study design was performed with a phenomenological approach using semi-structured interviews at a regional cancer institute providing specialty care for breast cancer. The total sample size was thirteen, including eight oncology healthcare providers and five patients with breast cancer.

Prevalent patient-level barriers included (i) financial constraints, (ii) lack of knowledge about FP, and (iii) fear of delay in cancer treatment. Patient-level barriers, as perceived by physicians, also highlighted the financial burden and the overwhelming news of a cancer diagnosis when treatment often takes priority. Common healthcare provider-level barriers were (i) time constraints to independently coordinate a referral process, (ii) limited specialized knowledge about FP, and (iii) assumptions about patients' fertility needs. Finally, the health system-level barriers included a lack of (i) a pre-determined referral pathway for FP and (ii) accessible information about existing resources.

Despite longstanding recognition of barriers to FP among patients with cancer, challenges persist, particularly in regional healthcare settings. Our findings highlight the need for a multi-level approach to enhance FP care for breast cancer survivors, including implementing automated referral systems, enhancing provider education on FP, and addressing financial barriers through targeted policy actions. These strategies could ensure equitable access to FP services and improve patient outcomes.