Walsh Sarah K, Ginsburg Elizabeth S, Lehmann Lisa Soleymani, Partridge Ann H
Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Oncologist. 2017 Jul;22(7):860-863. doi: 10.1634/theoncologist.2016-0373. Epub 2017 Apr 13.
Oncofertility is a unique, multidisciplinary field that serves to bridge the gap between available fertility resources and the special reproductive needs of cancer patients. Oncofertility is a growing field due to the increasing number of survivors, development of new oncologic therapies, extension of duration of therapies, and development and refinement of reproductive therapies. While the technologies and demand for services expand, clinicians need to be appropriately prepared for dealing with various clinical scenarios that may require ethical deliberation. Three real cases are presented in which the patient wishes to pursue reproductive assistance, but her decision is met with hesitance or uncertainty by her care team. Discussion of these clinical scenarios highlights ethical implications of oncofertility practice and serves to highlight the need for the establishment of multidisciplinary care teams and guidelines to support both clinicians and patients.
The growing field of oncofertility is ripe for conflict between patient autonomy and medical values due to the nature of cancer and associated threat on an individual's health and survival, as well as the personal significance of childbearing. Cases are presented and ethical implications are discussed to further explore the inherent difficulties in oncofertility practice and guide clinicians in similar situations. Developing guidelines and establishing multidisciplinary teams to facilitate oncofertility discussions and care, as well as training of clinical team members, may improve patient safety, well-being, and satisfaction within the context of fertility decision making, care, and outcomes.
肿瘤生育学是一个独特的多学科领域，旨在弥合现有生育资源与癌症患者特殊生殖需求之间的差距。由于幸存者数量增加、新肿瘤治疗方法的发展、治疗时间的延长以及生殖治疗方法的开发和完善，肿瘤生育学领域正在不断发展。随着技术和服务需求的扩大，临床医生需要做好充分准备，以应对各种可能需要进行伦理思考的临床情况。本文介绍了三个真实案例，患者希望获得生殖辅助，但她的决定遭到了其医疗团队的犹豫或不确定态度。对这些临床情况的讨论突出了肿瘤生育学实践的伦理影响，并凸显了建立多学科护理团队和指南以支持临床医生和患者的必要性。
由于癌症的性质以及对个人健康和生存的相关威胁，再加上生育的个人意义，肿瘤生育学这一不断发展的领域很容易出现患者自主权与医学价值观之间的冲突。本文展示了案例并讨论了伦理影响，以进一步探讨肿瘤生育学实践中固有的困难，并为处于类似情况的临床医生提供指导。制定指南、建立多学科团队以促进肿瘤生育学的讨论和护理，以及对临床团队成员进行培训，可能会在生育决策、护理和结果方面提高患者的安全性、幸福感和满意度。
