Odhiambo Martin, Muteshi Charles
Department of Obstetrics and Gynecology, Aga-Khan University, Nairobi, Kenya.
Int J Gynaecol Obstet. 2025 Jun;169(3):908-912. doi: 10.1002/ijgo.16175. Epub 2025 Jan 24.
This article examines existing literature on oncofertility in Africa and explores the barriers to oncofertility care. Patient-level barriers include lack of awareness about fertility preservation options, financial constraints, and the heavy emotional burden of cancer diagnosis and treatment. Healthcare-provider barriers encompass lack of awareness, prioritization of prompt cancer treatment, and implicit biases. Health-system barriers include limited facilities that can provide assisted reproductive technologies, limited insurance coverage for oncofertility services, weak referral systems, and the absence of national guidelines on oncofertility care. Socio-cultural barriers include religious objections, misinformation contributing to mistrust of fertility preservation options, and ethical dilemmas related to discussing future fertility with cancer patients whose primary focus is survival or with pediatric patients. This article also explores ways of improving oncofertility care in the region. These include educational initiatives for healthcare providers, capacity building, incorporation of oncofertility services into national cancer control programs, development of a centralized referral system, telemedicine, and increasing awareness to cancer patients.
本文审视了非洲关于肿瘤生育力的现有文献,并探讨了肿瘤生育力护理的障碍。患者层面的障碍包括对生育力保存选择缺乏认识、经济限制以及癌症诊断和治疗带来的沉重情感负担。医疗服务提供者层面的障碍包括缺乏认识、将迅速的癌症治疗置于优先地位以及隐性偏见。卫生系统层面的障碍包括能够提供辅助生殖技术的设施有限、肿瘤生育力服务的保险覆盖范围有限、转诊系统薄弱以及缺乏关于肿瘤生育力护理的国家指南。社会文化层面的障碍包括宗教反对、导致对生育力保存选择不信任的错误信息,以及与主要关注生存的癌症患者或儿科患者讨论未来生育力相关的伦理困境。本文还探讨了改善该地区肿瘤生育力护理的方法。这些方法包括针对医疗服务提供者的教育举措、能力建设、将肿瘤生育力服务纳入国家癌症控制项目、建立集中转诊系统、远程医疗以及提高癌症患者的认识。