# Fertility preservation practices and gastrointestinal oncologist in Europe: a pan-European study

## TL;DR

This study examines how gastrointestinal oncologists across Europe discuss and handle fertility preservation with young cancer patients, revealing significant variation in practices.

## Contribution

The study provides the first pan-European assessment of oncofertility practices among GI oncologists, highlighting gaps in adherence to guidelines.

## Key findings

- Only 57% of oncologists routinely discuss fertility impacts with patients under 40, and 17% do not refer for fertility preservation due to time/resource constraints.
- Referral rates for fertility preservation options differ significantly, with 59% referring female patients for embryo/oocyte preservation and 65% referring male patients for sperm preservation.
- There is notable variation in the use of GnRHa and referral for ovarian transposition, indicating inconsistent adherence to guidelines across Europe.

## Abstract

The rising incidence of early-onset gastrointestinal (GI) cancer has made the impact of treatments on fertility of high significance. While there is abundant evidence on oncofertility outcomes in breast cancer and hematological malignancies, data regarding these perspectives in GI cancers is lacking. We sought to evaluate current practices of fertility preservation (FP) among GI oncologists across Europe.

A cross-sectional survey was distributed through the Gastrointestinal Tract Cancer Group (GITCG) of the EORTC network and affiliated cooperative groups and cancer centers using a 10-item electronic survey regarding oncofertility practices. The target population was oncologists who routinely treat GI cancers. A statistical analysis was performed based on country, patient volume, and tumor type.

Two hundred and twenty-six GI oncologists from 27 countries completed the survey, the majority from high volume cancer centers. Fifty seven percent of the participating oncologists routinely discuss the impact of treatment on fertility in any patient <40 years, while 36% discuss this only in the curative setting. Fifty-nine percent refer female patients to standard FP options (embryo/oocyte preservation), while 24% chose to refer to ovarian cryopreservation. Of note, 17% indicated they would not refer a curative patient for FP at all due to time or resource issues. Sixty five percent routinely refer male patients to sperm preservation. Use of Gonadotropin Releasing Hormone analogues (GnRHa) in CRC patients is recommended by 34% of oncologists. In the setting of pelvic radiation, 65% refer a female patient for ovarian transposition before pelvic irradiation; 32% would consider uterine transposition. Sixty one percent would consider a nonradiation protocol as perioperative chemotherapy as a valid option for young female patients. We observed heterogeneity upon country but not upon physician gender.

Our study indicates a substantial diversity in current practices in Europe with regard to FP in young cancer patients with GI malignancies, which is not always aligned with current guidelines. There is a need to disseminate and educate GI oncologists on oncofertility perspectives and contemporary data. Additionally, there is a need to establish evidence on the utility of fertility preservation options for patients with GI cancers.