An FOI request has revealed serious under-provision of fertility preservation for cancer patients in England
New data being presented today at the Fertility 2019 conference* show that female cancer patients are missing out on freezing eggs or embryos prior to chemotherapy treatment.
*A collaboration between the British Fertility Society, Society for Reproduction and Fertility and the Association of Clinical Embryologists
Following an FOI request to all CCGs in England, only 1:3 were able to provide accurate information about the number of patients offered fertility preservation. Fewer than 500 of a total of 35,000 female cancer patients aged 20-44 underwent fertility preservation. From the evidence supplied it seems likely that this is because the treatment was not offered.
As more people survive cancer, there is a greater need to consider future fertility. For women who plan to have a family after curative treatment, often the best option is to freeze eggs or embryos. Later, these frozen cells can be used in IVF treatment, enabling cancer survivors to have much-wanted children of their own.
Dr Julia Kopeika, an NHS Consultant Gynaecologist who led the work, said: “It is a tragedy that women with cancer who wish to freeze eggs or embryos to preserve their fertility have this wish taken away because of a lack of funding by CCGs. And sometimes, even with funding, it is impossible to collect eggs in time before chemotherapy treatment begins, due to the bureaucracy involved.”
45% of CCGs are also going against NICE recommendations for cancer patients by restricting egg freezing and IVF according to age, BMI, and existing children.
Dr Melanie Davies, Chair of the British Fertility Society Fertility Preservation Special Interest Group said: “We understand the tough job CCGs do to allocate limited funding. Unfortunately the potential for future infertility is not always considered important even though it may have a huge impact on the quality of life of cancer survivors.
“We meet patients in our clinics who are far more concerned about infertility than their life-threatening cancer – that’s the reality and we simply can’t ignore this need.”
For cancer patients, timing is absolutely critical. NHS fertility clinics can begin ovarian stimulation immediately and complete the egg collection process within about two weeks. But in some cases patients are waiting a month or more for CCG paperwork to be processed and decisions to be made about funding. Waiting too long to begin chemotherapy risks the success of cancer treatment.
Dr Kopeika concluded: “We have uncovered a serious gap in provision that potentially affects thousands of women each year. It begs the question of whether CCGs are in the best position to make funding decisions in these cases. A solution could be to fund fertility preservation for cancer patients centrally, within NHS England. We could also say that fertility preservation is part of the cancer treatment programme and include it within oncology budgets.”
205 CCGs in England were surveyed with a 90% response rate
Compliance with NICE guidelines on fertility preservation for cancer patients
45% restrict by age and 2 CCGs excluded women under 18 years old
18% restrict by BMI
34% fund storage for less than the recommended 10 years
Treatment timeline issues
40% need an exceptional application form or other application paperwork that is likely to delay a decision and prevent egg collection within two weeks
61% take from 7 days to 8 weeks to process application for funding
Estimated number of cycles funded from Jan 2015 till Dec 2017 (3 years)
One third of CCGs could estimate the number of funded cycles. Other did not have this information
454 egg collection cycles for cancer patients were funded in this period
There were 35,000 female patients diagnosed with cancer at the age 20-44 during the same period