RESUMO
Access to assisted reproductive technology (ART) and fertility preservation remains restricted in middle and low income countries. We sought to review the status of ART and fertility preservation in Brazil, considering social indicators and legislative issues that may hinder the universal access to these services. Although the Brazilian Constitution expressly provides the right to health, and ordinary law ensures the state is obliged to support family planning, access to services related to ART and fertility preservation is neither easy nor egalitarian in Brazil. Only a handful of public hospitals provide free ART, and their capacity far from meets demand. Health insurance does not cover ART, and the cost of private care is unaffordable to most people. Brazilian law supports, but does not command, the state provision of ART and fertility preservation to guarantee the right to family planning; therefore, the availability of state-funded treatments is still scarce, reinforcing social disparities. Economic projections suggest that including ART in the Brazilian health system is affordable and may actually become profitable to the state in the long term, not to mention the ethical imperative of recognizing infertility as a disease, with no reason to be excluded from a health system that claims to be 'universal'.
Assuntos
Preservação da Fertilidade , Acessibilidade aos Serviços de Saúde , Técnicas de Reprodução Assistida , Brasil , Serviços de Planejamento Familiar/economia , Serviços de Planejamento Familiar/ética , Serviços de Planejamento Familiar/legislação & jurisprudência , Feminino , Preservação da Fertilidade/ética , Preservação da Fertilidade/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/ética , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/legislação & jurisprudência , Humanos , Recém-Nascido , Infertilidade/economia , Infertilidade/epidemiologia , Infertilidade/terapia , Masculino , Gravidez , Direitos Sexuais e Reprodutivos/ética , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Técnicas de Reprodução Assistida/economia , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/legislação & jurisprudênciaRESUMO
AIM: To evaluate the female oncofertility attitude and knowledge of reproductive health professionals in China. METHODS: An online survey was distributed to reproductive health professionals in Shanghai, China. RESULTS: Female professionals were more likely to consider that cancer patients would want to preserve their fertility. Participants with higher educational background tended to have a more positive attitude toward oncofertility. The majority of the participants (71.0%) obtained a fair or low level of oncofertility knowledge, and only 25.3% of them received scores at the 'good knowledge' level. CONCLUSION: There are significant gaps in the current oncofertility knowledge among reproductive health professionals in China, suggesting an urgent, unmet need for establishing an interdisciplinary fertility preservation training and service system.
Assuntos
Atitude Frente a Saúde , Fertilidade , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Neoplasias/epidemiologia , Saúde Reprodutiva , Adulto , China/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto JovemRESUMO
Purpose: In the accompanying article, "Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe," we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions. Methods: We provide data on the legalities of third-party assisted reproductive technologies and other family-building options in the 28 oncofertility-practicing countries surveyed. Results: We found regional and country differences that will be important in the development of tailored resources for physicians and for patient brochures that are sensitive to these local restrictions and cultural norms. Conclusion: Because many patients first consult Web-based materials, the formal assessment of the availability of these options provides members of the global oncofertility community with data to which they might otherwise not have ready access to better serve their patients.
Assuntos
Preservação da Fertilidade , Neoplasias , Humanos , Poder Familiar , Encaminhamento e Consulta , Inquéritos e QuestionáriosRESUMO
Purpose: Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale. Methods: Survey-based questionnaires were provided to 191 members of the Oncofertility Consortium Global Partners Network, a National Institutes of Health-funded organization. Responses were analyzed to measure trends and regional subtleties about patient oncofertility experiences and to analyze barriers to care at sites that provide oncofertility services. Results: Sixty-three responses were received (response rate, 25%), and 40 were analyzed from oncofertility centers in 28 countries. Thirty of 40 survey results (75%) showed that formal referral processes and psychological care are provided to patients at the majority of sites. Fourteen of 23 respondents (61%) stated that some fertility preservation services are not offered because of cultural and legal barriers. The growth of oncofertility and its capacity to improve the lives of cancer survivors around the globe relies on concentrated efforts to increase awareness, promote collaboration, share best practices, and advocate for research funding. Conclusion: This survey reveals global and regional successes and challenges and provides insight into what is needed to advance the field and make the discussion of fertility preservation and endocrine health a standard component of the cancer treatment plan. As the field of oncofertility continues to develop around the globe, regular assessment of both international and regional barriers to quality care must continue to guide process improvements.
Assuntos
Sobreviventes de Câncer , Preservação da Fertilidade , Neoplasias , Fertilidade , Humanos , Neoplasias/terapia , Inquéritos e Questionários , Estados UnidosRESUMO
Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.
RESUMO
PURPOSE: Oncofertility is a newly developed medical field dedicated to preserving adolescent and young adult-aged cancer patients' fertility. For female cancer patients who desire to have children, fertility preservation has become an important concern before the cancer therapy. This study for the first time aimed to investigate attitude and knowledge regarding female fertility preservation among reproductive health professionals in China. METHODS: An online questionnaire assessing participants' demographics, experience, attitude, and basic knowledge regarding oncofertility was designed and distributed to reproductive health professionals in Fujian, one of the major regions for cancer and reproductive care in southeast China. RESULTS: The majority of participants (96.6%) who were familiar with fertility preservation were willing to collaborate with oncologists on preserving patients' fertility. However, â¼20% of participants were not familiar with the term fertility preservation, and 30.4% and 52.2% of them were never consulted by a cancer patient or an oncologist about the infertility risk from cancer therapy, respectively. Years of working experience, but not gender, educational background, and marital status, was significantly associated with participants' oncofertility experience and attitude. A majority of participants (79.3%) had a middle or low level of oncofertility knowledge, which was significantly linked to their educational background. CONCLUSION: Most of the surveyed reproductive health professionals held a positive attitude toward interdisciplinary collaboration with oncologists during oncofertility practice. However, the lack of their oncofertility knowledge highlighted the need of standard oncofertility education and training in China.
Assuntos
Preservação da Fertilidade/métodos , Adulto , Atitude , Feminino , Humanos , Conhecimento , Masculino , Pessoa de Meia-Idade , Saúde Reprodutiva , Inquéritos e Questionários , Adulto JovemRESUMO
Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.