Identifying the Need of Discussing Infertility Concerns Affecting Testicular cancer patients; an Evaluation

Patients with treated testicular cancer (TC) risk an impaired fertility. Since
the high life expectancy and the onset in a young and reproductive age, quality
of life including fertility and masculinity are of major concern when treating
TC patients. In a short period of time after discovering cancer, patients
receive orchiectomy and eventual adjuvant therapy might follow, depending on
staging of the disease. In this brief period the patient will be stricken with
many questions about his health and future. Patients should be informed about
the risk of a impaired fertility as result of the treatment and the possibility
of cryopreservation as soon as possible. In this way, the patient is able to
make well-considered decisions about his fertility and cryopreservation of his
sperm. Furthermore, patients should be informed about the possibility of
placing an testicular implant.

This study is designed to determine quality of care for the discussion of
fertility concerns and cryopreservation after diagnosis and treatment for TC.
The consult with health care providers where patients are informed about the
risk of impaired fertility plays a central role. Furthermore, we will evaluate
the way patients obtain information and the influence on subsequent choices
about cryopreservation. Also, the experience of cryopreservation is addressed,
as well as which health care provider and which context would have the
preference of the patient for discussion fertility concerns. Last, the
provision of information on testicular implants is assessed.This survey will
contribute to improvements of healthcare so patients can make the right choices
after diagnosed cancer. In this way unexpected fertility and embarrassment
problems later in life can be diminished.

A cross-sectional questionnaire survey will be conducted among patients with
testicular cancer who are or were treated in the LUMC in the Netherlands
(n=625). The questionnaire was designed by the authors, based on study aim and
a review of the literature in the area. A patient panel of the Dutch Testicular
Cancer Society piloted the questionnaire. Suitable patients are obtained
through the local cancer registry of the LUMC and will receive an information
letter and a included consent. After agreeing to participate, patients will
receive the questionnaire by mail. The questionnaire can be completed at home
(approximately 20 minutes) an will be sent back by post. Data will be processed
and analysed anonymously.

The questionnaire could be confronting and may raise fertility concerns,
depending on the patient's knowledge on impaired fertility and the patient's
attitude towards fertility. This risk will be constrained as much as possible
by sending an information letter in advance. In this way ambiguities on the
risk of a impaired fertility in relation to the treatment of testicular cancer
are clarified.