Fertility Preservation for Brain Tumor Patients

|| January 3, 2018

A new Connecticut law mandating insurance coverage for fertility preservation expands coverage to include cancer patients and others for whom fertility treatment is medically necessary.  The new law became effective January 1, 2018, while research shows a growing desire and need for brain tumor patients to discuss fertility preservation with their doctors.  

The new Connecticut law, Public Act 17-55, "An Act Concerning Health Insurance Coverage for Fertility Preservation for Insureds Diagnosed with Cancer," mandates that certain individual and group health insurance policies cover the medically necessary costs of diagnosing and treating infertility and expands coverage to those with cancer and brain tumor diagnoses by removing the prior limitation that the insured be "presumably healthy."  It leaves unchanged the right of insurers to impose certain limitations on infertility coverage, such as those related to age of the insured and maximum benefits, and the right of religious employers to exclude infertility coverage from their policies if contrary to their religious tenets.  (In addition to the full text of Public Act 17-55 above, a summary of the act is available here).

Public Act 17-55 is particularly relevant to the brain tumor community, as research shows that brain tumor patients need, and often don't receive, fertility counseling. 

Vy Phan, a college senior majoring in neuroscience and Hispanic studies at Trinity College in Connecticut, recently summarized a research study for the CTBTA, which addresses fertility preservation in brain tumor patients, in order to make this useful clinical information more accessible to brain tumor patients and their caregivers. The original research study was published in the article, “Fertility Preservation in Primary Brain Tumor Patients” in Neuro-Oncology Practice (1)   Phan's summary appears below:

Emerging Need for Fertility Preservation Discussions Between Clinicians and Patients
Research summary by Vy Phan

Fertility preservation is a process that helps cancer patients have biological children in the future by saving and protecting their eggs or sperm.  Drs. Jacqueline Stone, Joanne Kelvin, and Lisa DeAngelis from Memorial Sloan Kettering Cancer Center (MSKCC) suggest in their 2016 study that current advancements in the diagnosis and treatments of cancer have given many young adults with primary brain tumors the opportunity to look towards the future and think about building a family. (2)  Because many of these treatments may have negative side-effects on a person’s ability to have children, however, fertility counseling is extremely important in providing brain tumor patients with options to preserve fertility before treatment begins and to provide guidance with starting a family after treatment is over. (3)

Patients who have had the opportunity to receive fertility counseling before cancer treatment report improvements in quality of life after treatment and a decrease in long-term regret regarding fertility decisions. (4)  It may be of no surprise then that the American Society of Clinical Oncology (ASCO) has recommended that neuro-oncologists discuss the risks of infertility and fertility preservation options as early as possible with their patients. (5)  Unfortunately, in reality, this topic is not often discussed between patients of a reproductive age and their clinicians. The study found that clinicians may be reluctant to discuss fertility options because of fear of delaying treatment, presumed life expectancy, and worry about sending mixed messages to patients.  (6)

Phan reports that in response to the lack of discussion regarding fertility preservation options for patients, some treatment centers like MSKCC have developed programs that provide support and education for both clinicians and patients. (7)  Within these programs, a fertility nurse specialist works with clinicians so that they are more prepared to address the effects of cancer treatment on fertility, discuss fertility preservation options with their patients, and refer the patients to the proper specialists.  Patients can also contact a fertility nurse specialist directly if they would like more information, counseling, and/or help in facilitating referrals and coordinating care. (8).  The CTBTA hopes that, even in the absence of an identified program, interested brain tumor patients will feel empowered by their own goals and the information provided in articles like this one to ask their doctors about fertility preservation and access to a specialist.

 (1) Stone JB, Kelvin JF, DeAngelis LM.  Fertility preservation in primary brain tumor patients(2016, December 9); 4(1): 40-45.  Retrieved from https://academic.oup.com/nop/article/4/1/40/2661726/Fertility-preservation-in-primary-brain-tumor. 

(2) Stone JB, Fertility preservation in primary brain tumor patients.  40-45.

(3) Stone JB, Fertility preservation in primary brain tumor patients.  40-45.

(4) Stone JB, Fertility preservation in primary brain tumor patients.  40, citing Letourneau J, Ebbel EE, Katz PP et al.  Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer.  Cancer. 2012; 118(6):1710-1717.

(5) Stone JB, Fertility preservation in primary brain tumor patients.  40, citing Lee SJ, Schover LR, Partridge AH et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.  J Clin Oncol. 2006; 24(18):2917-2931 and Lorren A, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer:  American Society of Clinical Oncology clinical practice guideline update.

(6) Stone JB, Fertility preservation in primary brain tumor patients.  43-45.

(7) Stone JB, Fertility preservation in primary brain tumor patients.  41.

(8) Stone JB, Fertility preservation in primary brain tumor patients.  41.

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