Oncofertility in gastrointestinal oncology: a pan-European study of the patient perspective.

introductionThe rising incidence of early-onset gastrointestinal (GI) cancer has made the impact of treatment-related gonadal toxicity increasingly significant. While there is ample evidence on oncofertility outcomes in breast cancer and hematological malignancies, data in GI cancers remain limited. We sought to evaluate oncofertility perspectives from the viewpoint of young GI cancer survivors across Europe.

methodsA cross-sectional 60-item electronic survey regarding oncofertility practices was distributed via patient digital platforms. The target population was survivors treated for GI cancers before the age of 45 or 50 years (women/men). Statistical analysis was performed on country, gender, and tumor type.

resultsOne hundred and forty survivors from 19 countries completed the survey (78F/62M), median age at diagnosis was 36.9/35.6 years (F/M), the majority had colorectal cancer, treated with chemotherapy (88%/89%) and radiotherapy (34%/48%). Fertility impact was discussed in 66% of women and 71% of men, but fewer were referred for fertility preservation (43%/57%), and fewer underwent preservation (18%/61%), with variability between countries. The main reason for not preserving fertility was lack of desire of future offspring (women) or lack of referral (men). Sexual health counseling was conducted in less than 50% of patients. Among women, 46% reported persistent amenorrhea and 64% menopausal symptoms. Significant sexual dysfunction was indicated by 69% of women and 83% of men.

conclusionAnti-cancer treatment has substantial impact on fertility and sexual function in young GI cancer survivors. Counseling, referral, and uptake vary across countries. Gonadal-related issues remain an unmet need in GI oncology, requiring improved counseling and clinical practice.