H.B. went to the hospital with what he thought was a stubborn infection. Suddenly, he was processing the word no 34-year-old expects to hear—"cancer”—and needed to begin treatment immediately. The next few days were overwhelming, full of tests and procedures necessary to save his life. He was angry, difficult to approach physically and emotionally, and he disengaged in any activities that were not a complete medical necessity. He received his induction chemotherapy and, after a month in the hospital, was discharged home.

As an Oncology Nurse Navigator on an inpatient oncology unit, one of my primary responsibilities is to educate and offer support to patients newly diagnosed with cancer. I met with H.B. and his wife during his second admission to our inpatient unit for scheduled consolidation chemotherapy. Now open and gregarious, he shared his journey up to this date, building rapport between us. They both opened up to me about how they were adjusting to H.B.’s diagnosis. They shared that they had been married just a few years and had been actively trying to conceive. I asked whether they had discussed potential fertility side effects and options prior to his initial chemotherapy. They looked at me in shock. Now, after receiving medications in his system with unknown effects on fertility and months of chemotherapy and a stem cell transplant ahead, they quickly realized how cancer can yet again wreak havoc. Our conversation on this topic continued throughout his hospitalization.

Our talks, which initially started with basic fertility education and options for cryopreservation, grew into deeper conversations about cancer and its impact on intimacy and sexual health. H.B. shared his anger and frustration about not having participated in fertility preservation prior to the initiation of his chemotherapy. He told me, “No one told me. I don’t care how sick I was. I would have [done that].” With these words, I heard him loud and clear, and knew it was my mission to advocate.

As an experienced oncology nurse, I found myself challenged to deepen my knowledge regarding the impact of cancer on fertility and sexual health and ways in which I could improve patient satisfaction and outcomes. I assessed my current practice and recognized gaps in provider communication and documentation about fertility preservation options prior to initiation of cancer treatments. This discovery led to improving my practice—including building collaborative relationships with oncologists and other members of the health care team, educating staff, preparing readily available semen collection kits, and initiating a fertility preservation assessment and referral process for newly diagnosed oncology patients. Educational growth—including attending sexual health seminars, continuing education and collaborating with oncology social workers—has led to improved changes in my professional practice. I have committed to having conversations with patients and partners that were not happening on the inpatient oncology unit, ensuring that they not only get assessed and receive the information, but also that ongoing support and education are provided and referrals to other professionals for additional support.

According to the Oncofertiltiy^® Consortium:

Risk and adverse effects of treatment are components of consent for chemotherapy, including potential for sterility, which is buried toward the end of 32 potential risks and complications. How does one differentiate the importance between skin rash and dizziness and potential for infertility? Do our best practices demonstrate thorough informed consent as it relates to fertility and sexual health? Patients quickly sign consent forms to proceed with life-saving chemotherapy, but do not routinely know to ask about potential for fertility impairment and options available for preservation. In retrospect, H.B. passionately shared that had he been accurately informed of his risk for potential fertility problems, he would have, without a doubt, opted for fertility preservation prior to the initiation of his chemotherapy. Overwhelmed, it is easy for the newly diagnosed patient to be focused on potential unpleasant side effects such as nausea, vomiting and hair loss. As an Oncology Nurse Navigator, I have facilitated change by raising awareness and advocating for each patient to have full informed consent. My knowledge and experience has enhanced my role as a member of the multidisciplinary team. Now I am consulted to meet with patients when they are given their cancer diagnosis so I can initiate or deepen conversations about fertility preservation and sexual health. As I have grown, my knowledge and approach in discussing fertility options and sexual health in conservations around these topics seem to happen effortlessly. Communication about sexual health practices has strengthened interdisciplinary communication and partnership and, most importantly, benefitted the patient with cancer.

The Oncology Nursing Society and the American Society of Clinical Oncology both report recommend that “fertility preservation is a key component of cancer care that should be addressed.” In 2017, updated American Society of Clinical Oncology guidelines (Carter et al., 2017) recommend that a member of the healthcare team have a discussion with the patient regarding sexual health and dysfunction, including psychosocial and psychosexual counseling. Regardless of race, culture or religion, my conversations have been very well-received. Patients and partners have remarked (about fertility preservation options and sexual health education):

• “We’re so glad you came to talk to us. We were wondering about that.”
• “I didn’t know who to ask.”
• “I appreciate you talking to me about my options.”

Commitment to changing the culture surrounding fertility and sexual health in oncology begins with communication and collaboration in the hope of reducing distress and additional loss in already complex medical situations. Collaboration between oncology nurses and oncology social workers is crucial as it relates to fertility and sexual health discussions. Grief is a significant aspect of the sexual health changes and losses that are experienced by a patient with a cancer diagnosis. A partnership of oncology nurses and oncology social workers allows all aspects of sexual health and recovery to be addressed in a true patient-centered way. Approaching sexual health and fertility as a team is a best practice and strengthens the patient’s opportunities to have the greatest biopsychosocial outcomes.