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IVF postcode lottery for breast cancer patients

24 August 2020
Appeared in BioNews 1061

Breast cancer patients seeking NHS-funded fertility treatment are facing a postcode lottery to access the service.

A report published in The Breast Journal, which surveyed 98 percent of 209 local Clinical Commissioning Groups (CCGs), found that only 30 percent of CCGs offer cancer patients unrestricted access to fertility preservation treatments such as IVF, as recommended by the National Institute for Health and Care Excellence (NICE). This has resulted in a 'postcode lottery', whereby a patient's ability to have a child following treatment is potentially hindered based on their CCG.

Co-author Professor Allan Pacey, an andrologist at the University of Sheffield, described this variable treatment access to the Mail Online as 'fundamentally unfair to cancer patients.'

Cancer treatment can cause infertility in young women with breast cancer. The NICE guidelines were designed to ensure that a patient's decision to undergo full treatment for breast cancer would not affect their ability to start a family. 

Whilst the guidelines recommend that cancer patients are 'given special consideration for fertility preservation', treatment access varied between CCGs, and was restricted based on factors including age, BMI, smoking status, and whether or not the patient had children already.

Additionally, 11 CCGs did not offer oocyte cryopreservation, where a patient's eggs are frozen as opposed to an embryo. This would significantly disadvantage single women or those in same-sex relationships at the time of their cancer diagnosis.

'It's so difficult breaking the horrendous news to women that they have cancer and may not be able to have children', said Isabella Dash, a consultant surgeon at North Bristol NHS Trust and lead author of the study. She added, 'for them then to be told that they can't freeze their embryos on the NHS because of arbitrary criteria like their weight and age just seems unfair and cruel.'

The study also found that over half of CCGs do not offer NHS-funded storage of eggs and embryos for the ten years suggested by NICE. This time period may be required by patients who must undergo additional cancer therapy, such as endocrine treatment.

The authors state that this 'could put women in the difficult position of having to prioritise either their treatment for cancer survival, or fulfil their desire to have a baby by having a treatment break.'

Sarah Norcross, director of the Progress Educational Trust, told the Mail Online, 'as survival rates improve for young women with breast cancer, their future wellbeing needs to be considered and the opportunity to have a family is a key part of this', adding, 'the fact some CCGs are depriving women of this opportunity is a national scandal.'

In response, the CCGs membership organisation, NHS Clinical Commissioners, said that individual CCGs are 'very aware that specific patient circumstances do not always fit' its policies, adding 'there is a process to consider exceptions on an individual basis.'

SOURCES & REFERENCES
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