Lessons Learned: Feasibility of a Discussion Prompting Tool to Increase Fertility Risk Discussion Among Adolescent Oncology Families (original) (raw)
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Optimizing Fertility Preservation Practices for Adolescent and Young Adult Cancer Patients
Journal of the National Comprehensive Cancer Network
Most adolescents and young adults (AYAs) with cancer will survive their disease, and fertility issues are a major concern for this population. The ASCO and new NCCN Clinical Practice Guidelines in Oncology for Adolescent and Young Adult Oncology recommend that oncologists offer the option of fertility preservation to all postpubertal AYAs before the start of potentially gonadotoxic chemotherapy or radiotherapy, providing that the patient does not require emergent start of therapy. Despite the published practice guidelines, many AYAs diagnosed with cancer are still not offered fertility preservation, with oncologists citing lack of time, lack of knowledge, and discomfort in discussing fertility and sexuality with AYAs as reasons. Developing a systematic and coordinated multidisciplinary strategy for fertility preservation referrals within a practice site may streamline the referral process, off-loading some tasks from the oncologist and potentially increasing patient satisfaction, provider satisfaction, and compliance with the guidelines.
Purpose: The doctor-parent-adolescent triad is a unique communication challenge, particularly in the area of fertility preservation for adolescents with cancer. This paper provides a preliminary exploration into the barriers experienced by physicians in discussing cancer related fertility issues with patients aged 12-18. Methods: This study used a subset of the data from qualitative interviews with pediatric oncologists. Results: The majority of physicians agreed that fertility preservation conversations were awkward because of limited options and resources for the technology as well as the existence of a fine line between establishing a sense of trust between doctor and patient, while not excluding parents. Conclusions: Healthcare providers need training on how and when to broach fertility issues with patients, emphasizing open communication and early disclosure. Ó
Incorporating fertility preservation into the care of young oncology patients
Cancer, 2011
As the number of cancer survivors continues to increase, oncologists are faced with the challenge of providing cancer therapy to patients who may one day want to have children. Yet gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. There are established means of preserving fertility prior to cancer treatment, specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy, and thus patients' wishes regarding future fertility and the available fertility preservation alternatives should be discussed prior to the initiation of therapy. This commentary provides an overview of the range of fertility preservation options currently available and under development, and utilizes case-based discussions to illustrate ways in which fertility preservation can be incorporated into oncology care. Cases involving breast cancer, testicular cancer, and rectal cancer are described to illustrate fertility issues experienced by male and female patients, as well as to provide examples of strategies for modifying surgical, medical, and radiation therapy in order to spare fertility. Current guidelines in oncology and reproductive medicine are also reviewed to underscore the importance of communicating fertility preservation options to young patients with cancer.
Fertility issues among pediatric oncology patients – short communication
Romanian Journal of Pediatrics
Childhood cancer survival rates are constantly improving due to treatment. Fertility research has focused on adult cancer patients, but studies among childhood cancer survivors who reach reproductive age are rare and mainly based on small numbers of patients. This is surprising as childhood cancer survivors constitute a distinct, ever-growing population that may have temporarily or permanently impaired fertility due to cancer treatment. Thus, the basic scientific concern specific to the pediatric population has focused on improving protection techniques and cryopreserved tissue transfer. Research on preservation techniques confirms the safety of surgical retrieval of gonadal (ovarian and testicular) tissue for cryopreservation. Outcomes may improve, but it is clear that large registries of long-term follow-up of patients are needed. Current research efforts imply the need to develop a national strategy in each country to ensure the education and information of pediatric patients und...
Journal of pediatric hematology/oncology, 2018
Fertility preservation (FP) discussions in children with cancer presents unique challenges due to ethical considerations, lack of models-of-care, and the triadic nature of discussions. This study evaluated a fertility toolkit for clinicians involved in FP discussions with pediatric, adolescent, and young adult patients and parents. A survey-based, longitudinal study of clinicians at The Royal Children's Hospital Melbourne involved in FP discussions undertaken at 3 time-points: 2014, alongside an education session for baseline assessment of oncofertility practices (survey 1); after each toolkit use to evaluate case-specific implementation (survey 2); 2016, to evaluate impact on clinical practice (survey 3). Fifty-nine clinicians completed survey 1. Over 66% reported baseline dissatisfaction with the existing FP system; 56.7% were not confident in providing up-to-date information. Only 34.5% "often" or "always" provided verbal information; 14.0% "often&quo...
Journal of the National Comprehensive Cancer Network, 2016
Background: Professional guidelines have been developed to promote discussion between providers and newly diagnosed young adults with cancer about the possibility of cancer treatment-related infertility, but previous research suggests many young adults fail to receive this information. The aim of this study was to examine rates of and factors predictive of oncologists' compliance with national guidelines for discussing potential treatment-related infertility with newly diagnosed young adults with cancer seen at an NCI-designated comprehensive cancer center. Methods: We reviewed data from the electronic medical record for new clinic encounters between medical oncologists and young adults with cancer (ages 18-39 years) from 2010 to 2012. Data from oncologist discussions of fertility preservation were abstracted, as were patient (age, sex, race, ethnicity, cancer type) and oncologist (gender, graduation year from fellowship) characteristics. Results: A total of 1,018 cases were reviewed, with 454 patients (mean, 31.5 years; 67.8% women) meeting inclusion criteria. Overall, 83% of patients were informed about potential treatment-related infertility, with patients with breast cancer (85% informed), Hodgkin lymphoma (95% informed), non-Hodgkin's lymphoma (94% informed), leukemia (88% informed), or testicular cancer (100% informed) more likely to be informed than those with other cancer types (60%-74% informed). There was a significant effect for patient sex (odds ratio, 3.57; CI, 1.33, 9.60; P=.012), with women being more likely to be informed than men. Conclusions: Reported compliance with fertility preservation guidelines was greater than published rates. Higher compliance rates in female patients and in patients with cancers more common among young adults may reflect greater awareness of fertility-related concerns among these patients and their providers.
Fertility Preservation: A Key Survivorship Issue for Young Women with Cancer
Frontiers in oncology, 2016
Fertility preservation in the young cancer survivor is recognized as a key survivorship issue by the American Society of Clinical Oncology and the American Society of Reproductive Medicine. Thus, health-care providers should inform women about the effects of cancer therapy on fertility and should discuss the different fertility preservation options available. It is also recommended to refer women expeditiously to a fertility specialist in order to improve counseling. Women's age, diagnosis, presence of male partner, time available, and preferences regarding use of donor sperm influence the selection of the appropriate fertility preservation option. Embryo and oocyte cryopreservation are the standard techniques used while ovarian tissue cryopreservation is new, yet promising. Despite the importance of fertility preservation for cancer survivors' quality of life, there are still communication and financial barriers faced by women who wish to pursue fertility preservation.
Middle East Fertility Society Journal, 2021
Background Impaired fertility is one of the side effects of effective cancer therapy. Saving the potential or storing the material to enable people to have biological children after cancer treatment can be of high importance to many cancer survivors. Therefore, we designed a study to determine knowledge and attitudes to fertility preservation (FP) in adult cancer patients and the parents of patients with cancer. Participants who completed this survey were a convenience sample of 384 parents of cancer patients < 18 years and cancer patients ≥ 18 years from two large referral hospitals. A 25-item self-administered questionnaire measured knowledge and attitudes to FP. Responses were yes/no, or on a 4-point Likert scale (greatly, usually, rarely, never) scored from 1 for never to 4 for greatly. Results Most parents and most cancer patients were unaware of the FP methods of embryo cryopreservation (96.3% and 88.4%, respectively) and sperm cryopreservation (97.5% and 89.0%, respectivel...