Consult and procedure incidence outcomes following establishment of a fertility preservation program for children with cancer

Abstract

Purpose Fertility is a quality of life outcome adversely affected by cancer therapy. Many childhood cancer patients, however, are not offered options to preserve their fertility. Providers acknowledge difficulty discussing impaired fertility to patients due to lack of knowledge of available options. Our objective was to review the impact of a pediatric multidisciplinary fertility preservation program on providers' fertility preservation counseling and discussion of options. Methods A retrospective medical chart review was conducted for pediatric cancer patients prior to and following program establishment. Fertility preservation discussions, consults, and incidence were noted. Following filtering and stratification, 198 and 237 patients were seen prior to and following program establishment, respectively. Results Following program establishment, provider-patient discussions of impaired fertility (p = 0.007), fertility preservation consults (p = 0.01), and incidence of fertility preservation procedures (p < 0.001) increased among patients. Furthermore, the number of patients who received fertility preservation consults after receiving gonadotoxic treatment decreased (p < 0.001). This trend was particularly noted in pre-pubertal and female patients, for whom fertility preservation options are limited without an established program. ConclusionThe establishment of a formal program greatly improved access to fertility preservation consults and procedures in children with cancer.

The evolution of fertility preservation care models in a large pediatric cancer and blood disorders center

“…3,6 The incorporation of dedicated oncofertility teams within pediatric hematology/oncology centers facilitates such FP consultations; however, many pediatric institutions experience infrastructure-related barriers to establishing dedicated FP teams. 7,[25][26][27] Through evolving care models, including the use of nurse navigators and stratifying patients based on urgency, our institution's FP team has been able…”

“…National guidelines recommend that FP discussions take place with pediatric and adolescent patients at the time of cancer diagnosis 3,6 . The incorporation of dedicated oncofertility teams within pediatric hematology/oncology centers facilitates such FP consultations; however, many pediatric institutions experience infrastructure‐related barriers to establishing dedicated FP teams 7,25–27 . Through evolving care models, including the use of nurse navigators and stratifying patients based on urgency, our institution's FP team has been able to build a program that allows for the accommodation of a substantial increase in the number of annual FP consults.…”

Establishment of a Pediatric Ovarian and Testicular Cryopreservation Program for Malignant and Non-Malignant Conditions: The Mayo Clinic Experience

“…A retrospective analysis from our group on the pediatric oncology practice at the Mayo Clinic showed that patient −provider discussions of impaired fertility significantly increased after the establishment of our program, as did the incidence rates for fertility preservation consults and incidence of fertility preservation options by patients. 61 Since its inception in 2016, the MC-FP has faced challenges and limitations. For instance, the need for continued provider education and training of new staff on the study protocol is an ongoing challenge.…”

A multidisciplinary pediatric oncofertility team improves fertility preservation and counseling across 7 years

“…While developing an oncofertility program has improved patient satisfaction and FP referral in adults, 11,12 continued improvement is needed. Many Children's Oncology Group member institutions report the creation of a designated FP individual or team and that this has improved access to FP procedures, 13 and some individual centers note an increase in FP counseling and referral in electronic medical record (EMR) documentation following the implementation of such a designated FP team 14–16 . Specific defined metrics to measure “success” of an FP team, such as rate of FP counseling and FP referral for at‐risk patients, are needed to measure the effectiveness of these interventions.…”

“…Many Children's Oncology Group member institutions report the creation of a designated FP individual or team and that this has improved access to FP procedures, 13 and some individual centers note an increase in FP counseling and referral in electronic medical record (EMR) documentation following the implementation of such a designated FP team. 14 , 15 , 16 Specific defined metrics to measure “success” of an FP team, such as rate of FP counseling and FP referral for at‐risk patients, are needed to measure the effectiveness of these interventions. Ideally, all patients should receive counseling on the risk of infertility prior to starting genotoxic therapy with curative intent.…”