Modest Increase in Fertility Consultations in Female Adolescents and Young Adults with Lymphoma: A Population-Based Study

Abstract

While survival after hematological malignancies in adolescent and young adult patients is improving, patients report poor oncofertility care. This population-based, retrospective, cohort study used data from the Ontario Cancer Registry and billing codes to identify fertility consultations for lymphoma patients between 2000 and 2018. Consultation trends across time and different patient and physician characteristics were analyzed. We identified 2088 patients and a consultation rate of 3.4% (increasing from 1% in 2000–2006 to 8% in 2014–2018). Patient parity and regional deprivation scores decreased rates. Despite mild improvement, there is ample missed opportunity for fertility discussions.

Barriers to Oncofertility Care among Female Adolescent Cancer Patients in Canada

“…In Ontario, a population study by Korkidakis et al [5] found that only 4% of women aged 15-39 years, with recently diagnosed breast cancer, were referred for a fertility consultation between 2000 and 2017. A similar Ontario study in lymphoma patients, by Coleman et al [6], found that only 3.4% of AYA patients received fertility referrals between 2000 and 2018. In regards to fertility conversations, a 2015 pan-Canadian study [7] found that 71% of site-lead and 44% of general breast cancer surgeons indicated that they routinely initiated fertility discussions with patients.…”

“…Since 2006, the national and international cancer guidelines have advised that early fertility conversations should occur between health care providers (HCPs) and all cancer patients, and referrals to a fertility specialist should be offered to all interested patients [4]. Unfortunately, recent Canadian research [5][6][7] has shown that the majority of cancer patients do not receive the recommended standard of oncofertility care-a result of a combination of parent, patient, and health care system barriers to developmentally appropriate fertility care. The aims of this narrative review are to (1) describe the psychosocial impacts of cancer-related infertility in adolescents, (2) identify multilevel barriers to FP conversations and referrals, and (3) conclude with evidence-based clinical solutions for improving the oncofertility support available to Canadian adolescents.…”

Premature ovarian insufficiency in female adolescent and young adult survivors of non-gynecological cancers: a population-based cohort study

“…Yet, fertility preservation counseling and referral rates remain low. [ 32 , 33 ] Thus, our research further advocates for increased efforts in knowledge translation and improvements in interdisciplinary coordination to overcome barriers to fertility preservation referral, as well as long-term surveillance of reproductive function in survivors of AYA cancer. In terms of surveillance, assessment of pre-treatment ovarian function, in particular through AMH levels, in premenopausal women with a diagnosis of breast cancer or haematological malignancy is recommended to predict post-treatment recovery of ovarian function [ 28 ].…”

Access to information and oncofertility consultation for young women with breast cancer: a population-based study

“…However, the rate increased steadily over time starting from less than 1% in 2000 to over 10% after 2014 15 . Another Ontario registry study of lymphoma cases diagnosed between 2000 and 2018 in young patients aged 15–39 years found a steadily increasing infertility consultation rate from 1% between 2000 and 2006 to 7.9% between 2014 and 2018 16 . More recently, the PREFER study, an observational, prospective study enrolling premenopausal women with early breast cancer, shows that after being informed of the risks associated with chemotherapy a complete reproductive counseling conducted at the fertility unit was accepted by 34,6% of women aged between 18 and 40 years 17 .…”