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von Rohden E, Jensen CFS, Andersen CY, Sønksen J, Fedder J, Thorup J, Ohl DA, Fode M, Hoffmann ER, Mamsen LS. Male fertility restoration: in vivo and in vitro stem cell-based strategies using cryopreserved testis tissue: a scoping review. Fertil Steril 2024:S0015-0282(24)00603-4. [PMID: 38992744 DOI: 10.1016/j.fertnstert.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
IMPORTANCE Advances in the treatment of childhood cancer have significantly improved survival rates, with more than 80% of survivors reaching adulthood. However, gonadotoxic cancer treatments endanger future fertility, and prepubertal males have no option to preserve fertility by sperm cryopreservation. In addition, boys with cryptorchidism are at risk of compromised fertility in adulthood. OBJECTIVE To investigate current evidence for male fertility restoration strategies, explore barriers to clinical implementation, and outline potential steps to overcome these barriers, a scoping review was conducted. This knowledge synthesis is particularly relevant for prepubertal male cancer survivors and boys with cryptorchidism. EVIDENCE REVIEW The review was conducted after the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews criteria and previously published guidelines and examined studies using human testis tissue of prepubertal boys or healthy male adults. A literature search in PubMed was conducted, and 72 relevant studies were identified, including in vivo and in vitro approaches. FINDINGS In vivo strategies, such as testis tissue engraftment and spermatogonial stem cell transplantation, hold promise for promoting cell survival and differentiation. Yet, complete spermatogenesis has not been achieved. In vitro approaches focus on the generation of male germ cells from direct germ cell maturation in various culture systems, alongside human induced pluripotent stem cells and embryonic stem cells. These approaches mark significant advancements in understanding and promoting spermatogenesis, but achieving fully functional spermatozoa in vitro remains a challenge. Barriers to clinical implementation include the risk of reintroducing malignant cells and introduction of epigenetic changes. CONCLUSION Male fertility restoration is an area in rapid development. On the basis of the reviewed studies, the most promising and advanced strategy for restoring male fertility using cryopreserved testis tissue is direct testis tissue transplantation. RELEVANCE This review identifies persistent barriers to the clinical implementation of male fertility restoration. However, direct transplantation of frozen-thawed testis tissue remains a promising strategy that is on the verge of clinical application.
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Affiliation(s)
- Elena von Rohden
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Laboratory of Reproductive Biology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | - Claus Yding Andersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Sønksen
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Fedder
- Department of Gynecology and Obstetrics, Centre of Andrology & Fertility Clinic, Odense University Hospital, Odense, Denmark; Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jørgen Thorup
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Pediatric Surgery, Surgical Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dana A Ohl
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva R Hoffmann
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Molecular and Cellular Medicine, DNRF Center for Chromosome Stability, University of Copenhagen, Copenhagen, Denmark
| | - Linn Salto Mamsen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Asadi-Azarbaijani B, Oskam IC, Jahnukainen K. A 12-year overview of fertility preservation practice in Nordic pediatric oncology centers. J Cancer Surviv 2024:10.1007/s11764-024-01627-x. [PMID: 38871993 DOI: 10.1007/s11764-024-01627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Fertility preservation is the only option to safeguard fertility following gonadotoxic treatments. This study aimed to provide an updated status on fertility preservation for pediatric cancer patients in the Nordic countries. METHODS A questionnaire consisting of 14 questions was sent to directors of 18 main pediatric oncology centers in the Nordic countries in 2010 and 2022. We received information regarding indications, guidelines, counseling, and available fertility preservation options. RESULTS The response rates were 89% in 2010 and 72% in 2022. The results reveal an increase in clinical practice guidelines on fertility preservation for cancer patients, from 25% in 2010 to 70% in 2022. Counseling on fertility preservation options in 2022 was more specific and offered to most patients who fulfilled indications for fertility preservation (from 19 to 77%). Sperm cryopreservation continues to be the predominant fertility preservation method for pubertal boys in the Nordic countries. However, there has been a notable increase in the availability of testicular tissue preservation for prepubertal boys (0 to 62%). A similar increase in the offer of ovarian tissue preservation for prepubertal girls (0 to 92%) was observed among pediatric cancer patients. CONCLUSIONS The past decade has shown commendable advancements in fertility preservation for pediatric cancer patients in the Nordic countries. IMPLICATIONS FOR CANCER SURVIVORS As fertility care evolves globally, continuous assessment of regional practices and challenges is imperative to enhance the quality of care and life for pediatric cancer survivors in the Nordic regions.
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Affiliation(s)
| | - Irma C Oskam
- The Livestock Production Research Centre, Norwegian University of Life Sciences, Aas, Norway
| | - Kirsi Jahnukainen
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Sira N, McNeil S, Hegde A, Geistman K, Schwartz A. Infertility and Identity: A Closer Look Into Experiences of Emerging Young Adult Childhood Cancer Survivors. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:32-43. [PMID: 37858932 DOI: 10.1177/27527530231190386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Objective: While medical advances are enabling more children with cancer to live into adulthood, a large majority of them suffer from the late effects of treatment and about 30% experience infertility. Infertility impacts both male and female survivors complicating typical development for emerging young adults (EYAs) who typically spend this developmental period actively constructing their identities related to family and gender roles, attaining professional skills, and establishing social views. As literature is limited on identity formation and coping with infertility in young survivors, this study aimed to understand the experiences of childhood cancer survivors who are faced with infertility as a late treatment effect while reconstructing their identity. Method: A qualitative descriptive approach was used to explore the experiences and effects of childhood cancer complications on the identity development of six emerging adults (ages 18-29). Guided by the theoretical framework of identity development data were collected using semistructured interviews. Results: Four distinct themes emerged after the data analyses: restricted exploration and uncertain future, challenges to intimacy and communication, restructuring identity through redefining roles, and coping through familial support. Conclusions: Findings indicate that developmental processes of identity formation are complicated by the challenges stemming from infertility and require specific efforts to reconstruct core identity and redefine desired parental roles. Experimentation and self-discovery may be restricted for EYA cancer survivors as they reevaluate their views on intimate relationships, communication, potential professional roles, and family composition. Practical recommendations for multidisciplinary team members to support this growing population are discussed.
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Affiliation(s)
- Natalia Sira
- Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Sarah McNeil
- Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Archana Hegde
- Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Kayla Geistman
- Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Abby Schwartz
- Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
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Hartley T, Gillespie MK, Graham ID, Hayeems RZ, Li S, Sampson M, Boycott KM, Potter BK. Exome and genome sequencing for rare genetic disease diagnosis: A scoping review and critical appraisal of clinical guidance documents produced by genetics professional organizations. Genet Med 2023; 25:100948. [PMID: 37551668 DOI: 10.1016/j.gim.2023.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE Exome and genome sequencing have rapidly transitioned from research methods to widely used clinical tests for diagnosing rare genetic diseases. We sought to synthesize the topics covered and appraise the development processes of clinical guidance documents generated by genetics professional organizations. METHODS We conducted a scoping review of guidance documents published since 2010, systematically identified in peer-reviewed and gray literature, using established methods and reporting guidelines. We coded verbatim recommendations by topic using content analysis and critically appraised documents using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. RESULTS We identified 30 guidance documents produced by 8 organizations (2012-2022), yielding 611 recommendations covering 21 topics. The most common topic related to findings beyond the primary testing indication. Mean AGREE II scores were low across all 6 quality domains; scores for items related to rigor of development were among the lowest. More recently published documents generally received higher scores. CONCLUSION Guidance documents included a broad range of recommendations but were of low quality, particularly in their rigor of development. Developers should consider using tools such as AGREE II and basing recommendations on living knowledge syntheses to improve guidance development in this evolving space.
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Affiliation(s)
- Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
| | - Meredith K Gillespie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ian D Graham
- University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Z Hayeems
- Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Sheena Li
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Karalexi MA, Kontogeorgi A, Papaioannou G, Neofytou S, Messaropoulos P, Moschovi M, Kalantaridou SN. Fertility status in childhood cancer survivors of hematological malignancies: a systematic review. Hormones (Athens) 2023; 22:211-221. [PMID: 36964890 DOI: 10.1007/s42000-023-00443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/14/2023] [Indexed: 03/26/2023]
Abstract
Stunning advances in treatment modalities implemented in children with hematological malignancies have led to 5-year overall survival rates exceeding 85%. However, this growing population of long-term survivors has raised significant concerns about their fertility status throughout adulthood, while specific treatment- and non-treatment-related factors appear to possibly affect fertility through distinct mechanisms. We aimed to comprehensively review the published literature on the association between treatment-related factors and risk of impaired fertility in childhood hematological cancer survivors. We searched PubMed up to March 2021 to identify eligible studies published during the last two decades. A narrative synthesis of the results was performed, although no meta-analysis was feasible due to the small number of studies and the large heterogeneity of evidence. Five studies on 2020 survivors of childhood leukemia were deemed eligible. The qualitative data synthesis showed significant fertility deficits in survivors treated with cranial radiotherapy and chemotherapy for childhood leukemia. Two studies examined biochemical measures of reduced ovarian reserve, providing some evidence that the levels of anti-Müllerian hormone can be used as a proxy for diminished ovarian reserve. The current findings should facilitate the delivery of age- and gender-appropriate interventions to optimize reproductive outcomes in childhood hematological cancer survivors.
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Affiliation(s)
- Maria A Karalexi
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece.
| | - Adamantia Kontogeorgi
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - George Papaioannou
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Spyridoula Neofytou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Messaropoulos
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Sophia N Kalantaridou
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Str, 12462, Athens, Greece
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Chemotherapy: how to reduce its adverse effects while maintaining the potency? Med Oncol 2023; 40:88. [PMID: 36735206 DOI: 10.1007/s12032-023-01954-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
Chemotherapy is one of the widely used anticancer treatments that involves the use of powerful cytotoxic drugs to stop tumor growth by targeting rapidly dividing cells through various mechanisms, which will be elucidated in this review. Introduced during the early twentieth century, chemotherapy has since lengthened the longevity of innumerable cancer patients. However, the increase in lifespan is at the expense of quality of life as patients are at risk of developing short-term and long-term side effects following chemotherapy, such as alopecia (hair loss), chemotherapy-induced peripheral neuropathy, chemotherapy-induced nausea and vomiting, cardiotoxicity, diarrhea, infertility, and chemo brain. Currently, a number of these chemotherapy-induced adverse effects are managed through supportive care and approved treatments, while the rest of the side effects are unavoidable. Hence, chemotherapeutic drugs associated with inevitable side effects are only administered when their therapeutic role outweighs their chemotoxicity, thus severely limiting the potency of chemotherapy in treating malignancy. Therein, the potential approaches to alleviating side effects of chemotherapy ranging from pharmaceutical drugs to alternative therapies will be discussed in this review in hopes of increasing the tolerance and effectiveness of future chemotherapeutic treatments.
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Yousef S, Hayawi L, Manuel D, Colman I, Papadimitropoulos M, Hossain A, Faris MA, Wells GA. Assessment of the quality and content of clinical practice guidelines (CPGs) for vitamin D and for immigrants using the AGREE-II instrument: a protocol for systematic review. Syst Rev 2022; 11:245. [PMID: 36397107 PMCID: PMC9673290 DOI: 10.1186/s13643-022-02129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants, which is attributed to ethnic variations, place or region of birth, skin pigmentation, clothing style, and resettlement-related changes in diet, physical activity, and sun exposure. Current recommendations in clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants. CPGs may also lack guidance for physicians on vitD supplementation for immigrants. Moreover, there are concerns about the overall quality of these CPGs. OBJECTIVES This systematic review will collate and critically appraise CPGs relevant to immigrants' health and vitD. Moreover, we will evaluate whether the CPGs of vitD including recommendations for immigrants and clarify whether the CPGs of immigrants include recommendations on vitD. METHODS A systematic search of Ovid MEDLINE® ALL, EMBASE, and Turning Research Into Practice (TRIP) electronic databases, guideline repositories, and gray literature will be conducted to identify relevant CPGs. Two reviewers will independently evaluate the methodological quality of the retrieved guidelines using the Appraisal of Guidelines, Research, and Evaluation-II (AGREE-II) instrument. CPGs scoring ≥60% in at least four domains, including "rigor of development," will be considered high quality. CONCLUSION Evaluating the quality and content of relevant CPGs may support researchers in developing national and global guidelines for immigrants. Furthermore, it may support vitD testing, nutritional counseling, and supplementation for vulnerable immigrant sub-populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021240562.
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Affiliation(s)
- Said Yousef
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Room H1281, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada.
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Manny Papadimitropoulos
- Eli Lilly Canada Inc., Toronto, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Alomgir Hossain
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - Moez AlIslam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, UAE
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Room H1281, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
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Chen Q, Carpenter E, White K. Non-physician's challenges in sexual and reproductive health care provision for women of reproductive age with cancer: a scoping review of barriers and facilitators. Support Care Cancer 2022; 30:10441-10452. [PMID: 36214878 DOI: 10.1007/s00520-022-07388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The American Society of Clinical Oncology Clinical Practice guidelines recommend that non-physicians such as nurses, social workers, and psychologists should be prepared to discuss fertility and sexual concerns with patients. However, literature showed that the utilization rate of sexual and reproductive care for women with cancer remained low. We conducted a scoping review to describe non-physicians' roles, barriers, and facilitators providing sexual and reproductive health (SRH) care to women of reproductive age with cancer. METHODS We searched six databases for articles that met the following criteria: (1) English language; (2) original research; (3) non-physician providers; (4) women with cancer under age 50. We categorized barriers and facilitators at the system-, individual-, and clinical encounter-levels from providers' and patients' perspectives. RESULTS We included 27 studies from 3451 retrieved articles. The majority of studies have a focus on fertility preservation or sexuality (n = 25). At the system level, the main barriers for non-physicians were lack of SRH care guidelines and collaborating experts. Concerns for patients included socioeconomic and geographic constraints in obtaining care. At the encounter level, providers and patients lacked experience discussing SRH. At the individual level, providers' lack of knowledge in SRH treatment options and interprofessional collaboration and patients' lack of awareness about treatment effects hindered SRH discussions. Facilitators include the availability of SRH programs and specialists, and rapport between providers and patients. CONCLUSIONS Supporting non-physicians to provide SRH services to women with cancer requires investment in clinical guidelines, interprofessional collaboration, and training in patient communication.
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Affiliation(s)
- Qi Chen
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
| | - Emma Carpenter
- Texas Policy Evaluation Project, University of Texas at Austin, Austin, TX, USA
| | - Kari White
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Edens C. The Impact of Pediatric Rheumatic Diseases on Sexual Health, Family Planning, and Pregnancy. Rheum Dis Clin North Am 2021; 48:113-140. [PMID: 34798942 DOI: 10.1016/j.rdc.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comprehensive review of reproductive health subtopics, including sexual intercourse, romantic relationships, contraception, sexually transmitted infections, pregnancy, and infertility, as they pertain to patients with pediatric rheumatic diseases and those who care for them.
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Affiliation(s)
- Cuoghi Edens
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA; Department of Internal Medicine, Section of Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA.
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Karimi-Zarchi M, Khalili MA, Binesh F, Vatanparast M. Ovarian Tissue Reservation and Risk of Reimplantation in a Young Girl with Acute Lymphocytic Leukemia after 6-Month Chemotherapy: A Case Report. South Asian J Cancer 2021; 10:112-114. [PMID: 34568225 PMCID: PMC8460347 DOI: 10.1055/s-0041-1729495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In the fertility preservation programs, ovarian cryopreservation is usually offered when the risk of premature ovarian failure is high (>30-50%) while the risk of ovarian metastasis is low. According to the guidelines, it must be done before the patient receives chemotherapy. A 22-year-old girl with acute lymphocytic leukemia was a candidate for ovarian cryopreservation after 6 months of chemotherapy. Despite chemotherapy, the anti-Mullerian hormone survey was within normal range. Ovarian tissue cryopreservation was done. In the histology survey, follicular density was 7.48. This case shows that only having a history of chemotherapy does not exclude the patient from the fertility preservation program. Regarding referring the patients for fertility preservation, cumulative factors such as a history of gonadotoxic treatment, age, and treatment protocol should be considered. In addition, the case was negative for assessing of CD45 marker. New data may challenge previous strict criteria, and extend the indications of this effective method in preserving fertility among cancer patients.
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Affiliation(s)
- Mojgan Karimi-Zarchi
- Department of Gynecology Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Khalili
- Research and Clinical Center for Infertility, Yazd University of Medical Sciences, Yazd, Iran
| | - Fariba Binesh
- Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahboubeh Vatanparast
- Molecular Medicine Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Bradford N, Cashion C, Condon P, Rumble S, Bowers A. Recruitment principles and strategies for supportive care research in pediatric oncology. BMC Med Res Methodol 2021; 21:178. [PMID: 34454413 PMCID: PMC8400402 DOI: 10.1186/s12874-021-01371-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Variations in clinical practice contribute to negative outcomes for children with cancer. Research in this area is imperative to standardise practice, yet such research is challenging to undertake, and a significant proportion of studies fail. A common reason for failure is poor recruitment, yet little information is available to support researchers and clinicians planning such research. METHODS Our primary aim was to describe the recruitment strategies and outcomes in a tertiary children's hospital across multiple observational supportive care studies. Secondary aims were to establish principles to improve both recruitment strategies and the reporting of recruitment. We undertook a retrospective descriptive analysis of the recruitment logs and data from three studies in pediatric oncology. The mean time to recruit one participant was calculated. Common reasons for not approaching eligible participants and reasons potential participants declined are described. RESULTS Of the 235 potential candidates across all studies, 186 (79%) were approached and of these 125 (67%) provided consent, with 117 (63%) completing baseline measures. We estimated recruitment per participant required an average 98 min of experienced research nurse time. Four factors are described that influence recruitment and six principles are outlined to maximise recruitment and the generalisability of research findings. CONCLUSIONS We highlight the recruitment experiences across three different projects in children's cancer supportive care research and provide a roadmap for other researchers planning to undertake clinical research in pediatrics.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre and School of Nursing, Brisbane, Australia.
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia.
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.
| | - Christine Cashion
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Paula Condon
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Shelley Rumble
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Alison Bowers
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre and School of Nursing, Brisbane, Australia
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
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van den Berg MH, van Dijk M, Byrne J, Berger C, Dirksen U, Winther JF, Fossa SD, Grabow D, Grandage VL, Haupt R, van den Heuvel-Eibrink MM, Kaiser M, Kepak T, van der Kooi ALF, Kremer LCM, Kruseova J, Lambalk CB, van Leeuwen FE, Leiper A, Modan-Moses D, Spix C, Twisk JWR, Ronckers CM, Kaatsch P, van Dulmen-den Broeder E. Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE). Hum Reprod 2021; 36:1561-1573. [PMID: 33744927 DOI: 10.1093/humrep/deab035] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/21/2021] [Indexed: 02/02/2023] Open
Abstract
STUDY QUESTION Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors? SUMMARY ANSWER Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. WHAT IS KNOWN ALREADY Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce. STUDY DESIGN, SIZE, DURATION The current case-control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites. MAIN RESULTS AND THE ROLE OF CHANCE A positive dose-effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score > 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9-3.6) P < 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. LIMITATIONS, REASONS FOR CAUTION Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results. WIDER IMPLICATIONS OF THE FINDINGS We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired. STUDY FUNDING/COMPETING INTEREST(S) This study has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- M H van den Berg
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M van Dijk
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Byrne
- Boyne Research Institute, Department of Epidemiology, Drogheda, Ireland
| | - C Berger
- Department of Pediatric Hematology and Oncology, University-Hospital, Saint-Etienne, France
| | - U Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - J F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - S D Fossa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - D Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | | | - R Haupt
- Gaslini Children Hospital, Epidemiology and Biostatistics Section, Genova, Italy
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic
- International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - A L F van der Kooi
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Leiper
- Great Ormond Street Children's Hospital, London, UK
| | - D Modan-Moses
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Spix
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, THE Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Institute for Biostatistics and Registry Research, Medical University Brandenburg, Neuruppin, Germany
| | - P Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND There is a lack of a comprehensive evaluation for pediatric clinical practice guidelines (CPGs) published in recent years. Here, we assessed the quality of pediatric CPGs, considering factors that might affect their quality. The aim of the study is to promote a more coherent development and application of CPGs. METHODS Pediatric CPGs published in PubMed, MedLive, Guidelines International Network, National Institute for Health and Care Excellence, and World Health Organization between 2017 and 2019 were searched and collected. Paired researchers conducted screening, data extraction, and quality assessment using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Linear regression analysis determined the factors affecting CPGs' quality. RESULTS The study included a total of 216 CPGs, which achieved a mean score of 4.26 out of 7 points (60.86%) in the AGREE II assessment. Only 6.48% of the CPGs reached the "recommend" level. The remaining 69.91% should have been modified before recommendation, while the other 23.61% did not reach the recommended level at all. The overall quality of recent pediatric CPGs was higher than previously, and the proportion of CPGs with low-quality decreased over time. However, there were still too few CPGs that reached a high-quality level. The "applicability" and "rigor of development" domains had generally low scores. CPGs formulated by developing countries or regions, those that are not under an organizations or groups responsibility, and those that used non-evidence-based methods were found to be associated with poorer quality in different domains as independent or combinational factors. CONCLUSIONS The quality of pediatric CPGs still needs to be improved. Specifically, a quality control before applying new CPGs should be essential to ensure their quality and applicability.
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14
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Piazza T, Izidoro JB, Portella MAMP, Panisset U, Afonso Guerra-Júnior A, Cherchiglia ML. [Assessment of Brazilian clinical guidelines in oncology: gaps in drafting, applicability, and editorial independence]. CAD SAUDE PUBLICA 2021; 37:e00031920. [PMID: 33886704 DOI: 10.1590/0102-311x00031920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
The expansion in the variety of clinical guidelines in oncology is perceptible worldwide, highlighting the need to guarantee the quality of these documents. The study thus aimed to assess the quality of Brazilian national guidelines for treatments of breast, prostate, and colon and rectal cancers. We selected 12 Brazilian guidelines published by four different drafting groups (Ministry of Health, Supplementary Health System, and medical societies and associations), and the AGREE II instrument was applied. In all these guidelines, we identified important weaknesses in more than one Domain, especially low values for "applicability" and "editorial independence". The patterns observed per Domains are more related to the drafting group than the respective clinical conditions. Lower scores in "drafting rigor" and "editorial independence" were obtained by nongovernmental drafting groups, including absence of information or lack of its transparency. Although the "clarity of presentation" in the Ministry of Health guidelines was relatively lower, all the guidelines presented major limitations in "applicability". Consequently, in the overall assessment, none of the guidelines was recommended without modifications, and four were not recommended at all. Finally, it is necessary to upgrade the guidelines according to the underlying evidence ("methodological rigor") and to present the recommended practices in a comprehensible and applicable way ("applicability"), and to mitigate conflicting interests in order to offer cancer patients the best available care in Brazil.
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Affiliation(s)
- Thais Piazza
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Ulysses Panisset
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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15
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Bojic S, Murray A, Bentley BL, Spindler R, Pawlik P, Cordeiro JL, Bauer R, de Magalhães JP. Winter is coming: the future of cryopreservation. BMC Biol 2021; 19:56. [PMID: 33761937 PMCID: PMC7989039 DOI: 10.1186/s12915-021-00976-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/03/2021] [Indexed: 12/24/2022] Open
Abstract
The preservative effects of low temperature on biological materials have been long recognised, and cryopreservation is now widely used in biomedicine, including in organ transplantation, regenerative medicine and drug discovery. The lack of organs for transplantation constitutes a major medical challenge, stemming largely from the inability to preserve donated organs until a suitable recipient is found. Here, we review the latest cryopreservation methods and applications. We describe the main challenges-scaling up to large volumes and complex tissues, preventing ice formation and mitigating cryoprotectant toxicity-discuss advantages and disadvantages of current methods and outline prospects for the future of the field.
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Affiliation(s)
- Sanja Bojic
- School of Computing, Newcastle University, Newcastle upon Tyne, UK.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Alex Murray
- Department of Chemistry, University of Warwick, Coventry, UK
| | - Barry L Bentley
- Faculty of Science, Technology, Engineering & Mathematics, The Open University, Milton Keynes, UK.,Magdalene College, University of Cambridge, Cambridge, UK
| | | | - Piotr Pawlik
- Cancer Genome Evolution Research Group, University College London Cancer Institute, University College London, London, UK
| | | | - Roman Bauer
- Department of Computer Science, University of Surrey, Guildford, UK.
| | - João Pedro de Magalhães
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
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16
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Mulder RL, Font-Gonzalez A, Green DM, Loeffen EAH, Hudson MM, Loonen J, Yu R, Ginsberg JP, Mitchell RT, Byrne J, Skinner R, Anazodo A, Constine LS, de Vries A, Jahnukainen K, Lorenzo A, Meissner A, Nahata L, Dinkelman-Smit M, Tournaye H, Haupt R, van den Heuvel-Eibrink MM, van Santen HM, van Pelt AMM, Dirksen U, den Hartogh J, van Dulmen-den Broeder E, Wallace WH, Levine J, Tissing WJE, Kremer LCM, Kenney LB, van de Wetering MD. Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e57-e67. [PMID: 33539754 DOI: 10.1016/s1470-2045(20)30582-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Male patients with childhood, adolescent, and young adult cancer are at an increased risk for infertility if their treatment adversely affects reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of interventions that preserve fertility. As part of the PanCareLIFE Consortium, in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in male patients who are diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. Recognising the need for global consensus, this clinical practice guideline used existing evidence and international expertise to rigorously develop transparent recommendations that are easy to use to facilitate the care of male patients with childhood, adolescent, and young adult cancer who are at high risk of fertility impairment and to enhance their quality of life.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Richard Yu
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
| | - Jill P Ginsberg
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Rod T Mitchell
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, NY, USA
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Helsinki, Finland
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Meissner
- Center for Reproductive Medicine, Amsterdam UMC, location AMC, Amsterdam, Netherlands; Department of Urology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marij Dinkelman-Smit
- Division of Andrology, Department of Urology, Erasmus MC, Rotterdam, Netherlands
| | - Herman Tournaye
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and Livebirth Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Ans M M van Pelt
- Laboratory for Reproductive Biology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organization (VOX), Nieuwegein, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
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17
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Mulder RL, Font-Gonzalez A, van Dulmen-den Broeder E, Quinn GP, Ginsberg JP, Loeffen EAH, Hudson MM, Burns KC, van Santen HM, Berger C, Diesch T, Dirksen U, Giwercman A, Gracia C, Hunter SE, Kelvin JF, Klosky JL, Laven JSE, Lockart BA, Neggers SJCMM, Peate M, Phillips B, Reed DR, Tinner EME, Byrne J, Veening M, van de Berg M, Verhaak CM, Anazodo A, Rodriguez-Wallberg K, van den Heuvel-Eibrink MM, Asogwa OA, Brownsdon A, Wallace WH, Green DM, Skinner R, Haupt R, Kenney LB, Levine J, van de Wetering MD, Tissing WJE, Paul NW, Kremer LCM, Inthorn J. Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e68-e80. [PMID: 33539755 DOI: 10.1016/s1470-2045(20)30595-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/06/2023]
Abstract
Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the literature and developed a clinical practice guideline that provides recommendations for ongoing communication methods for fertility preservation for patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger and their families. Moreover, the guideline panel formulated considerations of the ethical implications that are associated with these procedures. Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the evidence and recommendations. In this clinical practice guideline, existing evidence and international expertise are combined to develop transparent recommendations that are easy to use to facilitate ongoing communication between health-care providers and patients with childhood, adolescent, and young adult cancer who might be at high risk for fertility impairment and their families.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Department of Population Health, and Division of Medical Ethics, New York University School of Medicine, New York University, New York, NY, USA
| | - Jill P Ginsberg
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Karen C Burns
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Claire Berger
- Department of Pediatric Hematology and Oncology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France; Host Research Team EA4607 Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health, Jean Monnet University of Saint-Étienne, Education and Research Cluster Lyon, Saint-Étienne, France
| | - Tamara Diesch
- Department of Pediatric Oncology and Hematology, University Children's Hospital Basel, Basel, Switzerland
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Aleksander Giwercman
- Division of Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Clarisa Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah E Hunter
- Starship Blood and Cancer Centre, Starship Hospital, Auckland, New Zealand
| | | | - James L Klosky
- Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, Netherlands
| | - Barbara A Lockart
- Division of Pediatric Surgery and Division of Hematology, Oncology, and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Sophia Children's Hospital and Pituitary Center Rotterdam, Endocrinology Section, Department of Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Damon R Reed
- Adolescent Young Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eva Maria E Tinner
- Division of Pediatric Hematology/Oncology, University Children's Hospital, Inselspital, Bern, Switzerland
| | | | - Margreet Veening
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marleen van de Berg
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboudumc Nijmegen, Nijmegen, Netherlands
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Kenny Rodriguez-Wallberg
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Erasmus MC, Rotterdam, Netherlands
| | | | - Alexandra Brownsdon
- Children and Young Peoples' Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Norbert W Paul
- Department of Obstetrics and Gynecology, Department of Population Health, and Division of Medical Ethics, New York University School of Medicine, New York University, New York, NY, USA
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Inthorn
- Institute for the History, Philosophy, and Ethics of Medicine, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
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18
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Mulder RL, Font-Gonzalez A, Hudson MM, van Santen HM, Loeffen EAH, Burns KC, Quinn GP, van Dulmen-den Broeder E, Byrne J, Haupt R, Wallace WH, van den Heuvel-Eibrink MM, Anazodo A, Anderson RA, Barnbrock A, Beck JD, Bos AME, Demeestere I, Denzer C, Di Iorgi N, Hoefgen HR, Kebudi R, Lambalk C, Langer T, Meacham LR, Rodriguez-Wallberg K, Stern C, Stutz-Grunder E, van Dorp W, Veening M, Veldkamp S, van der Meulen E, Constine LS, Kenney LB, van de Wetering MD, Kremer LCM, Levine J, Tissing WJE. Fertility preservation for female patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e45-e56. [PMID: 33539753 DOI: 10.1016/s1470-2045(20)30594-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/05/2023]
Abstract
Female patients with childhood, adolescent, and young adult cancer are at increased risk for fertility impairment when treatment adversely affects the function of reproductive organs. Patients and their families desire biological children but substantial variations in clinical practice guidelines reduce consistent and timely implementation of effective interventions for fertility preservation across institutions. As part of the PanCareLIFE Consortium, and in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in female patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. This clinical practice guideline leverages existing evidence and international expertise to develop transparent recommendations that are easy to use to facilitate the care of female patients with childhood, adolescent, and young adult cancer who are at high risk for fertility impairment. A complete review of the existing evidence, including a quality assessment, transparent reporting of the guideline panel's decisions, and achievement of global interdisciplinary consensus, is an important result of this intensive collaboration.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Karen C Burns
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Department of Population Health, and Division of Medical Ethics, New York University School of Medicine, New York University, New York, NY, USA
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Anke Barnbrock
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
| | - Joern D Beck
- Hospital for Children and Adolescents, University of Erlangen-Nürnberg, Erlangen, Germany; LESS Group, Hospital for Children and Adolescents, University of Lübeck, Lübeck, Germany
| | - Annelies M E Bos
- Department of Reproductive Medicine and Gynaecology, UMC Utrecht, Utrecht, Netherlands
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction and Fertility Clinic, Department of Obstetrics and Gynecology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Holly R Hoefgen
- Division of Pediatric and Adolescent Gynecology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey; Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Cornelis Lambalk
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thorsten Langer
- Division Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Division of Hematology/Oncology and Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Kenny Rodriguez-Wallberg
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Catharyn Stern
- Melbourne IVF, East Melbourne, VIC, Australia; Reproductive Services, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Eveline Stutz-Grunder
- Department of Pediatric Oncology, Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Wendy van Dorp
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
| | - Margreet Veening
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Saskia Veldkamp
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
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King DA, Lane S, Yeomanson D. Fifteen-minute consultation: Fertility preservation in children with cancer. Arch Dis Child Educ Pract Ed 2020; 105:342-346. [PMID: 32414812 DOI: 10.1136/archdischild-2019-318619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
Abstract
Advances in the treatment of childhood cancer have led to significant numbers of children surviving into adulthood and beyond. There is therefore an increasing focus on reduction of long-term effects of treatment including subfertility. In this article, we give an overview of the different methods of fertility preservation and how to discuss this important topic in children newly diagnosed with cancer.
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Affiliation(s)
- David Anthony King
- Paediatric Oncology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sheila Lane
- Paediatric Oncology and Haematology, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Daniel Yeomanson
- Paediatric Oncology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
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20
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Gonçalves V, Ferreira PL, Quinn GP. Integration of partners of young women with cancer in oncofertility evidence-based informational resources. Cancer Med 2020; 9:7375-7380. [PMID: 32864852 PMCID: PMC7571813 DOI: 10.1002/cam4.3377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022] Open
Abstract
Oncofertility has evolved over the years, with a prodigious amount of research documenting the importance of fertility for young patients with cancer, and the potential impact that fertility impairments due to cancer treatments has on their Quality of Life (QoL). Multiple professional bodies and scientific societies have included fertility as an integral part of clinical management. Clinical guidelines advocate that health professionals have the duty to discuss the risk of infertility and fertility preservation options as early as possible and refer to fertility specialists when appropriate. Collectively, fertility decisions are regarded as difficult for both patients and providers. Since providing fertility‐related information is vital for better decision making, researchers and policy makers have concentrated their efforts in developing educational tools to aid decisions and guidelines to optimize the delivery of this information, focusing mainly on patients‐providers and largely neglecting the role and influence that partners play in this process. Here, we reflect on the importance of partners in fertility decisions, with a focus on the provision of fertility‐related information that is also geared towards partner. We highlight the need to involve partners in fertility discussions, and that their needs should be taken into account in both clinical guidelines and in the development of educational tools, for an optimal decision‐making process.
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Affiliation(s)
- Vânia Gonçalves
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Pedro L Ferreira
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Gwendolyn P Quinn
- Departments of Obstetrics and Gynecology and Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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Schleedoorn M, van der Velden J, Braat D, Beerendonk I, van Golde R, Peek R, Fleischer K. TurnerFertility trial: PROTOCOL for an observational cohort study to describe the efficacy of ovarian tissue cryopreservation for fertility preservation in females with Turner syndrome. BMJ Open 2019; 9:e030855. [PMID: 31831533 PMCID: PMC6924773 DOI: 10.1136/bmjopen-2019-030855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the occurrence of live birth in women with Turner syndrome (TS) after ovarian tissue cryopreservation in childhood followed by auto transplantation in adulthood and to find reliable prognostic markers for estimating the ovarian reserve in girls with TS in the future. SETTING An observational cohort study with long-term follow-up in a tertiary fertility clinic in the Netherlands. Patients recruitment between January 2018 and December 2021. PARTICIPANTS 100 females aged 2 through 18 years with classical Turner (ie, 45,X0) or Turner variants (ie, 45,X mosaicism or structural anomalies). Girls with Y chromosomal content, minor X deletions with marginal impact on fertility, active HIV, hepatitis B or hepatitis C infection, and/or an absolute contra indication for surgery, anaesthesia or future pregnancy will be excluded. INTERVENTIONS Ovarian cortical tissue will be harvested by performing a unilateral oophorectomy via laparoscopic approach. Ovarian cortex fragments will be prepared and cryopreserved. One fragment per patient will be used to determine follicular density by conventional histology, and to perform fluorescence in situ hybridisation analysis of ovarian cells. Routine chromosome analysis will be performed on both lymphocytes and buccal cells. A blood sample will be taken for hormonal analysis and all subjects will undergo a transabdominal ultrasound to determine the uterine and ovarian size. Patient characteristics, pregnancy rates and pregnancy outcomes will be collected from the patient's medical record. ETHICS AND DISSEMINATION The study protocol has been approved by the Central Committee on Research Involving Human Subjects in November 2017 (CCMO NL57738.000.16). TRIAL REGISTRATION NUMBER NCT03381300.
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Affiliation(s)
- Myra Schleedoorn
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | | | - Didi Braat
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Ina Beerendonk
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Ron van Golde
- Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ron Peek
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
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22
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Ciccarone M, Hohaus S, Pulsoni A, Cavaceppi P, Franzò S, Fabbri R, Cudillo L, Battistini R, Di Rocco A, Annibali O, Cox MC, Provenzano I, Abruzzese E, Renzi D, Tesei C, Anticoli Borza P, Cuccaro A, Andriani A, D'Elia GM, Facchiano A, Marchetti P, Cantonetti M. Preliminary results of a counselling programme for fertility preservation in female cancer patients: The experience of the GEMME DORMIENTI network. Eur J Cancer Care (Engl) 2019; 29:e13174. [PMID: 31571303 DOI: 10.1111/ecc.13174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a population of patients referred for fertility preservation (FP), how to efficiently provide FP care, and how FP care changed over time. METHODS This longitudinal observational study enrolled 281 female cancer patients referred between 2013 and 2016 to the non-profit organisation Gemme Dormienti ONLUS (GD) for FP care. All patients underwent the same battery of instrumental and laboratory diagnostic tests. GnRHa therapy was started at least seven days before CTh treatment. RESULTS From 2013 to 2016, we observed a progressive increase in the number of patients referred for FP care. Out of 251 eligible patients, 135 patients were treated with GnRHa only, and 72 patients underwent GnRHa therapy and cryopreservation. The median time from GD referral to oocyte and ovarian tissue cryopreservation was 11 and 5 days respectively. Tissue cryopreservation requests increased during our study period (from four cases in 2013 to 17 cases in 2016). During follow-up, 17β-estradiol and FSH levels were significantly increased (p < .0001), and AMH levels were significantly decreased (p < .0001). CONCLUSION The rapid increase in the number of patients who requested FP care and in the complexity of FP procedures overtime reflects the need to improve quality of life for cancer patients.
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Affiliation(s)
- Mariavita Ciccarone
- Department of Gynaecology, San Carlo di Nancy Hospital, Rome, Italy.,Gemme Dormienti Association ONLUS, Rome, Italy
| | - Stefan Hohaus
- Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Pulsoni
- Department of Cellular Biotechnology and Haematology, Sapienza University, Rome, Italy
| | | | | | - Raffaella Fabbri
- Gynaecology and Physiopathology of Human Reproduction Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Laura Cudillo
- Haematology and Stem Cell Transplant Unit, Tor Vergata University, Roma, Italy
| | - Roberta Battistini
- A.O. San Camillo Forlanini U.O.C. Ematologia e Trapianti CSE, Rome, Italy
| | - Alice Di Rocco
- Department of Cellular Biotechnology and Haematology, Sapienza University, Rome, Italy
| | - Ombretta Annibali
- UOC Haematology Stem Cell Transplantation, University Campus Bio Medico, Rome, Italy
| | - Maria Christina Cox
- Haematology Unit, Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | - Ida Provenzano
- UOC Oncoematologia Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Daniela Renzi
- Haematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Annarosa Cuccaro
- Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Andriani
- UOSD di Ematologia, Rome, Italy.,UOC di Ematologia, Osp. F. Spaziani, ASL Frosinone, Rome, Italy
| | - Gianna Maria D'Elia
- Department of Cellular Biotechnology and Haematology, Sapienza University, Rome, Italy
| | | | - Paolo Marchetti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Maria Cantonetti
- UOC Oncoematologia Fondazione Policlinico Tor Vergata, Rome, Italy
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23
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Seay J, Hicks A, Markham MJ, Schlumbrecht M, Bowman‐Curci M, Woodard J, Duarte LF, Quinn GP, Schabath MB. Web‐based LGBT cultural competency training intervention for oncologists: Pilot study results. Cancer 2019; 126:112-120. [DOI: 10.1002/cncr.32491] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Julia Seay
- Sylvester Comprehensive Cancer Center Miami Florida
| | - Amanda Hicks
- University of Florida Health Cancer Center Gainesville Florida
| | | | | | | | | | - Luisa F. Duarte
- H. Lee Moffitt Cancer Center & Research Institute Tampa Florida
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24
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Farge D, Le Maignan C, Doucet L, Frere C. Women, thrombosis, and cancer. Thromb Res 2019; 181 Suppl 1:S47-S53. [DOI: 10.1016/s0049-3848(19)30367-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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26
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Poorvu PD, Frazier AL, Feraco AM, Manley PE, Ginsburg ES, Laufer MR, LaCasce AS, Diller LR, Partridge AH. Cancer Treatment-Related Infertility: A Critical Review of the Evidence. JNCI Cancer Spectr 2019; 3:pkz008. [PMID: 31360893 PMCID: PMC6649805 DOI: 10.1093/jncics/pkz008] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/08/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
Abstract
Cancer treatments may compromise the fertility of children, adolescents, and young adults, and treatment-related infertility represents an important survivorship issue that should be addressed at diagnosis and in follow-up to ensure optimal decision-making, including consideration of pursuing fertility preservation. Risk of infertility varies substantially with patient and treatment factors. The ability to accurately assess fertility risk for many patients is hampered by limitations of the current literature, including heterogeneity in patient populations, treatments, and outcome measures. In this article, we review and synthesize the available data to estimate fertility risks from modern cancer treatments for both children and adult cancer survivors to enable clinicians to counsel patients about future fertility.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann H Partridge
- Correspondence to: Ann H. Partridge, MD, MPH, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215-5450 (e-mail: .)
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27
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Datta SS, Saha T, Ojha A, Das A, Daruvala R, Reghu KS, Achari R. What do you need to learn in paediatric psycho-oncology? Ecancermedicalscience 2019; 13:916. [PMID: 31123499 PMCID: PMC6467458 DOI: 10.3332/ecancer.2019.916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 11/29/2022] Open
Abstract
Paediatric psycho-oncology is an evolving speciality and is increasingly being recognised as an essential component in children's cancer care. Modern paediatric oncology services aspire to integrate physical care with psycho-social care and build capacity within clinical teams to address the emotional needs of parents and children side by side with other aspects of medical care. This article discusses the unique challenges of paediatric psycho-oncology and common situations where psychological assessment and management of children and young people with cancer become especially important. The authors propose a tiered structure of training. Providing empathic evidence-based psycho-social care is 'everyone's business' in paediatric oncology and not merely that of mental health professionals. However, there are times when a more specialist intervention by a paediatric liaison psychiatrist and/or a clinical psychologist is needed for optimum outcome. Learning interviewing techniques suitable for children and adolescents should be a core part of the training in paediatric psycho-oncology. Professionals should be encouraged to reflect on their own emotional wellbeing, which in turn will provide a stable foundation of emotionally matured care to children, young people and their families.
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Affiliation(s)
- Soumitra Shankar Datta
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
- EGA UCL Institute for Women’s Health, University College London, London WC1E 6BT, UK
| | - Tania Saha
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
| | - Aparupa Ojha
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India
| | - Anirban Das
- Department of Paediatric Oncology, Tata Medical Centre, Kolkata 700160,, India
| | - Rhea Daruvala
- Department of Paediatric Haematology, Oncology and Bone Marrow Transplant, Mazumdar Shaw Cancer Centre, Narayana Health City, Bangalore 560099, India
| | | | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata 700160, India
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28
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Farge D, Le Maignan C, Doucet L, Frere C. WITHDRAWN: Women, thrombosis, and cancer. Thromb Res 2019. [DOI: 10.1016/j.thromres.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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29
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Hayawi LM, Graham ID, Tugwell P, Yousef Abdelrazeq S. Screening for osteoporosis: A systematic assessment of the quality and content of clinical practice guidelines, using the AGREE II instrument and the IOM Standards for Trustworthy Guidelines. PLoS One 2018; 13:e0208251. [PMID: 30521556 PMCID: PMC6283636 DOI: 10.1371/journal.pone.0208251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Numerous clinical practice guidelines (CPGs) are published to guide management of osteoporosis. Little is known about their quality or how recommendations have changed over time. OBJECTIVE To systematically assess the quality and content of the guidelines on screening for osteoporosis, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool, and the Institute of Medicine (IOM) standards for trustworthy guidelines. METHODS We conducted a systematic search for osteoporosis CPGs published between 2002-2016, using multiple databases and guideline websites. Two reviewers appraised the quality of eligible CPGs using the AGREE II. High quality CPGs were considered if they scored ≥ 60 in four or more domains including the domain for rigor of development. Non-parametric tests were used to test for the change of quality over time. One reviewer assessed the guidelines with IOM standards. We summarized the different evidence grading systems and extracted and compared the recommendations. RESULTS A total of 33 CPGs were identified. The mean scores for AGREE II differed by domain (range: 42% to 71%). CPGs scored higher on domains for clarity of presentation, scope and purpose, and rigor of development. CPGs scored lower on domains for stakeholder involvement, editorial independence and applicability. Assessment of CPGs by IOM standards showed that CPGs scored better on standards for systematic review, establishing evidence foundation and rating strength of recommendation, articulation of recommendation, and establishing transparency. While scored lower on standards for updating, external review, and the development group composition. There was no difference in AGREE II and IOM defined guidelines' quality before and after the introduction of the two tools (P values >0.05). The IOM identified four more guidelines as high quality compared to the AGREE II. Examining these additional guidelines indicated that the two tools may give conflicting results especially for the rigor of development domain. Recommendations in certain areas showed substantial differences between guidelines. CONCLUSION Osteoporosis screening CPGs are of variable quality, and their recommendations often differ. Guideline quality as measured by AGREE II and IOM standards has not improved overtime. Guideline developers should work together to improve the quality and consistency of recommendations to improve the likelihood that their guidelines will be used in practice.
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Affiliation(s)
- Lamia M. Hayawi
- Pallium Canada, Ottawa, ON, Canada
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, Queen’s University, Kingston, ON, Canada
| | - Peter Tugwell
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Centre for Global Health, University of Ottawa, Ottawa, ON, Canada
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Salarvand S, Hemati S, Adibi P, Taleghani F. Appraising of the Clinical Practice Guidelines Quality in the Non-Pharmacological Management of Chemotherapy-Induced Febrile Neutropenia; A Review. Asian Pac J Cancer Prev 2018; 19:2701-2707. [PMID: 30360594 PMCID: PMC6291058 DOI: 10.22034/apjcp.2018.19.10.2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Febrile neutropenia is a common and serious chemotherapy side effect, is associated with increased mortality, morbidity, and treatment expenditures. Several CPGs (Clinical practice guidelines) have been released for managing chemotherapy-induced febrile neutropenia. The aim of this study is Appraisal of the clinical practice Guidelines quality in the management of chemotherapy-induced febrile neutropenia. Methods: A review study with a systematic search of the present CPGs for the management of chemotherapy-induced febrile neutropenia. After screening the CPGs based on eligibility criteria, three CPGs were selected and 5 independent reviewers appraised them for methodological quality by using the AGREE II Instrument. Results: Three CPGs were included; all of them were evidence-based guidelines. The clarity of presentation domain scored the highest and the applicability domain has the lowest score among all domains of AGREE instrument and the rest of domains scored as descending respectively; Scope and purpose, stakeholder involvement, editorial independence, rigor of development. In general, the intra-class correlation coefficient (ICC) scores of all domains were very good according to the Landis and Koch’s scale, except the Applicability domain scored as substantial. Conclusions: This study showed the quality of appraised CPGs. Three domains of these CPGs based on the AGREE instrument scored less than other domains and were in relatively unfavorable status: applicability, rigor of development, editorial independence. Given the importance of these domains in guideline implementation, it is necessary to take actions for reducing these defects.
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Affiliation(s)
- Shahin Salarvand
- Social Determinant Health Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran. Taleghani@ nm.mui.ac.ir
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PanCareLIFE: The scientific basis for a European project to improve long-term care regarding fertility, ototoxicity and health-related quality of life after cancer occurring among children and adolescents. Eur J Cancer 2018; 103:227-237. [PMID: 30273888 DOI: 10.1016/j.ejca.2018.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022]
Abstract
AIMS Survival after cancer diagnosed during childhood or adolescence continues to improve with new treatments and supportive therapies. Optimal long-term care requires that risks to vulnerable organs are clearly defined and translated into guidelines that are implemented into practice. PanCareLIFE is a pan-European consortium that addresses survivorship issues comprising fertility, hearing impairment and quality of life. This article describes the scientific basis of PanCareLIFE's studies. METHODS PanCareLIFE involves 17 partner institutions from eight European countries, with additional 11 data providers from five other countries. Study designs and methods include molecular genetic, cohort and case-control studies, a longitudinal study and an intervention study. Ethics and data protection issues have been taken into account from the beginning. RESULTS PanCareLIFE will investigate the way that treatment impairs female fertility, by evaluating anti-Müllerian hormone levels and the underlying genetic susceptibility to loss of fertility. For our fertility studies, more than 6000 survivors have completed questionnaires, more than 1500 provided serum samples and more than 400 case-control triads have been identified. Fertility preservation guidelines for boys and girls will be developed. More than 2000 survivors have contributed audiograms for the ototoxicity study. Almost 1000 samples were sent for genetic analysis related to ototoxicity and gonadal reserve. The SF-36 questionnaire will measure quality of life in more than 10,000 survivors. CONCLUSIONS The large number of subjects enrolled in PanCareLIFE and the detailed information accumulated will allow in-depth evaluation of important outcomes. Fertility preservation guidelines will help patients and their families make informed decisions and contribute to their long-term well-being.
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Salarvand S, Hemati S, Adibi P, Taleghani F. The quality of guidelines in non-pharmacological prevention and management of chemotherapy-induced neuropathy: A review. Oncol Rev 2018; 12:359. [PMID: 30464808 PMCID: PMC6207849 DOI: 10.4081/oncol.2018.359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy is a common adverse effect occurring in patients undergoing neurotoxic chemotherapy. However, there is no FDA-approved treatment option for it. Given the importance of clinical practice guidelines in this area, this study aimed to determine the methodological quality of extant CIPN guidelines. The study was done as part of the adaptation process of CIPN related CPGs at Isfahan University of Medical Sciences, Iran. A systematic search of published CPGs about chemotherapy-induced CIPN in which the AGREE II instrument was applied for appraising CPGs of CIPN was performed. In general, amongst all of the AGREE II Instrument’s domains in the evaluated CPGs, the clarity of presentation and stakeholder involvement domains took favorable scores; and other domains obtained unfavorable and relatively favorable scores. The quality of cancer therapy-induced neuropathy CPGs needs to be improved and designing high-quality CPGs must be considered.
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Affiliation(s)
- Shahin Salarvand
- Social Determinant Health Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad
| | - Simin Hemati
- Radiation oncology department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan
| | - Payman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Timing Embryo Preservation for a Patient with High-Risk Newly Diagnosed Acute Myeloid Leukemia. Case Rep Hematol 2018; 2018:9807047. [PMID: 29862097 PMCID: PMC5971287 DOI: 10.1155/2018/9807047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 11/18/2022] Open
Abstract
Great strides have been made in the treatment of acute myeloid leukemia (AML) resulting in increased number of survivors over all age groups, but especially in patients of reproductive age. Given the gonadotoxicity of high-dose induction chemotherapy and subsequent allogeneic stem cell transplant, it is paramount that fertility preservation options are discussed and explored at the time of diagnosis as fertility preservation has been associated with greater quality of life in survivors. Starting the conversation early is especially important for female patients given the time needed for all currently available fertility preservation techniques. Furthermore, due to a lack of current guidelines for the optimal timing of treatment, patients often encounter difficulties trying to balance life-saving treatment and fertility preservation. We present a case of female patient of reproductive age diagnosed with AML who opted for ovarian stimulation, oocyte retrieval, and subsequent IVF following a cycle of induction chemotherapy with satisfactory results for both embryo generation and disease treatment.
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34
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Baysal Ö, Hamilton JAM, Hamilton CJCM, Braat DDM, Beerendonk CCM, Nelen WLDM. Clinical practice guidelines for fertility preservation in young women undergoing gonadotoxic treatment: an overview and critical appraisal of methodological quality and content. Reprod Biomed Online 2018; 37:60-70. [PMID: 29709394 DOI: 10.1016/j.rbmo.2018.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 12/21/2022]
Abstract
RESEARCH QUESTION What is the methodological quality and content of internationally available clinical practice guidelines (CPGs) on fertility preservation (FP) care in adult women? DESIGN Internationally available CPGs on FP care in adult women were identified after conducting an extensive literature search and consulting (inter)national key experts. The methodological quality of the CPGs was appraised by an (inter)national panel of experts using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. The content of the best CPGs, scoring ≥60% for the domain 'Rigour of development' of the AGREE II instrument, was extracted and categorized according to their topic. RESULTS Thirty of the 1808 documents found were included. After consulting (inter)national key experts, 30 CPGs were included, six of which scored ≥60% for their 'Rigour of development'. The number of FP-related topics discussed by these six CPGs ranged from 4 to 12. The number of recommendations provided by the CPGs on these topics varied. The number of topics to which ≥5 recommendations were dedicated ranged from 0 to 4 between CPGs. CONCLUSION CPGs on the subject of FP care are available, but there is room for improvement in quality and content. Although written for use in daily practice, the CPGs can also be used to develop quality indicators to monitor the quality of current FP care or to evaluate future improvement initiatives.
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Affiliation(s)
- Özlem Baysal
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands.
| | - Jozefien A M Hamilton
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Carl J C M Hamilton
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, 5200 ME, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
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Fertility preservation for men with testicular cancer: Is sperm cryopreservation cost effective in the era of assisted reproductive technology? Urol Oncol 2018; 36:92.e1-92.e9. [DOI: 10.1016/j.urolonc.2017.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
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36
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Gertosio C, Magistrali M, Musso P, Meazza C, Bozzola M. Fertility Preservation in Pediatric Oncology Patients: New Perspectives. J Adolesc Young Adult Oncol 2018; 7:263-269. [PMID: 29346023 DOI: 10.1089/jayao.2017.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, advances in antineoplastic treatment led to a significant increase in the survival of patients with childhood cancer. In Europe and the United States, 82% of children, adolescents, and young adults survive 5 years from the cancer diagnosis and the majority achieves long-term survival into adulthood. The impact of cancer therapy on fertility is related to the age of the patient and to the duration, dose/intensity, and type of treatment. Exposure to chemotherapy or to radiation to gonads or pituitary brings long-term complications of cancer-directed therapies that include effects on reproductive capacity. Different methods to preserve fertility can be offered. In prepubertal women, ovarian tissue freezing, in vitro maturation, and surgical movement of ovaries outside the field of irradiation are still experimental. In pubertal and postpubertal women, oocyte-embryo freezing is an established option. In men, the options are sperm cryopreservation, gonadal transposition, and testicular tissue or spermatogonial cryopreservation and reimplantation. Fertility risks and provision of strategies to minimize cancer treatment impact fertility include discussion of the tail of the option before cancer treatment. Having to make a decision in a limited time, while still coming to terms with a potentially life-threatening diagnosis, can cause patients to feel overwhelmed. To date, there are no uniform guidelines on how to approach this problem, so it is important to be aware of it for proper clinical practice.
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Affiliation(s)
- Chiara Gertosio
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mariasole Magistrali
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Paola Musso
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Cristina Meazza
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Mauro Bozzola
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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37
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Srikanthan A, Amir E, Bedard P, Giuliani M, Hodgson D, Laframboise S, Prica A, Yee K, Greenblatt E, Lewin J, Gupta A. Fertility preservation in post-pubescent female cancer patients: A practical guideline for clinicians. Mol Clin Oncol 2017; 8:153-158. [PMID: 29387409 DOI: 10.3892/mco.2017.1486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/30/2017] [Indexed: 11/06/2022] Open
Abstract
Increasing accessibility of fertility preservation (FP) options has permitted women to retain fertility following anticancer therapies. Several published guidelines have made recommendations for FP however their implementation into practice is currently unknown. In this review, we aim to provide oncology clinicians practical information about FP options for post-pubescent female cancer patients and recommendations for care delivery in order to answer preliminary questions and help triage whether FP referral is appropriate. Herein, we present a resource for oncology providers to guide them with FP discussions. Key points that are discussed in this critical review include: i) All cancer patients beginning a new plan of care should be informed of potential fertility risk. ii) If a woman requests further information on FP interventions, referral to a FP clinic should be made. iii) Given the evolving technologies in this area, patients should be informed of those which are proven and unproven, with oocyte and embryo preservation recognized as standard practice. iv) Random start (independent of menstrual cycle day) techniques are available to minimize oncologic treatment delays. v) Specific protocols for ovarian stimulation may be center-specific. vi) There is unlikely an increased cancer recurrence risk as a result of stimulation protocols in women with hormone-sensitive cancers. vii) Lastly, given the absence of consensus in the literature, routine use of GnRH analogs is not recommended for all cancer patients, however may be considered in select cases, such as high-risk women in whom definitive FP is not possible or feasible.
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Affiliation(s)
- Amirrtha Srikanthan
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Philippe Bedard
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - David Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Stephanie Laframboise
- Department of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Karen Yee
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Ellen Greenblatt
- Mount Sinai Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Toronto, ON M5T 2Z5, Canada
| | - Jeremy Lewin
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Abha Gupta
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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38
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Stachs A, Hartmann S, Gerber B. Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies. Geburtshilfe Frauenheilkd 2017; 77:861-869. [PMID: 28845050 DOI: 10.1055/s-0043-116222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 12/17/2022] Open
Abstract
Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies.
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Affiliation(s)
| | | | - Bernd Gerber
- Universitätsfrauenklinik Rostock, Rostock, Germany
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39
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Romao RLP, Lorenzo AJ. Fertility preservation options for children and adolescents with cancer. Can Urol Assoc J 2017; 11:S97-S102. [PMID: 28265333 DOI: 10.5489/cuaj.4410] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cancer in children and adolescents has seen a stark rise in survival rates in the last decades; overall survival in excess of 80% can be reasonably expected for many newly diagnosed patients with malignancies in this age group. Survivorship has unfolded several specific issues faced by these patients, including fertility concerns. Hence, fertility preservation efforts have been discussed and undertaken with increased frequency. METHODS In this article, the authors provide a broad overview of the current recommendations surrounding fertility preservation in this patient population. Reasons to offer fertility preservation, target groups for interventions, and methods available based on age group and gender are discussed in detail. RESULTS The medical literature and patient advocates strongly support a discussion about fertility preservation at the time of diagnosis; the risk of infertility is real and parents and families wish to be informed about it. In postpubertal males, sperm-banking is relatively straightforward and should be attempted by most newly diagnosed patients, ideally before commencement of treatment. Cryopreservation of testicular tissue in higher-risk prepubertal males is feasible, but still experimental. Female fertility preservation is more complex, requires more invasive procedures, and can delay initiation of treatment due to the requirement for hormone stimulation of follicles prior to harvesting. CONCLUSIONS Oncofertility initiatives in children and youth are still in their early days and will continue to expand; urologists should be prepared to offer counselling and interventions when appropriate to this growing vulnerable population.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Pediatric Urology and Pediatric General Surgery, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON, Canada
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40
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Vu JV, Llarena NC, Estevez SL, Moravek MB, Jeruss JS. Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients. J Surg Oncol 2016; 115:116-121. [PMID: 27966219 DOI: 10.1002/jso.24418] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. METHODS An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007-2012, after program initiation. The study included women <45, stages 0-III, diagnosed before (n = 278) and after (n = 515) program initiation. RESULTS Demographics for the cohorts were similar. Fertility discussions (P < 0.0001), patients interested in maintaining fertility at diagnosis (P = 0.0041), referrals to reproductive endocrinologists (P < 0.0001), appointments (P < 0.0001), and fertility preservation procedures (P < 0.0183) increased significantly after programmatic implementation. CONCLUSIONS An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. J. Surg. Oncol. 2017;115:116-121. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Natalia C Llarena
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Jacqueline S Jeruss
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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41
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Muñoz M, Santaballa A, Seguí MA, Beato C, de la Cruz S, Espinosa J, Fonseca PJ, Perez J, Quintanar T, Blasco A. SEOM Clinical Guideline of fertility preservation and reproduction in cancer patients (2016). Clin Transl Oncol 2016; 18:1229-1236. [PMID: 27896641 PMCID: PMC5138251 DOI: 10.1007/s12094-016-1587-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022]
Abstract
Chemotherapy and radiotherapy often result in reduced fertility in cancer patients. With increasing survival rates, fertility is an important quality-of-life concern for many young cancer patients. Around 70–75% of young cancer survivors are interested in parenthood but the numbers of patients who access fertility preservation techniques prior to treatment are significantly lower. Moreover, despite existing guidelines, healthcare professionals do not address fertility preservation issues adequately. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to cancer treatment.
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Affiliation(s)
- M Muñoz
- Servicio de Oncología Médica, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Hospital Clínic de Barcelona, Villarroel, 170-08036, Barcelona, Spain.
| | - A Santaballa
- Hospital Universitari I Politècnic la Fe, Valencia, Spain
| | - M A Seguí
- Corporació Sanitària Parc Taulì, Sabadell, Spain
| | - C Beato
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - S de la Cruz
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Espinosa
- Hospital General de Ciudad Real, Ciudad Real, Spain
| | - P J Fonseca
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Perez
- Hospital General Universitario de Elche y Vega Baja, Elche, Spain
| | - T Quintanar
- Hospital General Universitario de Elche y Vega Baja, Elche, Spain
| | - A Blasco
- Hospital General Universitario de Valencia, Valencia, Spain
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