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Duffy EA, Hooke MC, Landier W. Reflections on the Past Decade in Evidence-Based Practice Within the Children's Oncology Group. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:129-139. [PMID: 38437793 PMCID: PMC11145516 DOI: 10.1177/27527530231222827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Background: The Children's Oncology Group (COG) is the only National Cancer Institute-supported clinical trials organization focused exclusively on childhood and adolescent cancer research. The COG Nursing Discipline Committee has embedded the tenets of evidence-based practice (EBP) into clinical trials nursing in order to standardize the nursing care delivered to children enrolled on these trials. The COG nursing EBP initiative is aimed at developing evidence-based clinical resources and tools to provide guidance to clinicians regarding topics relevant to the provision of cancer treatment for patients enrolled on COG clinical trials from diagnosis through survivorship. A rigorous, evidence-based process designed to guide development of the evidence-based clinical tools and resources within the COG nursing discipline was developed and was implemented with the first nurse expert team beginning in 2012. Method: The standardized process included (a) selecting EBP projects and nursing expert teams (NETs), (b) providing leadership, mentoring, and championship for NETs; (c) approving clinical content developed through the NETs; and (d) providing guidance and oversight over planned dissemination of the COG EBP projects. Results: The COG Nursing EBP Subcommittee has developed 15 publications to date that include 90 authors. Eleven of these authors contributed to multiple publications. Discussion: On this 10th anniversary of the development of the EBP within the COG nursing discipline, we recognize its contributions to the professional growth of many of the discipline's members and to advances in nursing care for children enrolled in pediatric cancer clinical trials.
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Affiliation(s)
- Elizabeth A. Duffy
- Health Behavior and Biological Sciences, The University of Michigan School of Nursing
| | - Mary C. Hooke
- School of Nursing, University of Minnesota, Eden Prairie, Minnesota, USA
| | - Wendy Landier
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Zupanec S, Herriage T, Landier W. Children's Oncology Group 2023 blueprint: Nursing discipline. Pediatr Blood Cancer 2023; 70 Suppl 6:e30575. [PMID: 37470719 PMCID: PMC10655901 DOI: 10.1002/pbc.30575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
In contrast to other Children's Oncology Group (COG) committees, the COG nursing discipline is unique in that it provides the infrastructure necessary for nurses to support COG clinical trials and implements a research agenda aimed at scientific discovery. This hybrid focus of the discipline reflects the varied roles and expertise within pediatric oncology clinical trials nursing that encompass clinical care, leadership, and research. Nurses are broadly represented across COG disease, domain, and administrative committees, and are assigned to all clinically focused protocols. Equally important is the provision of clinical trials-specific education and training for nurses caring for patients on COG trials. Nurses involved in the discipline's evidence-based practice initiative have published a wide array of systematic reviews on topics of clinical importance to the discipline. Nurses also develop and lead research studies within COG, including stand-alone studies and aims embedded in disease/ treatment trials. Additionally, the nursing discipline is charged with responsibility for developing patient/family educational resources within COG. Looking to the future, the nursing discipline will continue to support COG clinical trials through a multifaceted approach, with a particular focus on patient-reported outcomes and health equity/disparities, and development of interventions to better understand and address illness-related distress in children with cancer.
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Affiliation(s)
- Sue Zupanec
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Wendy Landier
- University of Alabama at Birmingham, Birmingham, Alabama
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3
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Whiteside SL, Frias OJ, Clifford L, Schultz K, Erickson L, Caldwell M, Prebus O, Pruett M, Smith K. Oncofertility patient navigation: The frontlines of fertility and reproductive health care in cancer. Pediatr Blood Cancer 2023; 70 Suppl 5:e28810. [PMID: 37606939 DOI: 10.1002/pbc.28810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 08/23/2023]
Abstract
Oncofertility is an emerging field that incorporates diverse disciplines working together to care for oncology patients from birth to adulthood who are facing surgery, radiation therapy, or chemotherapy that may impact their fertility potential and reproductive function. Providing this care to newly diagnosed oncology patients in an expedited manner can be challenging. There is currently a paucity of published data about how this care is provided, training and education of individuals providing this care, and patient-reported outcomes related specifically to oncofertility care. The role of the oncofertility patient navigator is to bridge the institutional and disciplinary boundaries so oncology patients of all ages can receive timely information regarding fertility risk and preservation options at diagnosis and throughout survivorship care. The purpose of this paper is to define the role of the oncofertility patient navigator within diverse models of care and health care systems, and provide a framework for ongoing efforts to improve reproductive care for those affected by cancer in their years of child-bearing potential.
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Affiliation(s)
- Stacy L Whiteside
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio
| | - Olivia Jaworek Frias
- Division of Pediatric and Adolescent Gynecology, Comprehensive Fertility Care and Preservation Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lindsey Clifford
- Stead Family Children's Hospital and Holden Comprehensive Cancer Center Clinic, University of Iowa Health Care, Iowa City, Iowa
| | - Katie Schultz
- Department of Gynecology, Pediatric Fertility Preservation, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Erickson
- Fertility and Hormone Preservation and Restoration Program, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mary Caldwell
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Olivia Prebus
- Adolescent and Young Adult Oncology Program, Cook Children's Medical Center, Fort Worth, Texas
| | - Megan Pruett
- Division of Endocrinology and Diabetes, Aflac Cancer Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kristin Smith
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Northwestern Medicine, Chicago, Illinois
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4
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Chen L, Dong Z, Chen X. Fertility preservation in pediatric healthcare: a review. Front Endocrinol (Lausanne) 2023; 14:1147898. [PMID: 37206440 PMCID: PMC10189781 DOI: 10.3389/fendo.2023.1147898] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Survival rates for children and adolescents diagnosed with malignancy have been steadily increasing due to advances in oncology treatments. These treatments can have a toxic effect on the gonads. Currently, oocyte and sperm cryopreservation are recognized as well-established and successful strategies for fertility preservation for pubertal patients, while the use of gonadotropin-releasing hormone agonists for ovarian protection is controversial. For prepubertal girls, ovarian tissue cryopreservation is the sole option. However, the endocrinological and reproductive outcomes after ovarian tissue transplantation are highly heterogeneous. On the other hand, immature testicular tissue cryopreservation remains the only alternative for prepubertal boys, yet it is still experimental. Although there are several published guidelines for navigating fertility preservation for pediatric and adolescent patients as well as transgender populations, it is still restricted in clinical practice. This review aims to discuss the indications and clinical outcomes of fertility preservation. We also discuss the probably effective and efficient workflow to facilitate fertility preservation.
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Affiliation(s)
- Lin Chen
- Reproductive Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zirui Dong
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Xiaoyan Chen
- Maternal-Fetal Medicine Institute, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen University, Shenzhen, China
- The Fertility Preservation Research Center, Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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5
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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6
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Jiang M, Wang J, Yu R, Hu R, Li J. A narrative review on the research progress of gonadal function protection in children with cancer. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:374. [PMID: 35434006 PMCID: PMC9011244 DOI: 10.21037/atm-22-681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective The global incidence of malignant tumors in children (0-14 years) and adolescents (15-19 years) ranges between 95 per 1 million and 255 per 1 million, which seriously affects the survival of patients. In the past 30 years, with the application of comprehensive treatments (including surgery, chemotherapy, radiotherapy, and bone marrow transplantation), great progress has been made in the treatment of malignant tumors in children and adolescents. The 5-year survival rate now exceeds 80%, and most patients can smoothly enter adolescence or the reproductive period. However, due to the particular age of patients with malignant tumors in children and adolescents, treatment may cause abnormal growth of the patient's height, bones, and some vital organs (such as the pituitary gland and reproductive organs). Treatment may also cause abnormal secretion of growth hormones, thyroid hormones, and sex hormones. These complications seriously affect the quality of life of tumor patients. In the past ten years, countries have established long-term follow-up specifications for children with tumors. These programs have found that, in adulthood, 67% to 75% of children who survived having tumors have at least one treatment-related complication. Among patients receiving chemotherapy, gonadal dysfunction is the most common related endocrine dysfunction. Methods This paper reviews the literature on fertility protection services for cancer patients in foreign countries was conducted to provide a reference for developing gonadal protection services for cancer patients and for establishing consensus or guidelines on gonadal protection in China. Key Content and Findings In the treatment of childhood cancer, the assistance of reproductive technology can effectively reduce the occurrence of complications from treatment. Conclusions Therefore, minimizing the effects of radiotherapy and chemotherapy on the growth and endocrine of children and adolescents while treating tumors is a new challenge for oncologists.
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Affiliation(s)
- Mingyan Jiang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jialing Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ruixin Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ruolan Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jinrong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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7
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Mittal N, Langevin AM, Kyono W, Dickens DS, Grimes A, Salsman JM, Pollock BH, Roth M. Barriers to Pediatric Oncologist Enrollment of Adolescents and Young Adults on a Cross-Network National Clinical Trials Network Supportive Care Cancer Clinical Trial. J Adolesc Young Adult Oncol 2022; 11:117-121. [PMID: 33983848 PMCID: PMC8864435 DOI: 10.1089/jayao.2021.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Few studies have explored interventions to improve adolescent and young adult (AYA) cancer care delivery. While many AYAs receive cancer care at NCI Community Oncology Research Program (NCORP) sites, few enroll on clinical trials. Barriers and facilitators to pediatric oncologist activation of and enrollment on an AYA cross-network National Clinical Trials Network (NCTN) supportive care trial were assessed using a survey that was administered to 162 stakeholders representing all 47 children's oncology group (COG) institutions affiliated to an NCORP. Fifty-eight stakeholders participated representing 62% of all sites surveyed. Approximately half of participants (45%) were unaware of the trial. Seven sites had the study open and one enrolled a patient. Reasons for not opening and enrolling on the trial included limited research staff and resources, low anticipated accrual, and lower prioritization of the trial. Enrollment facilitators included having a local "AYA champion," improving communication between pediatric and medical oncology, and having site education on available AYA trials. Interventions focused on increasing site and provider awareness of AYA trials and decreasing local barriers to AYA enrollment are needed.
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Affiliation(s)
- Nupur Mittal
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois, USA.,Address correspondence to: Nupur Mittal, MD, Department of Pediatrics, Rush University Children's Hospital, 1725 West Harrison Street Suite 710, Chicago, IL 60605, USA
| | - Anne-Marie Langevin
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Wade Kyono
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - David S. Dickens
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Pediatrics, Holden Comprehensive Cancer, University of Iowa, Iowa City, Iowa, USA
| | - Allison Grimes
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brad H. Pollock
- Department of Public Health Sciences, Comprehensive Cancer Center, School of Medicine, University of California, Davis, Davis, California, USA
| | - Michael Roth
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ruan X, Cheng J, Du J, Jin F, Gu M, Li Y, Ju R, Wu Y, Wang H, Yang W, Cheng H, Li L, Bai W, Kong W, Yang X, Lv S, Wang Y, Yang Y, Xu X, Jiang L, Li Y, Mueck AO. Analysis of Fertility Preservation by Ovarian Tissue Cryopreservation in Pediatric Children in China. Front Endocrinol (Lausanne) 2022; 13:930786. [PMID: 35846295 PMCID: PMC9277002 DOI: 10.3389/fendo.2022.930786] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ovarian tissue cryopreservation (OTC) is the only method of fertility preservation (FP) in prepubertal girls, but the experience remains limited. This study investigates the effectiveness and feasibility of FP of OTC in children facing gonadotoxicity treatment in Chinese first ovarian tissue cryobank. PROCEDURE OTC and evaluation of 49 children ≤14 years old in the cryobank of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from July 2017 to May 19, 2022, were analyzed retrospectively. We compared children's general characteristics, follicle numbers, and hormone levels with and without chemotherapy before OTC. RESULTS The age of 49 children at the time of OTC was 7.55 (1-14) years old. There were 23 cases of hematological non-malignant diseases, eight cases of hematological malignant diseases, four cases of gynecological malignant tumors, one case of neurological malignant tumors, one case of bladder cancer, five cases of sarcoma, three cases of mucopolysaccharidosis, one case of metachromatic leukodystrophy, two cases of dermatomyositis, one case of Turner's syndrome. The median follicular count per 2-mm biopsy was 705. Age and AMH were not correlated (r = 0.084, P = 0.585). Age and follicle count per 2-mm biopsy was not correlated (r = -0.128, P = 0.403). Log10 (follicle count per 2-mm biopsy) and Log10 (AMH) were not correlated (r = -0.118, P = 0.456). Chemotherapy before OTC decreased AMH levels but had no significant effect on the number of follicles per 2-mm biopsy. CONCLUSIONS OTC is the only method to preserve the fertility of prepubertal girls, and it is safe and effective. Chemotherapy before OTC is not a contraindication to OTC.
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Affiliation(s)
- Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
- *Correspondence: Xiangyan Ruan,
| | - Jiaojiao Cheng
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Juan Du
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Fengyu Jin
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Muqing Gu
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yanglu Li
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Rui Ju
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yurui Wu
- Department of Thoracic Surgery and Surgical Oncology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Haiyan Cheng
- Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Weimin Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Shulan Lv
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yuejiao Wang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yu Yang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xin Xu
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Lingling Jiang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yanqiu Li
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Alfred O. Mueck
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Women’s Health, University of Tuebingen, University Women’s Hospital and Research Centre for Women’s Health, Tuebingen, Germany
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9
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Crespi C, Adams L, Gray TF, Azizoddin DR. An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2021; 48:491-505. [PMID: 34411081 DOI: 10.1188/21.onf.491-505] [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: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Adolescents and young adults (AYAs) with cancer commonly report future fertility as an important issue in care. Despite long-standing guidelines on fertility counseling and the trusting relationship between nurses and patients, little is known about the nurse's role in fertility preservation (FP) for AYAs with cancer. LITERATURE SEARCH The authors conducted a literature search of articles published through 2020 focused on nursing involvement in FP for AYAs with cancer. DATA EVALUATION 85 studies were identified. In total, 11 articles met inclusion criteria and were critically appraised in the review. SYNTHESIS Although well positioned to improve FP care among AYAs with cancer, nurses currently have a minimal role because of provider, institutional, and patient-related barriers. IMPLICATIONS FOR PRACTICE Interventions to enhance nurses' knowledge about FP, improvements in electronic health record documentation, and facilitation of institutional support are needed to support the nurse's role in FP for AYAs with cancer.
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10
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Linder LA. Contributions of Pediatric Oncology Nursing to Advance Care and Reduce Disparities Among Children and Adolescents with Cancer: Introduction. Semin Oncol Nurs 2021; 37:151165. [PMID: 34140191 DOI: 10.1016/j.soncn.2021.151165] [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: 10/21/2022]
Abstract
OBJECTIVE Highlight examples of pediatric oncology nursing's accomplishments during the past 2 decades with attention to specialized practice, patient/family education, research/evidence-based practice, and advocacy and how these efforts can be leveraged to reduce disparities in the cure and care of children and adolescents with cancer. DATA SOURCES Review of currently published literature, guidelines, and websites documenting pediatric oncology nursing's contributions. CONCLUSION Over the past 20 years, the collective work of pediatric oncology nurses across the world has improved the care of children with cancer and their families and brought attention to areas of disparities. IMPLICATIONS FOR NURSING PRACTICE Although work remains to reduce disparities, current evidence from nursing science and practice is available to address disparities and guide advocacy efforts for children and their families as well as the nurses who care for them.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City; Primary Children's Hospital, Salt Lake City, UT.
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11
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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: 85] [Impact Index Per Article: 28.3] [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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12
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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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13
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Eyni H, Ghorbani S, Nazari H, Hajialyani M, Razavi Bazaz S, Mohaqiq M, Ebrahimi Warkiani M, Sutherland DS. Advanced bioengineering of male germ stem cells to preserve fertility. J Tissue Eng 2021; 12:20417314211060590. [PMID: 34868541 PMCID: PMC8638075 DOI: 10.1177/20417314211060590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022] Open
Abstract
In modern life, several factors such as genetics, exposure to toxins, and aging have resulted in significant levels of male infertility, estimated to be approximately 18% worldwide. In response, substantial progress has been made to improve in vitro fertilization treatments (e.g. microsurgical testicular sperm extraction (m-TESE), intra-cytoplasmic sperm injection (ICSI), and round spermatid injection (ROSI)). Mimicking the structure of testicular natural extracellular matrices (ECM) outside of the body is one clear route toward complete in vitro spermatogenesis and male fertility preservation. Here, a new wave of technological innovations is underway applying regenerative medicine strategies to cell-tissue culture on natural or synthetic scaffolds supplemented with bioactive factors. The emergence of advanced bioengineered systems suggests new hope for male fertility preservation through development of functional male germ cells. To date, few studies aimed at in vitro spermatogenesis have resulted in relevant numbers of mature gametes. However, a substantial body of knowledge on conditions that are required to maintain and mature male germ cells in vitro is now in place. This review focuses on advanced bioengineering methods such as microfluidic systems, bio-fabricated scaffolds, and 3D organ culture applied to the germline for fertility preservation through in vitro spermatogenesis.
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Affiliation(s)
- Hossein Eyni
- Department of Anatomical Sciences,
School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sadegh Ghorbani
- Interdisciplinary Nanoscience Center
(iNANO), Aarhus University, Aarhus, Denmark
| | - Hojjatollah Nazari
- Research Center for Advanced
Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of
Medical Sciences, Tehran, Iran
| | - Marziyeh Hajialyani
- Pharmaceutical Sciences Research
Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah,
Iran
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering,
University of Technology Sydney, Sydney, NSW, Australia
| | - Mahdi Mohaqiq
- Institute of Regenerative Medicine,
School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | | | - Duncan S Sutherland
- Interdisciplinary Nanoscience Center
(iNANO), Aarhus University, Aarhus, Denmark
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14
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Affdal AO, Grynberg M, Hessissen L, Ravitsky V. Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists. BMC Med Ethics 2020; 21:25. [PMID: 32245465 PMCID: PMC7118810 DOI: 10.1186/s12910-020-00466-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a few options are open to post-pubertal patients, the only immediate option currently open to pre-pubertal girls is cryopreservation of ovarian tissue and subsequent transplantation. The aim of the study was to address a current gap in knowledge regarding the offer of fertility preservation by Ovarian Tissue Cryopreservation (OTC) for prepubescent girls with cancer, and to explore current practices and attitudes of Canadian, French and Moroccan pediatric heme oncologists. The comparative perspective is relevant since legal frameworks surrounding fertility preservation and funding offered by the healthcare system vary greatly. METHODS An online survey was sent to the 45 pediatric oncology centers in Canada, France and Morocco. RESULTS A total of 39 centers responded (86.6%). OTC is offered by almost all pediatric heme oncologists in France (98%), very few in Canada (5%), and none in Morocco (0%). For pediatric hematologists/oncologists who do not propose fertility preservation in Canada, the reasons are: the technique is still experimental (54%), it is not available locally (26%) and cost of the technique for the family (14%). 97% of Canadian and 100% of Moroccan pediatric hematologists/oncologists think OTC should be funded by the healthcare system as it is in France and in the province of Quebec in Canada. CONCLUSIONS The results of this study show tremendous diversity in the provision of OTC across countries, whereby its offer is correlated with legislation and funding. We argue that the current reality, in which this technology is often not offered to families, raises ethical issues related to justice and equity of access, as well as informed consent and future reproductive autonomy.
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Affiliation(s)
- Aliya Oulaya Affdal
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, Québec Canada
- Centre de Recherche en Santé Publique, Montreal, Québec Canada
| | - Michael Grynberg
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Beclere, Clamart, France; Université Paris Saclay, Clamart, France
| | - Laila Hessissen
- Pediatric Hematology and Oncology Center, Mohamed V University, Rabat, Morocco
| | - Vardit Ravitsky
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, Québec Canada
- Centre de Recherche en Santé Publique, Montreal, Québec Canada
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15
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Salama M, Ataman-Millhouse L, Sobral F, Terrado G, Scarella A, Bourlon MT, Adiga SK, Udupa KS, Mahajan N, Patil M, Venter C, Demetriou G, Quintana R, Rodriguez G, Quintana T, Viale L, Bonilla YAR, Noguera JAR, Velásquez JCV, Pineda JID, Aldecoa MDC, Javed M, Al Sufyan H, Daniels N, Ogunmokun AA, Woodruff TK. Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network. JCO Glob Oncol 2020; 6:369-374. [PMID: 35275747 PMCID: PMC9812505 DOI: 10.1200/go.22.00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network-Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.
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Affiliation(s)
- Mahmoud Salama
- Northwestern University, Chicago, IL,National Research Center, Cairo, Egypt
| | | | - Fabio Sobral
- Pregna Medicina Reproductiva, Buenos Aires,
Argentina
| | | | | | - Maria T. Bourlon
- Instituto Nacional de Ciencias Médicas y
Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Madhuri Patil
- Private Fertility and Endoscopy Clinic, Bangalore,
India
| | - Chris Venter
- Vitalab Fertility Centre, Johannesburg, South
Africa
| | | | | | | | | | | | - Yuly Andrea Remolina Bonilla
- Instituto Nacional de Ciencias Médicas y
Nutrición Salvador Zubirán, Mexico City, Mexico,Instituto Nacional de Cancerología, Bogota,
Colombia
| | | | | | | | | | - Murid Javed
- Thuriah Medical Center, Riyadh, Saudi Arabia
| | | | - Nonso Daniels
- The Oncology and Fertility Centres of Ekocorp, Eko
Hospitals, Lagos, Nigeria
| | | | - Teresa K. Woodruff
- Northwestern University, Chicago, IL,Teresa K. Woodruff, PhD, Northwestern University, 303 E Superior
St, Lurie 10-119, Chicago, IL 60611; Twitter: @teresakwoodruff; @oncofertility;
e-mail:
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16
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Salama M, Ataman-Millhouse L, Sobral F, Terrado G, Scarella A, Bourlon MT, Adiga SK, Udupa KS, Mahajan N, Patil M, Venter C, Demetriou G, Quintana R, Rodriguez G, Quintana T, Viale L, Bonilla YAR, Noguera JAR, Velásquez JCV, Pineda JID, Aldecoa MDC, Javed M, Al Sufyan H, Daniels N, Ogunmokun AA, Woodruff TK. Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network. JCO Glob Oncol 2020; 6:1800180. [PMID: 32259158 PMCID: PMC7853876 DOI: 10.1200/jgo.18.00180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network—Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.
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Affiliation(s)
- Mahmoud Salama
- Northwestern University, Chicago, IL.,National Research Center, Cairo, Egypt
| | | | - Fabio Sobral
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | | | | | - Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Madhuri Patil
- Private Fertility and Endoscopy Clinic, Bangalore, India
| | - Chris Venter
- Vitalab Fertility Centre, Johannesburg, South Africa
| | | | | | | | | | | | - Yuly Andrea Remolina Bonilla
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Instituto Nacional de Cancerología, Bogota, Colombia
| | | | | | | | | | - Murid Javed
- Thuriah Medical Center, Riyadh, Saudi Arabia
| | | | - Nonso Daniels
- The Oncology and Fertility Centres of Ekocorp, Eko Hospitals, Lagos, Nigeria
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17
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Lehmann V, Kutteh WH, Sparrow CK, Bjornard KL, Klosky JL. Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview. Support Care Cancer 2019; 28:3955-3964. [PMID: 31872295 DOI: 10.1007/s00520-019-05248-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/12/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Fertility-related services in pediatric oncology are increasing, but barriers to care remain and few structured programs are described in the literature. Therefore, the study objectives were (1) to characterize fertility-related services in a large pediatric oncology center and (2) to discuss recommendations for fertility-related services across the pediatric cancer continuum. METHODS Medical records of all cases referred to our Fertility Preservation Clinic within a 3-year period were reviewed, which included 292 patients/survivors with malignant disease. Approximately half (n = 152/292, 52.1%) were cancer patients referred prior to treatment (n = 92/152) or while on active therapy (n = 60/152). The other half (n = 140/292; 47.9%) were survivors who had completed treatment. RESULTS Referrals more than doubled over 3 years. Most patients referred before treatment were offered and opted for FP (72.8% attempted; 58.9% completed). More male than female patients opted for FP (77.6% vs. 22.4%), but completion rates were higher among females (93.3% vs. 76.9%). Rates of FP before treatment did not increase over time (p = .752). Many patients on-treatment were referred for infertility risk counseling, demonstrating information/support needs in this group. Referred survivors questioned their fertility post-treatment and completed fertility assessments, indicating intact fertility among few (~ 15%). CONCLUSIONS This review demonstrated the acceptance and increasing need for fertility-related services in pediatric oncology across the cancer continuum, including FP before treatment, counseling during treatment, and fertility assessment in survivorship. Based on our experiences, current recommendations are discussed and include standardized procedures, streamlined referrals, adequate communication/education (of providers and families), and meeting specific needs of young cancer patients/survivors.
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Affiliation(s)
- Vicky Lehmann
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, 38105, USA.
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - William H Kutteh
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, 38105, USA
- Fertility Associates of Memphis, 80 Humphreys Center Drive, Memphis, TN, 38120, USA
| | - Charlene K Sparrow
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, 38105, USA
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, 38105, USA
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN, 38105, USA
- The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, 5461 Meridian Mark Rd, Atlanta, GA, 30342, USA
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Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach. Ann Oncol 2019; 30:1760-1775. [PMID: 31418765 DOI: 10.1093/annonc/mdz284] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during, and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is essential to guarantee high standard of care.
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Affiliation(s)
- M Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA.
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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21
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Klosky JL, Wang F, Russell KM, Zhang H, Flynn JS, Huang L, Wasilewski-Masker K, Landier W, Leonard M, Albritton KH, Gupta AA, Casillas J, Colte P, Kutteh WH, Schover LR. Prevalence and Predictors of Sperm Banking in Adolescents Newly Diagnosed With Cancer: Examination of Adolescent, Parent, and Provider Factors Influencing Fertility Preservation Outcomes. J Clin Oncol 2017; 35:3830-3836. [PMID: 28976795 PMCID: PMC5707206 DOI: 10.1200/jco.2016.70.4767] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose To estimate the prevalence of sperm banking among adolescent males newly diagnosed with cancer and to identify factors associated with banking outcomes. Patients and Methods A prospective, single-group, observational study design was used to test the contribution of sociodemographic, medical, psychological/health belief, communication, and developmental factors to fertility preservation outcomes. At-risk adolescent males (N = 146; age 13.00 to 21.99 years; Tanner stage ≥ 3), their parents, and medical providers from eight leading pediatric oncology centers across the United States and Canada completed self-report questionnaires within 1 week of treatment initiation. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs for specified banking outcomes (collection attempt v no attempt and successful completion of banking v no banking). Results Among adolescents (mean age, 16.49 years; standard deviation, 2.02 years), 53.4% (78 of 146) made a collection attempt, with 43.8% (64 of 146) successfully banking sperm (82.1% of attempters). The overall attempt model revealed adolescent consultation with a fertility specialist (OR, 29.96; 95% CI, 2.48 to 361.41; P = .007), parent recommendation to bank (OR, 12.30; 95% CI, 2.01 to 75.94; P = .007), and higher Tanner stage (OR, 5.42; 95% CI, 1.75 to 16.78; P = .003) were associated with an increased likelihood of a collection attempt. Adolescent history of masturbation (OR, 5.99; 95% CI, 1.25 to 28.50; P = .025), banking self-efficacy (OR, 1.23; 95% CI, 1.05 to 1.45; P = .012), and parent (OR, 4.62; 95% CI, 1.46 to 14.73; P = .010) or medical team (OR, 4.26; 95% CI, 1.45 to 12.43; P = .008) recommendation to bank were associated with increased likelihood of sperm banking completion. Conclusion Although findings suggest that banking is underutilized, modifiable adolescent, parent, and provider factors associated with banking outcomes were identified and should be targeted in future intervention efforts.
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Affiliation(s)
- James L. Klosky
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Fang Wang
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Kathryn M. Russell
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Hui Zhang
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Jessica S. Flynn
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Lu Huang
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Karen Wasilewski-Masker
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Wendy Landier
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Marcia Leonard
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Karen H. Albritton
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Abha A. Gupta
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Jacqueline Casillas
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Paul Colte
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - William H. Kutteh
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
| | - Leslie R. Schover
- James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children’s Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children’s Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children’s Hospital, Salt Lake City, UT
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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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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P. Advances in fertility preservation of female patients with hematological malignancies. Expert Rev Hematol 2017; 10:951-960. [PMID: 28828900 DOI: 10.1080/17474086.2017.1371009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The most common forms of hematological malignancies that occur in female reproductive years are lymphoma and leukemia. Areas covered: Several aggressive gonadotoxic regimens such as alkylating chemotherapy and total body irradiation are used frequently in treatment of lymphoma and leukemia leading to subsequent iatrogenic premature ovarian failure and fertility loss. In such cases, female fertility preservation options should be offered in advance. Expert commentary: In order to preserve fertility of young women and girls with lymphoma and leukemia, several established, experimental, and debatable options can be offered before starting chemotherapy and radiotherapy. However, each of those female fertility preservation options has both advantages and disadvantages and may not be suitable for all patients. That is why a fertility preservation strategy should be individualized and tailored distinctively for each patient in order to be effective. Artificial human ovary is a novel experimental in vitro technology to produce mature oocytes that could be the safest option to preserve and restore fertility of young women and girls with hematological malignancies especially when other fertility preservation options are not feasible or contraindicated. Further research and studies are needed to improve the results of artificial human ovary and establish it in clinical practice.
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Affiliation(s)
- Mahmoud Salama
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Vladimir Isachenko
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Evgenia Isachenko
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Gohar Rahimi
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
| | - Peter Mallmann
- a Department of Gynecology and Obstetrics, Medical Faculty , University of Cologne , Cologne , Germany
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Hanselin MR, Roybal DL, Leininger TB. Ethics and Oncofertility: A Call for Religious Sensitivity. J Oncol Pract 2017; 13:e582-e589. [DOI: 10.1200/jop.2016.020487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines do not address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient’s faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today. We recommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient’s moral and religious preferences into the treatment plan. We encourage providers to be prepared to offer resources to patients who desire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources.
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Jia Y, Shi X, Xie Y, Xie X, Wang Y, Li S. Human umbilical cord stem cell conditioned medium versus serum-free culture medium in the treatment of cryopreserved human ovarian tissues in in-vitro culture: a randomized controlled trial. Stem Cell Res Ther 2017. [PMID: 28646900 PMCID: PMC5482969 DOI: 10.1186/s13287-017-0604-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To reduce young female fertility loss, the in-vitro culture of cryopreserved ovarian cortical tissues (OCTs) is considered an effective approach without delaying treatment and undergoing stimulation medicine. However, ischemic damage and follicular loss during the in-vitro culture of OCTs are major technical challenges. Human umbilical cord stem cells (HUMSCs) and their conditioned medium (HUMSC-CM) have been considered to be potential resources for regeneration medicine because they secrete cytokines and enhance cell survival and function. The aim of this study was to determine whether HUMSC-CM improves the development of frozen-thawed in-vitro cultured ovarian tissues compared with a serum-free culture medium (SF-CM). METHODS The thawed OCTs (n = 68) were cultivated in HUMSC-CM and SF-CM in vitro for 8 days, and the ovarian tissues were processed and analyzed by a classical histological evaluation. The microvessel density (MVD) and apotosis detection during in-vitro culture of OCTs were also performed. RESULTS A significant difference in the rate of morphologically normal primordial follicles in the HUMSC-CM group was observed compared to that in the SF-CM group (group C) from days 2 to 4 (day 2: group B 58.0 ± 2.45% vs group C 32.0 ± 5.83%, p = 0.002; day 3: group B 55.5 ± 4.20% vs group C 21.0 ± 9.80%, p = 0.048; day 4: group B 52.0 ± 4.08% vs group C 21.5 ± 8.19%, p = 0.019). The microvessel density (MVD) detection showed a time-dependent increase and peaked on day 4. There was a significant difference between groups B (49.33 ± 0.58) and C (24.33 ± 3.79) (p = 0.036). The percentage of apoptotic follicles in group B was lower than that in group C on day 1 (13.75 ± 2.50% vs 27.0 ± 10.10%, p = 0.003), day 5 (11.75 ± 1.50% vs 51.0 ± 10.5%, p = 0.019) and day 7 (15.0 ± 5.10% vs 46.5 ± 21.75%, p = 0.018). CONCLUSIONS These data have provided the first experimental evidence of the effect of HUMSC-CM on frozen-thawed OCTs in vitro. The results showed that the HUMSC-CM group provided a better protecting effect on the in-vitro culture of the cryopreserved OCTs compared to the SF-CM group.
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Affiliation(s)
- Yingxian Jia
- Division of Reproductive Medical Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaohan Shi
- Division of Reproductive Medical Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yidong Xie
- Division of Reproductive Medical Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaochuan Xie
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wang
- Division of Reproductive Medical Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shangwei Li
- Division of Reproductive Medical Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
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Salama M, Woodruff TK. Anticancer treatments and female fertility: clinical concerns and role of oncologists in oncofertility practice. Expert Rev Anticancer Ther 2017; 17:687-692. [PMID: 28537815 DOI: 10.1080/14737140.2017.1335199] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Anticancer treatments such as aggressive chemotherapy and radiotherapy have deleterious gonadotoxic side effects and are considered the most common causes of pathological and iatrogenic fertility loss in women. Areas covered: In order to preserve fertility of young women and girls with cancer, several established, experimental, and debatable options can be offered in the emerging field of oncofertility. This article reviews the effects of anticancer treatments on female fertility and discusses the current challenges and future directions of fertility preservation options that can be offered to the female patients with cancer. Expert commentary: Although promising, several medical, economic, social and legal barriers face oncofertility practice around the globe especially in underserved areas. To overcome such barriers, more effective solutions should be provided to spread awareness and enhance communication between patients, oncologists and gynecologists. Early referral by oncologists before initiation of chemotherapy and radiotherapy is an important key factor for success in female fertility preservation strategies.
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Affiliation(s)
- Mahmoud Salama
- a Department of Obstetrics and Gynecology, Medical Faculty , University of Cologne , Cologne , Germany
| | - Teresa K Woodruff
- b Department of Obstetrics and Gynecology, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
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27
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Petropanagos A. Testicular Tissue Cryopreservation and Ethical Considerations: A Scoping Review. JOURNAL OF BIOETHICAL INQUIRY 2017; 14:217-228. [PMID: 28353127 DOI: 10.1007/s11673-017-9781-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
Testicular tissue cryopreservation (TTCP) aims to preserve the future option of genetic reproduction for prepubescent cancer patients who are at risk of infertility as a result of their cancer therapies. This technology is experimental and currently only offered in the research context. As TTCP moves towards becoming more widely available, it is imperative that healthcare providers recognize the complex ethical issues surrounding this technology. This scoping review study identifies and assesses the range and depth of ethical concerns related to this testicular tissue cryopreservation technology. At present, no such scoping review of ethical concerns exists in the TTCP literature. The forty-three full-text articles included in this study yielded twenty-two different ethical considerations discussed in relation to TTCP. It was observed that these ethical considerations fit within a mainstream Principlism approach to bioethics. Accordingly, there are ethical gaps in the TTCP literature that can be identified with alternative moral lenses. In particular, it was found that ethical concerns related to context and relational aspects of identity were absent in nearly all ethical examinations of TTCP. Furthermore, only 9 per cent of articles reviewed in this study focused primarily on the ethics of TTCP, thus demonstrating a need for further in depth ethical analyses of this technology. The results of this study are important for supporting the ethical provision of TTCP and can contribute to policy and guideline development. The findings of this study demonstrate the need for greater depth and diversity in analyses of ethical considerations related to this technology.
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Affiliation(s)
- Angel Petropanagos
- Novel Tech Ethics, Faculty of Medicine, Dalhousie University, 1379 Seymour Street, PO BOX 15000, Halifax, NS, B3H 4R2, Canada.
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28
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Barlevy D, Elger BS, Wangmo T, Ravitsky V. Adolescent oncofertility discussions: Recommendations from a systematic literature review. AJOB Empir Bioeth 2017; 8:106-115. [PMID: 28949840 DOI: 10.1080/23294515.2017.1305006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Increasing cancer incidence and survivorship rates have made late-term effects, such as effects on fertility, a salient issue for adolescent cancer patients. While various barriers make it difficult for health care professionals to discuss oncofertility with adolescents and their parents, there are numerous reasons to hold such discussions, based on professional obligations and the ethical principles of respect for autonomy and beneficence. This systematic literature review presents and critically examines recommendations for adolescent oncofertility discussions. METHODS Conducted according to PRISMA guidelines, this systematic literature review includes English, French, and German articles published up until December 31, 2014. Articles were sought via a combination of search terms in four databases. RESULTS Eighty of 96 articles included in this review address recommendations for improving adolescent oncofertility discussions. These recommendations deal with how, when, what, and with whom professionals ought to have these discussions, as well as various systemic barriers and ways to address them. CONCLUSIONS Based upon the principles of beneficence, respect for autonomy, and justice, we endorse several recommendations for oncofertility discussions with adolescents and their parents, including having a specific professional on the health care team initiate these discussions with all newly diagnosed patients; regularly doing so before, during, and after treatment; allowing adolescents to decide for themselves whom they wish to include in such discussions; employing various forms of communication; obtaining both adolescent assent and parental consent for fertility preservation (FP) procedures, especially at each stage (e.g., procurement and use); properly educating and training professionals to discuss oncofertility; promoting interdisciplinary collaboration; creating and implementing guidelines and policies; and ensuring equity of access to FP.
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Affiliation(s)
- Dorit Barlevy
- a Institute for Biomedical Ethics , University of Basel
| | | | - Tenzin Wangmo
- a Institute for Biomedical Ethics , University of Basel
| | - Vardit Ravitsky
- b Bioethics Program, School of Public Health , University of Montreal
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29
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Abstract
Adult survivors of pediatric cancers are at substantial risk for infertility. Oncofertility is an emerging field in medicine that has focused on the fertility preservation of these patients. As the field continues to develop, there are several areas in which our practice has improved. However, several ethical concerns still exist involving beneficence, nonmaleficence, informed consent, adolescent assent, and posthumous use of reproductive tissues. Because the field is still developing, great disparities exist in available options depending on age, ability to pay, and geographic location. Such discrepancies in access may lead to health disparities in the adolescent patient population. As the science continues to make future fertility more feasible, the ethical questions will continue to be more complex. The purpose of this article is to review some of the developments regarding oncoferility and address future directions for research and inquiry in specific areas.
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30
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Stinson JN, Jibb LA, Greenberg M, Barrera M, Luca S, White ME, Gupta A. A Qualitative Study of the Impact of Cancer on Romantic Relationships, Sexual Relationships, and Fertility: Perspectives of Canadian Adolescents and Parents During and After Treatment. J Adolesc Young Adult Oncol 2016; 4:84-90. [PMID: 26812556 DOI: 10.1089/jayao.2014.0036] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We sought to gain insight into perspectives around core domains of adolescent development--romantic relationships, sexual relationships, and fertility--from the vantage point of Canadian adolescents and parents during and after cancer treatment. METHODS Twenty adolescents (12-17 years old at interview) and 20 parents (who may or may not have had an adolescent interviewed) participated in this study. Using a semistructured guide, adolescents and parents were interviewed separately. All interviews were audio-recorded and transcribed. Transcribed interview data were independently coded according to the study objectives by two trained analysts. Codes were organized into categories that reflected emerging themes. Discrepancies in coding were resolved through discussion with the lead investigator. RESULTS Qualitative analysis revealed main themes for adolescents and parents related to: (1) romantic relationships (opinions on the importance of dating in the context of cancer, expectations that cancer will impact future relationships, dating as a source of moral support, and limited opportunities to engage with partners); (2) sexual relationships (thoughts related to the impact of cancer on future sexual relationships); (3) fertility (initiating treatment as a primary concern and fear of infertility and perceived consequences); and (4) recommendations for care (access to knowledge and support through adolescent-friendly and accessible means). CONCLUSION Findings from this study highlight cancer-specific relationship and fertility issues faced by adolescents and provide important direction to the development of interventions that may ultimately improve the psychosocial health of adolescents during and after cancer treatment.
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Affiliation(s)
- Jennifer N Stinson
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada .,2 Department of Anesthesia and Pain Medicine, Hospital for Sick Children , Toronto, Ontario, Canada .,3 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada
| | - Lindsay A Jibb
- 3 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada .,4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,5 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada
| | - Mark Greenberg
- 4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,5 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Maru Barrera
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada .,4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Stephanie Luca
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada
| | | | - Abha Gupta
- 4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,8 Adolescent and Young Adult Program, Princess Margaret Cancer Centre , Toronto, Ontario, Canada
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31
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Johnson EK, Chen D, Gordon EJ, Rosoklija I, Holl JL, Finlayson C. Fertility-Related Care for Gender and Sex Diverse Individuals: A Provider Needs-Assessment Survey. Transgend Health 2016; 1:197-201. [PMID: 28861533 PMCID: PMC5549540 DOI: 10.1089/trgh.2016.0030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Twelve providers (eight institutions) participating in a Gender and Sex Diversity Fertility Working Group completed a survey assessing their hospital's transgender, disorders/differences of sex development (DSD), and fertility healthcare teams. Participants also prioritized the development of a: (1) Provider Assessment Tool (questionnaire assessing knowledge/feelings about future fertility), or (2) decision aid (DA). Healthcare team presence by institution: transgender (6/8; 75%), DSD (75%), and fertility preservation (75%). Two-thirds of providers reported that the DA was most needed. Respondents recommended the DA to: help manage complex information, have a take-home reference, and provide neutral information. Other identified resource needs included: fertility specialists in clinic and financial resources.
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Affiliation(s)
- Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane Chen
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elisa J Gordon
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jane L Holl
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney Finlayson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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32
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Abstract
Human ovary autotransplantation is a promising option for fertility preservation of young women and girls undergoing gonadotoxic treatments for cancer or some autoimmune diseases. Although experimental, it resulted in at least 42 healthy babies worldwide. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed for all relevant full-text articles published in English from 1 January 2000 to 01 October 2015 in PubMed to explore the latest clinical and research advances of human ovary autotransplantation. Human ovary autotransplantation involves ovarian tissue extraction, freezing/thawing, and transplantation back into the same patient. Three major forms of human ovary autotransplantation exist including (a) transplantation of cortical ovarian tissue, (b) transplantation of whole ovary, and (c) transplantation of ovarian follicles (artificial ovary). According to the recent guidelines, human ovary autotransplantation is still considered experimental; however, it has unique advantages in comparison to other options of female fertility preservation. Human ovary autotransplantation (i) does not need prior ovarian stimulation, (ii) allows immediate initiation of cancer therapy, (iii) can restore both endocrine and reproductive ovarian functions, and (iv) may be the only fertility preservation option suitable for prepubertal girls or for young women with estrogen-sensitive malignancies. As any other fertility preservation option, human ovary autotransplantation has both advantages and disadvantages and may not be feasible for all cases. The major challenges facing this option are how to avoid the risk of reintroducing malignant cells and how to prolong the lifespan of ovarian transplant as well as how to improve artificial ovary results.
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Affiliation(s)
- Mahmoud Salama
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 East Superior Street, Room 10-119, Chicago, IL 60611, USA
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33
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Ben-Aharon I, Abir R, Perl G, Stein J, Gilad G, Toledano H, Elitzur S, Avrahami G, Ben-Haroush A, Oron G, Freud E, Kravarusic D, Ben-Arush M, Herzel G, Yaniv I, Stemmer SM, Fisch B, Ash S. Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program. BMC Cancer 2016; 16:620. [PMID: 27506811 PMCID: PMC4979150 DOI: 10.1186/s12885-016-2584-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Current evidence indicates sub-optimal incidence of fertility preservation (FP) in eligible patients. We present herein our designated multidisciplinary program for FP in pediatric and adolescent population and present our data on FP in female patients. Methods Pediatric patients (age 0–18) who were candidate for highly gonadotoxic treatments were referred to FP program for a multidisciplinary discussion and gonadal risk-assessment followed by either oocyte cryopreservation or ovarian cryopreservation (OCP) for female patients, and sperm banking for male patients. The OCP protocol consists of aspiration of oocytes from small antral follicles and in-vitro maturation followed by cryopreservation, as well as ovarian tissue cryopreservation. Results The establishment of a designated FP program resulted in a significant increase in referral and subsequent FP procedures of all eligible patients. Sixty-two female patients were referred for FP discussion during a period of 36 months; 41 underwent OCP; 11 underwent oocyte cryopreservation and six were declined due to parental decision. The median age was 13.2y (range 18 months-18y). Thirty-two (51.6 %) were chemotherapy-naïve. Seventeen patients (27 %) had sarcoma, 16 patients (26 %) had acute leukemia. The mean number of mature oocytes that were eventually vitrified was significantly higher in chemotherapy-naïve patients compared with chemotherapy-exposed patients (mean 12 oocytes (1–42) versus 2 (0–7)). Conclusion Multidisciplinary programs that encompass experts of all relevant fields, skilled laboratory resources and a facilitated path appear to maximize the yield. We observed a considerable higher referral rates following launching a designated program and earlier OCP in chemo-naïve patients that culminated in a better fertility preservation procedure.
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Affiliation(s)
- Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - R Abir
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Stein
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Gilad
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Toledano
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Elitzur
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Avrahami
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Ben-Haroush
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Oron
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Freud
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kravarusic
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Ben-Arush
- Division of Pediatric Hematology Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - G Herzel
- Department of Pediatric Hematology Oncology, Ha'Emek Hospital, Afula, Israel
| | - I Yaniv
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Fisch
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Ash
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barlevy D, Wangmo T, Elger BS, Ravitsky V. Attitudes, Beliefs, and Trends Regarding Adolescent Oncofertility Discussions: A Systematic Literature Review. J Adolesc Young Adult Oncol 2016; 5:119-34. [DOI: 10.1089/jayao.2015.0055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Dorit Barlevy
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Vardit Ravitsky
- Bioethics Program, School of Public Health, University of Montreal, Montreal, Canada
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35
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Font-Gonzalez A, Mulder RL, Loeffen EAH, Byrne J, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Hudson MM, Kenney LB, Levine JM, Tissing WJE, van de Wetering MD, Kremer LCM. Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations. Cancer 2016; 122:2216-23. [PMID: 27175973 DOI: 10.1002/cncr.30047] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations. METHODS A systematic search in PubMed (January 2000-October 2014); guideline databases; and Web sites of oncology, pediatric, and fertility organizations was performed. Two reviewers evaluated the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). From high-quality CPGs, the authors evaluated concordant and discordant areas among the recommendations. RESULTS A total of 25 CPGs regarding fertility preservation were identified. The average AGREE II domain scores (scale of 0%-100%) varied from 15% on applicability to 100% on clarity of presentation. The authors considered 8 CPGs (32%) to be of high quality, which was defined as scores ≥60% in any 4 domains. Large variations in the recommendations of the high-quality CPGs were observed, with 87.2% and 88.6%, respectively, of discordant guideline areas among the fertility preservation recommendations for female and male patients with cancer. CONCLUSIONS Only approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors. Cancer 2016;122:2216-23. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Anna Font-Gonzalez
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Renée L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Melissa M Hudson
- Department of Pediatric Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa B Kenney
- Department of Pediatric Oncology, Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jennifer M Levine
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Wim J E Tissing
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marianne D van de Wetering
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
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36
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P. Updates in preserving reproductive potential of prepubertal girls with cancer: Systematic review. Crit Rev Oncol Hematol 2016; 103:10-21. [PMID: 27184425 DOI: 10.1016/j.critrevonc.2016.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/10/2016] [Accepted: 04/07/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION With increasing numbers of adult female survivors of childhood cancers due to advances in early diagnosis and treatment, the issue of preserving the reproductive potential of prepubertal girls undergoing gonadotoxic treatments has gained greater attention. METHODS According to PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English throughout the past 15 years to explore the significant updates in preserving the reproductive potential of prepubertal girls with cancer. RESULTS The two established fertility preservation options, embryo freezing and egg freezing, cannot be offered routinely to prepubertal girls as these options necessitate prior ovarian stimulation and subsequent mature oocytes retrieval that are contraindicated or infeasible before puberty. Therefore, the most suitable fertility preservation options to prepubertal girls are (1) ovarian tissue freezing and autotransplantation, (2) in vitro maturation, and (3) ovarian protection techniques. In this review, we discuss in detail those options as well as their success rates, advantages, disadvantages and future directions. We also suggest a new integrated strategy to preserve the reproductive potential of prepubertal girls with cancer. CONCLUSION Although experimental, ovarian tissue slow freezing and orthotopic autotransplantation may be the most feasible option to preserve the reproductive potential of prepubertal girls with cancer. However, this technique has two major and serious disadvantages: (1) the risk of reintroducing malignant cells, and (2) the relatively short lifespan of ovarian tissue transplants. Several medical and ethical considerations should be taken into account before applying this technique to prepubertal girls with cancer.
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Affiliation(s)
- Mahmoud Salama
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany; Department of Reproductive Medicine, Medical Division, National Research Center of Egypt, Egypt.
| | - Vladimir Isachenko
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany.
| | - Evgenia Isachenko
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany.
| | - Gohar Rahimi
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany.
| | - Peter Mallmann
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Germany.
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Pediatric Oncology Providers' Attitudes and Practice Patterns Regarding Fertility Preservation in Adolescent Male Cancer Patients. J Pediatr Hematol Oncol 2016; 38:118-22. [PMID: 26630536 PMCID: PMC4758901 DOI: 10.1097/mph.0000000000000488] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate pediatric oncology providers' attitudes toward fertility preservation (FP), their use of educational materials, their approach to FP discussion, and their FP knowledge specifically pertaining to adolescent males. METHODS A 40-item online survey was distributed to physicians, advanced practice nurses (APN), and nurses within pediatric oncology. RESULTS About 78.7% of physicians, 81.4% of APN, and 51.9% of nurses reported high levels of comfort in discussing FP options with adolescent males (P<0.05). Fifty-one percent of physicians and 54.2% of APN reported using educational materials, compared with 38.9% of nurses (P<0.05). Regarding knowledge of FP technologies, 48.7% of physicians, 52.5% of APN, and 81.1% of nurses reported being unfamiliar with intracytoplasmic sperm injection (P<0.05). An overwhelming majority (92.9%) of respondents reported having no formal training in discussing FP. Finally, 84.8% of respondents believed formal training on this issue would be useful to them. CONCLUSIONS This study illustrates an unmet need in the education of pediatric oncology providers, as knowledge gaps and discomfort are common themes reported by health care professionals within the context of adolescent male FP care. In addition, this study reveals a high level of receptiveness to FP training by these same providers.
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Hendershot E, Maloney AM, Fawcett S, Sarvanantham S, McMahon E, Gupta A, Mitchell L. Advanced practice nurses: Improving access to fertility preservation for oncology patients. Can Oncol Nurs J 2016; 26:40-45. [PMID: 31148620 DOI: 10.5737/236880762614045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cancer therapies such as chemotherapy, radiation therapy and surgery may place the future fertility of both children and young adults at risk. Oncofertility is a rapidly evolving area that involves increasing access to fertility preservation (FP) information and services. This manuscript aims to: a) highlight the fertility risks associated with cancer therapy and its psychosocial impact, b) describe FP options, c) discuss the unique challenges of FP in distinct cancer populations, and d) illustrate the pivotal role of APNs in oncofertility counselling and education.
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Affiliation(s)
- Eleanor Hendershot
- Nurse Practitioner, Pediatric Oncology, McMaster Children's Hospital, Hamilton, ON. (Corresponding author)
| | - Anne-Marie Maloney
- Nurse Practitioner, Pediatric Hematology/Oncology and Fertility Preservation Program, The Hospital for Sick Children, Toronto, ON.
| | - Sandy Fawcett
- Nurse Practitioner, Gattuso Rapid Diagnostic Breast Centre, Princess Margaret Cancer Centre, Toronto, ON.
| | - Sharmy Sarvanantham
- Nurse Practitioner, Gattuso Rapid Diagnostic Breast Centre, Princess Margaret Cancer Centre, Toronto, ON.
| | - Eileen McMahon
- Nurse Practitioner, Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Toronto, ON.
| | - Abha Gupta
- Medical Oncologist, The Hospital for Sick Children and Princess Margaret Cancer Centre, Toronto, ON. Co-Medical Director of the Fertility Preservation Program at The Hospital for Sick Children and Medical Director of the Adolescent and Young Adult Program at Princess Margaret Cancer Centre, Toronto, ON.
| | - Laura Mitchell
- Clinical Nurse Specialist, Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, ON.
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Assisted reproductive outcomes of male cancer survivors. J Cancer Surviv 2014; 9:208-14. [PMID: 25272983 DOI: 10.1007/s11764-014-0398-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of our study was to evaluate the reproductive outcome of male cancer survivors treated with intracytoplasmic sperm injection (ICSI) using cryopreserved sperm and compare it with the same treatment in non-cancer males. METHODS We retrospectively analyzed database derived from cancer and non-cancer patients undergoing sperm cryopreservation from August 2008 to August 2012 at a university-based center. We evaluated the reproductive outcome of those cancer and non-cancer patients that had frozen sperm and returned subsequently to the clinic for assisted reproduction. RESULTS We studied 272 males with cancer and 296 infertile males. The most prevalent types of cancer in our cohort were lymphoma (25.3 %), testicular cancer (19.2 %), leukemia (7.3 %), and other malignancies including sarcoma, gastrointestinal, and central nervous system malignancies (48.2 %). The use rate of cryopreserved sperm was 10.7 % for cancer patients and 30.7 % for non-cancer patients. The mean age of males with cancer who returned to the clinic for fertility treatment was 36.7 ± 6 years, and the diagnoses were testis cancer (43.4 %), lymphoma (36.9 %), leukemia (13 %), and other malignancies (6.7 %). Live birth rate of the cancer cohort was 62.1 %, which was higher than that of the normospermic non-cancer population (p < 0.0047). CONCLUSIONS The use rate of cryopreserved sperm from oncofertility preservation cases is at around 10 %. The live birth rate using assisted reproductive technologies among these patients is at least comparable to that of the non-cancer population. IMPLICATIONS FOR CANCER SURVIVORS To our knowledge, this was the first comparative study of male cancer survivors treated with ICSI using cryopreserved sperm, which were compared to non-cancer males undergoing the same treatment. Male fertility preservation is a highly valued service that should be strongly encouraged prior to beginning cytotoxic cancer treatment. These results can help healthcare professionals in oncology to improve the quality of counseling on fertility preservation when managing young men with newly diagnosed cancer that require gonadotoxic treatment.
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