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Pawłowski P, Ziętara KJ, Michalczyk J, Fryze M, Buchacz A, Zaucha-Prażmo A, Zawitkowska J, Torres A, Samardakiewicz M. Fertility Preservation in Children and Adolescents during Oncological Treatment-A Review of Healthcare System Factors and Attitudes of Patients and Their Caregivers. Cancers (Basel) 2023; 15:4393. [PMID: 37686669 PMCID: PMC10487203 DOI: 10.3390/cancers15174393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Oncofertility is any therapeutic intervention to safeguard the fertility of cancer patients. Anti-cancer therapies (chemotherapy, radiation therapy, etc.) entail the risk of reproductive disorders through cytotoxic effects on gamete-building cells, especially those not yet fully developed. This literature review analyzes the available data on securing fertility in pediatric and adolescent populations to identify the methods used and describe aspects related to financing, ethics, and the perspective of patients and their parents. Topics related to oncofertility in this age group are relatively niche, with few peer-reviewed articles available and published studies mostly on adults. Compared to pubertal individuals, a limited number of fertility preservation methods are used for prepubertal patients. Funding for the procedures described varies from country to country, but only a few governments choose to reimburse them. Oncofertility of pediatric and adolescent patients raises many controversies related to the decision, parents' beliefs, having a partner, ethics, as well as the knowledge and experience of healthcare professionals. As the fertility of young cancer patients is at risk, healthcare professionals should make every effort to provide them with an opportunity to fulfill their future reproductive plans and to have a family and offspring. Systemic solutions should form the basis for the development of oncofertility in pediatric and adolescent populations.
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Affiliation(s)
- Piotr Pawłowski
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Karolina Joanna Ziętara
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Justyna Michalczyk
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Magdalena Fryze
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (M.F.); (M.S.)
| | - Anna Buchacz
- Youth Cancer Europe, 400372 Cluj-Napoca, Romania;
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.Z.-P.); (J.Z.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.Z.-P.); (J.Z.)
| | - Anna Torres
- Department of Pediatric and Adolescent Gynecology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Marzena Samardakiewicz
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (M.F.); (M.S.)
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Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, Bradford N, Cohn R, Birdsall M, Barr R, Suzuki N, Takae S, Marinho R, Xiao S, Qiong-Hua C, Mahajan N, Patil M, Gunasheela D, Smith K, Sender L, Melo C, Almeida-Santos T, Salama M, Appiah L, Su I, Lane S, Woodruff TK, Pacey A, Anderson RA, Shenfield F, Ledger W, Sullivan E. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2019; 25:159-179. [PMID: 30462263 PMCID: PMC6390168 DOI: 10.1093/humupd/dmy038] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/15/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services. SEARCH METHODS A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOMES A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices. WIDER IMPLICATIONS This analysis identifies core components for delivery of oncofertility MOC. The provision of oncofertility services requires planning to ensure services have safe and reliable referral pathways and that they are age-appropriate and include medical and psychological oncofertility care into the survivorship period. In order for this to happen, collaboration needs to occur between clinicians, allied HCPs and executives within paediatric and adult hospitals, as well as fertility clinics across both public and private services. Training of both cancer and non-cancer HCPs is needed to improve the knowledge of HCPs, the quality of care provided and the confidence of HCPs with these consultations.
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Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
| | - Paula Laws
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
| | - Shanna Logan
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
- Fertility and Research Centre, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW, Australia
| | - Carla Saunders
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, Australia
| | - Jo Travaglia
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, Australia
| | - Brigitte Gerstl
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia
| | - Natalie Bradford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland, Australia
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
| | - Mary Birdsall
- Fertility Associates, 7 Ellerslie Racecourse Drive, Auckland City, New Zealand
| | - Ronald Barr
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Nao Suzuki
- St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki Kanagawa Prefecture, Japan
| | - Seido Takae
- St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki Kanagawa Prefecture, Japan
| | - Ricardo Marinho
- Pro Criar Medicina Reprodutiva, Rua Bernardo Guimarães 2063, Belo Horizonte, Brazil
| | - Shuo Xiao
- Reproductive Health and Toxicology Lab, Dept. Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene St, Rm 327, Columbia, SC, USA
| | - Chen Qiong-Hua
- Obstetrics and Gynecology Department, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Siming Qu, Xiamen Shi 35, China
| | - Nalini Mahajan
- Mother and Child Hospital, D-59 Defence Colony, New Delhi, India
| | - Madhuri Patil
- Dr. Patil’s Fertility and Endoscopy Center, Center for Assisted Reproductive Technology, Endoscopic Surgery and Andrology, Bangalore, India
| | - Devika Gunasheela
- Gunasheela Surgical & Maternity Hospital, No. 1, Dewan Madhava Road, Opp. M. N. Krishna Rao Park, Basavanagudi, Bengaluru, Karnataka, India
| | - Kristen Smith
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
| | - Leonard Sender
- Children’s Hospital Orange County, 1201 W La Veta Avenue, Orange, CA, USA
| | - Cláudia Melo
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Edifício de São Jerónimo, Piso 2, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Edifício de São Jerónimo, Piso 2, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mahmoud Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
- Reproductive Medicine Department, National Research Center, Buhouth Street 33, Cairo, Egypt
| | - Leslie Appiah
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
- Nationwide Children’s Hospital, Department of Paediatric Surgery, 700 Children’s Drive, Columbus, OH, USA
| | - Irene Su
- University of California San Diego, 355 Dickinson St # 315, San Diego, CA, USA
| | - Sheila Lane
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
- University of Oxford, Wellington Square, Oxford, UK
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
| | - Allan Pacey
- Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, South Yorkshire, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh University, 47 Little France Crescent, Scotland, UK
| | - Francoise Shenfield
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, 25 Grafton Way, London, UK
| | - William Ledger
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
- Fertility and Research Centre, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW, Australia
| | - Elizabeth Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, 15 Broadway, Ultimo, Sydney, NSW, Australia
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