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Mason I, Hewitt GD, McCracken KA, Whiteside S, Nahata L, Kebodeaux CA. Sexual and Reproductive Health Care after Gonadotoxic Treatment in Females at a Tertiary Pediatric Hospital. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00019-6. [PMID: 38253233 DOI: 10.1016/j.jpag.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
STUDY OBJECTIVES Recommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes. METHODS Follow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion. RESULTS We included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P = .03), to be diagnosed with POI (29.8% vs 0%, P = .01), and to have sexual activity recorded (77.2% vs 51.7%, P = .03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing. CONCLUSION This study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors.
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Affiliation(s)
- Isabelle Mason
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Geri D Hewitt
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kate A McCracken
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Stacy Whiteside
- Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Leena Nahata
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
| | - Chelsea A Kebodeaux
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
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Grégoire-Briard F, Mitsakakis N, Hayawi L, Dumont T. Evaluation of Fertility Preservation Counseling and Treatments for Female Oncology Patients in an Urban Pediatric Canadian Center. J Adolesc Young Adult Oncol 2021; 11:518-524. [PMID: 34936499 DOI: 10.1089/jayao.2021.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Purpose: Several international organizations and guidelines have recommended implementation of structured fertility preservation (FP) discussions with patients and their families before initiation of chemotherapy and radiation treatments in children. This study aimed to identify current trends and rates in FP counseling and treatments at a Canadian pediatric tertiary care center. Objectives were to measure guideline adherence for FP counseling at our institution by determining (1) the frequency of FP counseling in pediatric female oncological patients at our institution, (2) the frequency of FP treatment in this study population, and (3) the factors associated with FP pre-treatment counseling. Methods: A retrospective chart review was performed, including all pediatric and adolescent female patients (age <18) seen in consultation by the oncology team. Demographic data, as well as documentation of FP counseling and referral to a reproductive endocrinology and infertility (REI) specialist and subsequent FP treatment were collected. Results: A total of 89 female pediatric patients were included in our study. Forty-two patients received fertility counseling (47.2%; 95% confidence interval [CI] 37.2-57.5). Only 29/42 (69.0%; 95% CI: 54-80.9) received counseling before onset of treatment. A 12/42 (41.4%; 95% CI: 25-59.3) of the patients who received FP counseling were referred to an REI specialist and 11/12 proceeded with FP treatment (37.9%, 95% CI: 22.7-56). Conclusion: This study presents contemporary data on the rates of FP counseling in Canadian pediatric female oncological patients and demonstrates low rates of FP counseling in our patient population.
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Affiliation(s)
- Florence Grégoire-Briard
- Division of Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nicholas Mitsakakis
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lamia Hayawi
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Tania Dumont
- Division of Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Keim-Malpass J, Fitzhugh HS, Smith LP, Smith RP, Erickson J, Douvas MG, Thomas T, Petroni G, Duska L. What is the Role of the Oncology Nurse in Fertility Preservation Counseling and Education for Young Patients? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1301-1305. [PMID: 28667545 DOI: 10.1007/s13187-017-1247-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Oncology nurses are uniquely positioned to offer fertility preservation counseling and education for cancer patients of reproductive age, yet there is a dearth of research that focuses on current practice and perceptions of nursing role. In 2013, the American Society of Clinical Oncology extended the duties of fertility preservation counseling among patients of reproductive age undergoing cancer treatment to include registered nurses and other allied health professionals as active partners in the counseling and education process. This study used a cross-sectional descriptive survey to assess current practices, role perceptions, and barriers to fertility preservation counseling among registered nurses working in an academic care setting with outpatient and inpatient services. There were significant gaps in current practices and perceptions of roles regarding fertility preservation counseling. Many nurses expressed the perception that fertility preservation counseling was important, but it was outside the scope of their practice to perform this education. This preliminary work defined need for an interdisciplinary fertility preservation team, communication surrounding educational practice norms, and designated oncofertility navigator.
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Affiliation(s)
- Jessica Keim-Malpass
- University of Virginia School of Nursing, P.O. Box 800782, Charlottesville, VA, 22908, USA.
| | - Hannah S Fitzhugh
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
| | - Laura P Smith
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
- Reproductive Medicine and Surgery Center of Virginia, Charlottesville, VA, USA
- University of Virginia School of Medicine, Obstetrics and Gynecology, Charlottesville, VA, USA
| | - Ryan P Smith
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
- Division of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeanne Erickson
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI, USA
| | - Mike G Douvas
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
- Hematology-Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Tanya Thomas
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
- University of Virginia Health System Acute Oncology and Bone Marrow Transplant, Charlottesville, VA, USA
| | - Gina Petroni
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Linda Duska
- University of Virginia Emily Couric Cancer Center, Charlottesville, VA, USA
- Gynecologic Oncology, University of Virginia School of Medicine, Obstetrics and Gynecology, Charlottesville, VA, USA
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Latif N, Ali N. Patient and Physician Perspective on Sperm Banking to Overcome Post-Treatment Infertility in Young Cancer Patients in Pakistan. J Adolesc Young Adult Oncol 2018; 8:54-60. [PMID: 30256151 DOI: 10.1089/jayao.2018.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer survivor rates have increased over the past few decades leading to a growing interest in research related to quality of life (QoL). We attempted to explore the unique barriers that might prevent adult male cancer patients from accessing sperm cryopreservation in Pakistan. METHODS Semi-structured interviews of male cancer patients aged 18-45 years were audio-recorded in Urdu and translated to English and were transcribed ad verbatim. The topics included information regarding risk of infertility following chemotherapy, future reproductive choices, and barriers to sperm cryopreservation. Questionnaire to physicians containing four content domains of knowledge, attitude, practice, and barriers to sperm banking was also delivered. Data were entered and analyzed on SPSS. RESULTS Of the 25 patients interviewed, there were 10 cases of leukemia, 3 cases of lymphoma, 2 cases each of colorectal carcinoma and multiple myeloma, 1 case each of neuroblastoma and osteosarcoma, and solitary cases involving the lung, breast, thymus, brain, jaw, and testis. Four patients knew about the risk of infertility. All patients were aware of the option of sperm cryopreservation. Two patients had their sperm preserved before the initiation of chemotherapy. Perceived treatment-related expenses appeared to be the major barrier to sperm cryopreservation in nine patients. This was followed by lack of information, which was cited by eight patients, and religious reasons (n = 2 patients). Other barriers were female gender of the doctor and patient's preferences. Four patients stated no barriers. Nine physicians responded to the questionnaire. Seventy-eight percent of physicians agreed that cancer treatment increases the risk of infertility. 33.3% strongly agreed and 55.6% agreed that infertility can have an adverse impact on QoL. CONCLUSIONS There is a significant lack of awareness among male cancer patients regarding infertility following cancer treatment. It is imperative that physicians inform them of this and discuss treatment options, along with addressing potential barriers.
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Affiliation(s)
- Nida Latif
- 1 Civil Hospital Karachi, Karachi, Pakistan
| | - Natasha Ali
- 2 Department of Pathology and Laboratory Medicine/Oncology, Aga Khan University, Karachi, Pakistan
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Roche BM, Mazanec SR, Toly VB, Pateva I. Addressing Fertility in Adolescent and Young Adult Oncology Patients: A Descriptive Study. J Adolesc Young Adult Oncol 2018; 8:84-89. [PMID: 30156439 DOI: 10.1089/jayao.2018.0051] [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: 11/13/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYA) undergoing cancer therapy may be at risk for infertility as a consequence of their treatment and should be informed of their risk of infertility and referred to infertility specialists at the time of diagnosis. The overall aim of the study was to describe fertility consult practices in AYA patients at a single institution. METHODS We conducted a retrospective chart review over a 2-year time period collecting data on newly diagnosed or relapsed AYA oncology patients aged 10-30 years. Records of 57 charts were reviewed for documentation of initiation and completion of a fertility consult before starting cancer treatment. Demographic and medical data were collected to determine infertility risk stratification. Analyses included descriptive statistics, chi-squared analysis, and logistic regression analysis. RESULTS Documentation of discussion of fertility risk before the initiation of therapy was noted in 19% of charts (n = 10). There was no statistically significant relationship between documentation of the initiation or completion of a fertility consult and infertility risk. Demographic and medical factors were not associated with higher odds of having completed a fertility consult. Documentation of the initiation of a fertility consult was associated with higher odds that a consult was completed (p < 0.001). CONCLUSION Strategies are needed to improve documentation of discussions of infertility risk. Utilizing technology, promoting staff education, and developing enhancements in electronic medical record can provide triggers to promote documentation of the initiation of fertility consults. Implementing a fertility navigator could facilitate consultation and coordination of care for fertility preservation services.
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Affiliation(s)
- Breanne M Roche
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.,2 Angie Fowler Adolescent & Young Adult Cancer Center, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Susan R Mazanec
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.,3 University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Valerie Boebel Toly
- 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Irina Pateva
- 2 Angie Fowler Adolescent & Young Adult Cancer Center, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio
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Hand M, Kemertzis MA, Peate M, Gillam L, McCarthy M, Orme L, Heloury Y, Sullivan M, Zacharin M, Jayasinghe Y. A Clinical Decision Support System to Assist Pediatric Oncofertility: A Short Report. J Adolesc Young Adult Oncol 2018; 7:509-513. [PMID: 29733237 DOI: 10.1089/jayao.2018.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Fertility preservation discussions with pediatric and adolescent cancer patients can be difficult for clinicians. This study describes the acceptability of a fertility clinician decision support system (CDSS). METHODS A cross-sectional study of clinicians at The Royal Children's Hospital, Melbourne. Participants were trained on CDSS purpose, contents, and use. A survey captured the perceived benefits and weaknesses of the CDSS. RESULTS Thirty-nine clinicians participated. Over 90% felt the CDSS aims and format were clear, and understood the components. Over 80% felt it would enable adherence to clinical pathways, policy, and standards of care. CONCLUSIONS The CDSS provided significant perceived benefits to oncofertility care.
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Affiliation(s)
- Meredith Hand
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia
| | - Matthew A Kemertzis
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia .,2 Department of Gynaecology, Royal Children's Hospital , Melbourne, Victoria, Australia
| | - Michelle Peate
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia
| | - Lynn Gillam
- 3 School of Population and Global Health, University of Melbourne , Parkville, Victoria, Australia .,4 Children's Bioethics Centre, Royal Children's Hospital , Melbourne, Victoria, Australia
| | - Maria McCarthy
- 5 Social and Mental Health Research Group, Murdoch Children's Research Institute , Melbourne, Victoria, Australia
| | - Lisa Orme
- 6 Children's Cancer Centre, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Yves Heloury
- 7 Department of Surgery, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Michael Sullivan
- 6 Children's Cancer Centre, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Margaret Zacharin
- 8 Department of Endocrinology, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Yasmin Jayasinghe
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia .,2 Department of Gynaecology, Royal Children's Hospital , Melbourne, Victoria, Australia .,9 Department of Obstetrics and Gynaecology, University of Melbourne , Parkville, Victoria, Australia
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Gonçalves V, Hudson J, Canavarro MC, Morris J, Lee MC, Donovan KA, Sutton SK, Vadaparampil ST, Quinn GP. Childbearing across borders: Fertility and parenthood attitudes and decisions among breast cancer survivors in USA and Portugal. Breast 2018; 40:16-22. [PMID: 29674220 DOI: 10.1016/j.breast.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare fertility and childbearing attitudes and decisions of Portuguese and American female reproductive aged breast cancer survivors. METHODS This was a cross-sectional study of 102 young breast cancer survivors (59 from Portugal and 43 from USA). Demographic, clinical and reproductive information were collected. Fertility and parenthood attitudes and decisions were assessed through a self-report questionnaire devised specifically for the study. RESULTS Fertility issues became very important after the diagnosis for most of the women (51%). Few differences existed between USA and Portuguese participants. USA participants were more likely to undergo FP (23% USA vs Portugal 5%, p = 0.01). Portuguese women were more dissatisfied with their physician's explanations about fertility (Portugal: 23% vs USA: 3%; p = 0.01). Overall, women relied on their oncologist for fertility information (70%); only Portuguese women discussed fertility with their family medicine physician (11%). Overall, women showed positive attitudes towards motherhood. Portuguese women were more likely to report their partners placed more value on the family after their illness (Portuguese agree: 55% vs USA agree: 14%; p < 0.001). CONCLUSIONS Fertility and childbearing after breast cancer are important issues regardless of culture, background or country's heath care system. Overall, few differences across the USA and Portuguese samples were found on fertility and childbearing attitudes and decisions.
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Affiliation(s)
- Vânia Gonçalves
- Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal.
| | - Janella Hudson
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Maria Cristina Canavarro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal
| | - Julie Morris
- University Hospital of South Manchester, Wythenshawe Hospital, 1st Floor, Education and Research Centre, Southmoor Road, Manchester, UK
| | - M Catherine Lee
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Kristine A Donovan
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Steven K Sutton
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; Department of Oncologic Science, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Gwendolyn P Quinn
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; Department of Ob-Gyn, NYU Langone Medical Center, NY, NY 10016, USA
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Kim J, Kim SK, Hwang KJ, Kim SH. Fertility preservation during cancer treatment: The Korean Society for Fertility Preservation clinical guidelines. Clin Exp Reprod Med 2017; 44:171-174. [PMID: 29376012 PMCID: PMC5783912 DOI: 10.5653/cerm.2017.44.4.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/20/2017] [Accepted: 07/05/2017] [Indexed: 11/06/2022] Open
Abstract
While many fertility preservation (FP) options now exist for reproductive-aged cancer patients, access to these services continues to be limited. A comprehensive FP program should be organized to serve oncofertility patients effectively. Also, much effort is needed from various individuals—patients, specialists from various fields, and consultants—to facilitate FP in a timely manner. Various challenges still exist in improving access to FP programs. To improve access to FP treatment, it is important to educate oncologists and patients via electronic tools and to actively navigate patients through the system. Reproductive endocrinology practices that receive oncofertility referrals must be equipped to provide a full range of options on short notice. A multidisciplinary team approach is required, involving physicians, nurses, mental health professionals, office staff, and laboratory personnel. The bottom line of FP patient care is to understand the true nature of each patient's specific situation and to develop a patient flow system that will help build a successful FP program. Expanding the patient flow system to all comprehensive cancer centers will ensure that all patients are provided with adequate information regarding their fertility, regardless of geography.
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Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Cha Fertility Center at Seoul Station, CHA University, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Joo Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Carlson CA, Kolon TF, Mattei P, Hobbie W, Gracia CR, Ogle S, Ginsberg JP. Developing a Hospital-Wide Fertility Preservation Service for Pediatric and Young Adult Patients. J Adolesc Health 2017; 61:571-576. [PMID: 28917444 DOI: 10.1016/j.jadohealth.2017.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Gonadal damage is a common consequence of treatment for pediatric malignancies. Nononcologic conditions may also utilize treatments with potential impact on fertility. Models for oncology fertility preservation programs have emerged and demonstrate that a multidisciplinary team approach can have a positive impact on referral patterns, appropriate risk counseling, and access to fertility preservation options. Expansion of programmatic breadth is needed, providing improved care to nonmalignant conditions where the disease itself may impact reproductive health or treatment modalities. METHODS With support from the Department of Pediatrics Chair's Initiative, a multidisciplinary, hospital-wide Fertility Preservation Service was created at the Children's Hospital of Philadelphia. A centralized team provides fertility consults across the institution, allowing for risk-based counseling and facilitation of fertility preservation options (both standard care and experimental). RESULTS Team structure, consult process, and available fertility options for prepubertal and pubertal males and females are described. Preinitiative and postinitiative referral patterns were analyzed. Postinitiative referrals from divisions outside oncology more than doubled (34% vs. 15% at baseline). CONCLUSIONS A comprehensive model for fertility counseling provides accessible, high-value fertility preservation care to pediatric and young adult patients with a wide variety of diagnoses. A centralized point of contact ensures timely referrals and risk-based counseling and streamlines access to fertility preservation procedures.
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Affiliation(s)
- Claire A Carlson
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas F Kolon
- Department of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter Mattei
- Department of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wendy Hobbie
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue Ogle
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jill P Ginsberg
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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11
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Low Fertility Preservation Utilization Among Transgender Youth. J Adolesc Health 2017; 61:40-44. [PMID: 28161526 DOI: 10.1016/j.jadohealth.2016.12.012] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Research demonstrates a negative psychosocial impact of infertility among otherwise healthy adults, and distress among adolescents facing the prospect of future infertility due to various medical conditions and treatments that impair reproductive health. Guidelines state that providers should counsel transgender youth about potential infertility and fertility preservation (FP) options prior to initiation of hormone therapy. The purpose of this study was to examine the rates of fertility counseling and utilization of FP among a cohort of adolescents with gender dysphoria seen at a large gender clinic. METHODS An Institutional Review Board-approved retrospective review of electronic medical records was conducted of all patients with ICD-9/10 codes for gender dysphoria referred to Pediatric Endocrinology for hormone therapy (puberty suppression and/or cross-sex hormones) from January 2014 to August 2016. RESULTS Seventy-eight patients met inclusion criteria. Five children were prepubertal, no hormone therapy was considered, and they were therefore excluded. Of the remaining 73 patients, 72 had documented fertility counseling prior to initiation of hormone therapy and 2 subjects attempted FP; 45% of subjects mentioned a desire or plan to adopt, and 21% said they had never wanted to have children. CONCLUSIONS Utilization rates of FP are low among transgender adolescents. More research is needed to understand parenthood goals among transgender youth at different ages and developmental stages and to explore the impact of gender dysphoria on decision-making about FP and parenthood. Discussions about infertility risk, FP, and other family building options should be prioritized in this vulnerable adolescent population.
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Nahata L, Sivaraman V, Quinn GP. Fertility counseling and preservation practices in youth with lupus and vasculitis undergoing gonadotoxic therapy. Fertil Steril 2016; 106:1470-1474. [DOI: 10.1016/j.fertnstert.2016.07.1102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
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Benedict C, Thom B, Kelvin JF. Fertility preservation and cancer: challenges for adolescent and young adult patients. Curr Opin Support Palliat Care 2016; 10:87-94. [PMID: 26730794 DOI: 10.1097/spc.0000000000000185] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to treatment. RECENT FINDINGS Several barriers prevent fertility from being adequately addressed in the clinical context. Providers' and patients' incomplete or inaccurate understanding of infertility risks exacerbate patients' reproductive concerns. For female patients in particular, making decisions about fertility preservation before treatment often leads to decision conflict, reducing the likelihood of making informed, value-based decisions, and posttreatment regret and distress. Recent empirically based interventions to improve provider training around fertility issues and to support patient decision-making about fertility preservation show promise. SUMMARY Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in fertility preservation options.
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Affiliation(s)
- Catherine Benedict
- aDepartment of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset bSurvivorship Center, Memorial Sloan Kettering Cancer Center, New York, USA
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14
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Gonçalves V, Quinn GP. Review of fertility preservation issues for young women with breast cancer. HUM FERTIL 2016; 19:152-65. [DOI: 10.1080/14647273.2016.1193228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Vânia Gonçalves
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Gwendolyn P. Quinn
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer and Research Institute, Morsani College of Medicine, The University of South Florida, Tampa, FL, USA
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Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22:281-305. [PMID: 26759231 DOI: 10.1093/humupd/dmv066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The trend toward late childbearing has made fertility preservation a major issue for women who face gynecological cancer. New techniques in assisted reproductive medicine enable conception after primary treatment of these cancers. Here, we aimed to review the efficacy and safety of assisted reproductive techniques (ART) after fertility-preserving treatment of gynaecological cancers. METHODS We conducted a systematic literature review of both prospective and retrospective studies in the PubMed, EMBASE, CENTRAL and SciSearch databases. In the retrieved studies, we evaluated live births, clinical pregnancies, overall survival and disease-free survival. RESULTS We identified many prospective and retrospective studies on this topic, but no relevant randomized clinical trials. Fertility-sparing treatments with safe oncological outcomes are feasible in endometrial, cervical and ovarian cancer cases. After cancer treatment, ART seem safe and show variable obstetrical outcomes. CONCLUSIONS After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.
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Affiliation(s)
- Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | | | - Maria D Diestro
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
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Levine JM, Kelvin JF, Quinn GP, Gracia CR. Infertility in reproductive-age female cancer survivors. Cancer 2015; 121:1532-9. [PMID: 25649243 DOI: 10.1002/cncr.29181] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 02/05/2023]
Abstract
Improved survival rates among reproductive-age females diagnosed with cancer have increased the focus on long-term quality of life, including maintenance of the ability to conceive biological children. Cancer-directed therapies such as high-dose alkylating agents and radiation to the pelvis, which deplete ovarian reserve, radiation to the brain, which affects the hypothalamic-pituitary-gonadal axis, and surgical resection of reproductive structures can decrease the likelihood of having biological children. Standard fertility preservation strategies such as embryo and oocyte cryopreservation before the onset of therapy offer the opportunity to conserve fertility, but they may not be feasible because of the urgency to start cancer therapy, financial limitations, and a lack of access to reproductive endocrinologists. Ovarian tissue freezing is considered experimental, with limited data related to pregnancies, but it minimizes treatment delay. Studies evaluating gonadotropin-releasing hormone analogues have had mixed results, although a recent randomized, prospective study in women with breast cancer demonstrated a protective effect. Fertility preservation programs are increasingly being developed within cancer programs. In this article, we describe risks to infertility and options for preservation, raise psychosocial and ethical issues, and propose elements for establishing an effective fertility preservation program.
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Affiliation(s)
- Jennifer M Levine
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
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Linkeviciute A, Boniolo G, Chiavari L, Peccatori FA. Fertility preservation in cancer patients: The global framework. Cancer Treat Rev 2014; 40:1019-27. [DOI: 10.1016/j.ctrv.2014.06.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 12/20/2022]
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Preserving Fertility in Children and Adolescents with Cancer. CHILDREN-BASEL 2014; 1:166-85. [PMID: 27417474 PMCID: PMC4928722 DOI: 10.3390/children1020166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 12/02/2022]
Abstract
In the face of excellent survival rates for pediatric and adolescent cancer, preserving the opportunity to have biological children is an important component of long term quality of life. Yet, modern chemotherapeutic regimens continue to pose a threat to fertility. The only fertility preservation methods available to pre-pubertal children of both genders is cryopreservation of gonadal tissue, a highly experimental intervention, or shielding/re-location of reproductive tissue in the setting of radiation. These techniques are available in the post pubertal population as well, but post pubertal patients also have the option for cryopreservation of gametes, a process that is much simpler in males than females. For this reason, prior to the initiation of therapy, sperm banking should be considered standard of care for males, while consideration of embryo or oocyte cryopreservation should be limited to those females at risk of developing ovarian failure. Attention to reproductive health and fertility preservation should continue after the completion of therapy. Establishing programs that streamline access to current fertility preservation techniques will assist in ensuring that all eligible patients can avail themselves of current options.
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Moffat R, Güth U. Preserving fertility in patients undergoing treatment for breast cancer: current perspectives. BREAST CANCER-TARGETS AND THERAPY 2014; 6:93-101. [PMID: 25114587 PMCID: PMC4108258 DOI: 10.2147/bctt.s47234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Invasive breast cancer (BC) is the most frequent cancer of young women. Considering the trend toward postponing childbearing until the later reproductive years, the number of childless women at diagnosis of BC will continue to increase. The American Society of Clinical Oncology and the American Society for Reproductive Medicine have recommended that the impact of cancer treatments on fertility should be addressed with all cancer patients of reproductive age and that options for fertility preservation, such as cryopreservation of embryos and oocytes, ovarian tissue, in vitro maturation of immature oocytes, and ovarian suppression with gonadotropin-releasing hormone analogs, should be discussed routinely. To optimally counsel patients on how to best weigh the risks and benefits of fertility preservation, both the health care provider and the patient must know about the options, their risks, and their likelihood of success. The aim of this review is to summarize current knowledge on fertility preservation options for young BC patients, surrogates of ovarian function, psychosocial aspects of infertility after cancer treatment, women’s attitudes towards childbearing after cancer treatment, and health care providers’ attitudes towards fertility preservation.
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Affiliation(s)
- Rebecca Moffat
- Women's Hospital, Clinic for Gynecologic Endocrinology and Reproductive Medicine, University Hospital Basel, Basel, Switzerland
| | - Uwe Güth
- Department of Gynecology and Obstetrics, Breast Center, SenoSuisse, Cantonal Hospital Winterthur, Winterthur, Switzerland
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