Development of successful oncofertility program for pediatric, adolescent, and young adult population
Andrew Strine, MD, MPH, Abbey Riazzi, MSPAS, PA-C, Beth Spitznagel, MSN, APRN, CPNP, Marion Schulte, MHSA, BSN, RN, Tracey Knabe, MA, Olivia Frias, MSN, RN, CNL, Christine Phillips, MD, Kas Myers, MD, Mickey Daugherty, MD, Brian VanderBrink, MD, Bob DeFoor, MD, MPH, Eugene Minevich, MD, Lesley Breech, MD, Pramod Reddy, MD, Tara Streicher-Tilles, MD, MPH, Karen Burns, MD, MS.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
BACKGROUND: Many therapies for pediatric cancers and other non-malignant conditions are gonadotoxic. With an improving survival due to the advent of more effective multimodal therapies, the late effects on fertility have becoming increasing important. Pediatric centers, however, have struggled with identifying the patients at risk of infertility and discussing the options for fertility preservation.
METHODS: Our Comprehensive Fertility Care and Preservation Program was established in September 2013. The team consists of oncology, gynecology, urology, reproductive endocrinology, pathology, ethics, and a fertility navigator. Fertility consultations were obtained via an order in the electronic medical record, pager, or e-mail. The fertility navigator was designated as the main point of contact. All patients were prospectively entered into an IRB-approved REDCap database. Administrative databases from the Cancer and Blood Diseases Institute were used to ensure that all patients were captured. Patients were considered to be ineligible for a fertility consultation if they met one or more of the following criteria: declined by patient or family, prior fertility consultation, second opinion, observation or surgery only, Phase I clinical trial, and palliative care. Quality improvement (QI) was performed to assess all missed opportunities and to improve the process for fertility consultation on a monthly basis.
RESULTS: A total of 3810 patients were reviewed between September 2013 and December 2021. Of 1764 eligible patients, 1620 patients (91.8%) received a fertility consultation. The percentage of eligible patients receiving a fertility consultation increased and was then sustained over time: 80.0% in 2013, 76.5% in 2014, 93.0% in 2015, 99.0% in 2016, 90.7% in 2017, 94.9% in 2018, 93.9% in 2019, 90.5% in 2020, and 91.5% in 2021. A total of 386 patients (23.8%) pursued an option for fertility preservation, including 171 ovarian tissue cryopreservations, 121 sperm cryopreservations, 90 testicular tissue cryopreservations, and 4 oocyte/embryo cryopreservations.
CONCLUSIONS: A successful oncofertility program was developed to meet the needs of this pediatric, adolescent, and young adult population through a comprehensive, team-based approach and focus on QI.
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