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COSA guidelines for fertility preservation for people with cancer
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Discussing Risk
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Role of oncology services

Role of oncology services

Role of oncology services

Clinical Question

Does the implementation of oncofertility programs and health professional education improve clinician-patient discussion of fertility preservation following a cancer diagnosis?

Increasing the opportunity for discussion with patients diagnosed with cancer about the risk to their fertility from cancer treatments is a priority for oncology services. The few studies performed in this area demonstrate that interventions such as professional education and the provision of fertility programs have increased the proportion of families involved in discussions about fertility:

  • An educational program for health care providers in Japan improved their confidence and knowledge of fertility preservation, and increased the rate of providing brochures or websites about fertility preservation to patients.[1]
  • Implementation of an adolescent and young adult program at a cancer centre in Canada improved the number of infertility risk discussions documented in patient medical records from 56% to 85%.[2]
  • Five cancer centres in Australia implemented bundled interventions, including the development of quality indicators, resources, and targeted education. Following the intervention patients with cancer were 1.47 times more likely to have a documented discussion of risk of infertility.[3]
  • In an Australian paediatric setting, the development and provision of a governed fertility program within the cancer care plan, and provision of clinician and family tools and resources for use at the point of care (fertility preservation toolkit, computerised decision support) doubled oncofertility consultations and written information to families and improved provider knowledge and satisfaction with oncofertility services.[4][5][6]

A systematic scoping review by Anazodo et al details further hospitals with oncofertility services and the model of care of their services.[7]

Evidence Summary

Evidence summaryLevelReferences
Optimising education and training of cancer and fertility health care providers and implementing a formal oncofertility service assists with improving the number of patients who receive information and advice about fertility risk and fertility preservation and reduces the risk of decisional conflict and regret regarding fertility preservation options.IV[1], [2], [3], [4], [5]

Recommendation

Evidence-based recommendationGrade
Cancer services should develop organised oncofertility programs aligned with the Australasian Oncofertility Charter so that fertility care is incorporated into essential cancer care. Oncofertility programs should provide resources (including age-appropriate decision aids where available) for patients, and education programs for staff, to ensure that patients are given clear, timely information about fertility risk and fertility preservation options. Oncofertility programs should have a clear governance process which include specific requirements for children.C


References

  1. Takeuchi E, Kato M, Miyata K, Suzuki N, Shimizu C, Okada H, et al. The effects of an educational program for non-physician health care providers regarding fertility preservation. Support Care Cancer 2018 Oct;26(10):3447-3452 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29681013.
  2. Lewin J, Ma JMZ, Mitchell L, Tam S, Puri N, Stephens D, et al. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer 2017 Jun;25(6):1915-1922 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28155019.
  3. Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28934554.
  4. Kemertzis MA, Ranjithakumaran H, Hand M, Peate M, Gillam L, McCarthy M, et al. Fertility Preservation Toolkit: A Clinician Resource to Assist Clinical Discussion and Decision Making in Pediatric and Adolescent Oncology. J Pediatr Hematol Oncol 2018 Apr;40(3):e133-e139 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29481385.
  5. Hand M, Kemertzis MA, Peate M, Gillam L, McCarthy M, Orme L, et al. A Clinical Decision Support System to Assist Pediatric Oncofertility: A Short Report. J Adolesc Young Adult Oncol 2018 Aug;7(4):509-513 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29733237.
  6. Carlson CA, Kolon TF, Mattei P, Hobbie W, Gracia CR, Ogle S, et al. Developing a Hospital-Wide Fertility Preservation Service for Pediatric and Young Adult Patients. J Adolesc Health 2017 Nov;61(5):571-576 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28917444.
  7. Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, et al. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2018 Nov 20 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30462263.

Body of evidence

What is the effect of oncofertility programs or health professional education on the number of clinician-patient discussions about fertility preservation following a cancer diagnosis?

Citation Level of Evidence Quality of Evidence Size of Effect Number of Patients Relevance of Evidence
Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28934554 IV Medium 1 476 1
Lewin J, Ma JMZ, Mitchell L, Tam S, Puri N, Stephens D, et al. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer 2017 Jun;25(6):1915-1922 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28155019 IV Low 1 173 2
Razzano A, Revelli A, Delle Piane L, Salvagno F, Casano S, Randaccio S, et al. Fertility preservation program before ovarotoxic oncostatic treatments: role of the psychological support in managing emotional aspects. Gynecol Endocrinol 2014 Nov;30(11):822-4 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25054374 IV Low 5 48 1
Takeuchi E, Kato M, Miyata K, Suzuki N, Shimizu C, Okada H, et al. The effects of an educational program for non-physician health care providers regarding fertility preservation. Support Care Cancer 2018 Oct;26(10):3447-3452 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29681013 IV Low 2 74 2