Oncofertility service provision

What is the best practice approach for developing and implementing oncofertility services in relation to referral pathways and models of care?

There is very little research into how to provide the best oncofertility services in terms of referral pathways and models of care. Despite this, studies of interventions initiated at a small number of institutions indicate that establishment of oncofertility programs has a positive impact on referrals to fertility specialists and use of fertility preservation services. Examples of these include:

• The establishment of a designated multidisciplinary fertility preservation program at the Davidoff Center in Israel resulted in a significant increase in referral and subsequent fertility preservation procedures.^[1]
• Patients were more likely to have documented discussion of risk of infertility, documented referral to fertility specialists and documented fertility preservation outcomes following introduction of a bundled intervention including quality indicators, fertility preservation resources, and targeted education in five cancer centres in Australia.^[2]
• Establishment of a multidisciplinary, hospital-wide Fertility Preservation Service at the Children's Hospital of Philadelphia saw the number of referrals double.^[3]
• A dedicated oncofertility clinic at the Massachusetts General Hospital (MGH) Cancer Center saw an increase in the number of patients referred for a fertility preservation consultation.^[4]
• An intervention as simple as distribution of a patient education brochure at the H. Lee Moffitt Cancer Center increased the number of calls to the reproductive endocrinologist/infertility clinic by nine times the number before distribution of the brochure.^[5]
• The development of a dedicated pediatric fertility preservation program has also been described.^[6]

A large systematic scoping review of oncofertility models of care identified a number of areas for improvement to services: patient communication on fertility risk and fertility preservation options; provision of oncofertility care in a timely manner; access to age-appropriate care and improving communication between health care professionals. The review also called for increased education of health professional in oncofertility care.^[7]

Further work from this group has led to the development of an ‘International Oncofertility Competency Framework’ which defines components of care across 10 domains of health care (communication, oncofertility decision aids, age‐appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility‐related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care as well as the roles that health care professionals play in the provisions of oncofertility health care.(https://pubmed.ncbi.nlm.nih.gov/31147490/)

Consumers' experience of oncofertility care in Australia has informed the development of the Australasian Oncofertility Consortium Charter which contains eight key elements of quality oncofertility care. These elements include discussion of fertility with all patients, referral to a fertility specialist, data collection, training for health professionals, affordability of services, psycho-social support and information on reproductive health.^[8]

With the establishment of Australasian Oncofertility Registry there is the potential to track local and national oncofertility referral patterns, uptake of fertility preservation and track complications and outcomes (https://pubmed.ncbi.nlm.nih.gov/30655118/). The collection of data on the Australasian Oncofertility Registry will allow for benchmarking of uptake and utilisation of oncofertility care against the Australasian Oncofertility Charter recommendations.