Building Oncofertility Core Competency in Developing Countries: Experience From Egypt, Tunisia, Brazil, Peru, and Panama

Salama, Mahmoud; Ataman, Lauren; Taha, Tamer; Azmy, Osama; Braham, Marouen; Douik, Fatma; Khrouf, Mohamed; Rodrigues, Jhenifer Kliemchen; Reis, Fernando M.; Sánchez, Flor; Romero, Sergio; Vega, Mario; Woodruff, Teresa K.

doi:10.1200/jgo.17.00121

Cited by 19 publications

(28 citation statements)

References 24 publications

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“…A diverse range of countries were included in this study with diversity in clinical practices around the world and different availability of resources in caring for patients’ oncofertility needs . Despite these differences, participants from middle income and higher income countries had agreement on consensus views, which is consistent with the literature showing how important reproductive needs and concerns are to cancer patients around the world .…”

Section: Discussionsupporting

confidence: 59%

The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation

et al. 2019

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Background. Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play. Materials and Method. A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (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.Results. The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, withThe Oncologist 2019;24:e1450-e1459 www.TheOncologist.com Symptom Management and Supportive Care Implications for Practice: Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. The competency framework gives 108 competencies that will allow health care professionals (HCPs) and services a structure for the development of oncofertility care, as well as define the role HCPs play to provide care and support. The framework also proposes a three-tier oncofertility service development model which prioritizes the development of components of oncofertility care into essential, enhanced, and expert services, giving clear recommendations for service development. The competency framework will enhance the implementation of FP guidelines, improving the equitable access to medical and psychological oncofertility care. Initial QuestionnaireQuestionnaires were developed for HCPs and PFAs. These questionnaires were reviewed by PFA to ensure consensus on appropriate terminology and language and breadth of

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Section: Discussionsupporting

confidence: 59%

The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation

et al. 2019

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“…Stem cells reproductive technologies may be attempted in research settings. If fertility preservation options are rejected, contraindicated, infeasible, unavailable, or unsuccessful, adoption and thirdparty reproduction (egg donation, embryo donation, and surrogacy) can be offered as family building alternatives [252][253][254]. In such situations, patient navigators can play a crucial rule in reassuring and guiding patients during counseling.…”

Section: Current Multidisciplinary Challenges and Future Trends Of Fementioning

confidence: 99%

Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach

2019

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Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during, and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is essential to guarantee high standard of care.

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“…This result underlines the lack of knowledge and awareness and the need to develop oncofertility education in Morocco. As observed by Overbeek et al [19], lack of awareness is an important barrier, particularly in developing countries [46]. To address this issue, one option could be the establishment of centers with appropriate expertise.…”

Section: Discussionmentioning

confidence: 99%

“…Over the past few years, several programs were developed to improve fertility preservation care that had positive effects in patients [49][50][51]. The development of such programs could promote oncofertility services in countries where offer is currently insufficient, such as Morocco and Canada [46].…”

Section: Discussionmentioning

confidence: 99%

Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists

Affdal

Grynberg

Hessissen³

et al. 2020

BMC Med Ethics

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Background: Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a few options are open to post-pubertal patients, the only immediate option currently open to pre-pubertal girls is cryopreservation of ovarian tissue and subsequent transplantation. The aim of the study was to address a current gap in knowledge regarding the offer of fertility preservation by Ovarian Tissue Cryopreservation (OTC) for prepubescent girls with cancer, and to explore current practices and attitudes of Canadian, French and Moroccan pediatric heme oncologists. The comparative perspective is relevant since legal frameworks surrounding fertility preservation and funding offered by the healthcare system vary greatly. Methods: An online survey was sent to the 45 pediatric oncology centers in Canada, France and Morocco. Results: A total of 39 centers responded (86.6%). OTC is offered by almost all pediatric heme oncologists in France (98%), very few in Canada (5%), and none in Morocco (0%). For pediatric hematologists/oncologists who do not propose fertility preservation in Canada, the reasons are: the technique is still experimental (54%), it is not available locally (26%) and cost of the technique for the family (14%). 97% of Canadian and 100% of Moroccan pediatric hematologists/oncologists think OTC should be funded by the healthcare system as it is in France and in the province of Quebec in Canada. Conclusions: The results of this study show tremendous diversity in the provision of OTC across countries, whereby its offer is correlated with legislation and funding. We argue that the current reality, in which this technology is often not offered to families, raises ethical issues related to justice and equity of access, as well as informed consent and future reproductive autonomy.

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Building Oncofertility Core Competency in Developing Countries: Experience From Egypt, Tunisia, Brazil, Peru, and Panama

Cited by 19 publications

References 24 publications

The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation

The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation

Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach

Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists

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