Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer

Covelli, Andrea; Facey, Marcia; Kennedy, Erin; Gupta, Abha; Greenblatt, Ellen; Baxter, Nancy N.

doi:10.1001/jamanetworkopen.2019.14511

Cited by 49 publications

(42 citation statements)

References 39 publications

(73 reference statements)

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“…Multiple physicians in this study 14 expressed that they did not believe that they were qualified or knew enough about fertility preservation to have conversations about this issue. This study 14 found that often physicians attributed the responsibility of fertility counseling to other clinicians, focused on the part of the body being treated, and did not see fertility preservation as their responsibility. In these multispecialty clinics, physicians possibly deferred these conversations, assuming that colleagues would address risks, potentially allowing such conversations to be missed.…”

Section: Discussionmentioning

confidence: 98%

“…One theory for this decreased rate of counseling in multispecialty clinics could be an unclear delineation of who is responsible for discussing the risk of infertility associated with chemotherapy. A recent qualitative study by Covelli et al 14 included 22 Canadian physicians who were interviewed regarding adherence to ASCO guidelines about fertility preservation conversations with patients. Multiple physicians in this study 14 expressed that they did not believe that they were qualified or knew enough about fertility preservation to have conversations about this issue.…”

Section: Discussionmentioning

confidence: 99%

“…A recent qualitative study by Covelli et al 14 included 22 Canadian physicians who were interviewed regarding adherence to ASCO guidelines about fertility preservation conversations with patients. Multiple physicians in this study 14 expressed that they did not believe that they were qualified or knew enough about fertility preservation to have conversations about this issue. This study 14 found that often physicians attributed the responsibility of fertility counseling to other clinicians, focused on the part of the body being treated, and did not see fertility preservation as their responsibility.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey

et al. 2020

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IMPORTANCE The opportunity to discuss fertility preservation is essential for patients of reproductive age with newly diagnosed cancer before the initiation of treatment. OBJECTIVE To identify factors associated with fertility preservation counseling among patients of reproductive age before initiating chemotherapy. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data obtained from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveys approximately 400 oncology practices biannually, from January, 2015, to June, 2019. MAIN OUTCOMES AND MEASURES The primary outcome was whether reproductive risks were discussed before initiation of chemotherapy. Multivariate logistic regression was performed to identify factors associated with fertility preservation counseling, controlling for age, sex, race/ ethnicity, cancer type, year of study, region, clinic type (academic vs private), annual clinic volume, and rates of insurance coverage. RESULTS Among the 6976 patients of reproductive age (3571 men [51%]; mean (SD) age, 42.5 [7.1] years), with reproductive age ranging from 18 to 40 years for 3405 women and from 18 to 50 years for 3571 men, clinics reported that 3036 of 6976 patients (44%) received counseling regarding the risk of infertility associated with chemotherapy. Women were more likely to be informed (1912 of 3405 [56%]) compared with men (1126 of 3571 [32%]) (P < .001). Factors associated with reduced likelihood of fertility risk discussion included male sex (odds ratio [OR], 0.73; 95% CI, 0.60-0.90), increasing age (OR, 0.93; 95% CI, 0.92-0.94), private practice setting (OR, 0.70; 95% CI, 0.53-0.93), and lack of multidisciplinary team planning (OR, 0.54; 95% CI, 0.41-0.70). Factors associated with increased likelihood of fertility risk discussion included having breast cancer (OR, 1.39; 95% CI,

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey

et al. 2020

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“…International guidelines recommend that oncologists address the possibility of future infertility with patients with newly diagnosed cancer in their reproductive years [7,13,14]. Despite these guidelines, the likelihood of discussions regarding fertility preservation, among others, is influenced by unfamiliarity with fertility preservation processes, risks, and outcomes [15]. Patients should be referred as early as possible to specialists who can offer fertility preservation (FP).…”

Section: Introductionmentioning

confidence: 99%

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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Purpose We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. Methods Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan-Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. Results Of 118 counseled women with a median age of 31 years (range 19-40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). Conclusions Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.

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“…This lack of a standardised process may produce guidelines that are not relevant for end-users or do not address their clinical needs. For example, when describing barriers to guideline implementation, clinicians highlight other clinical concerns that they prioritise in practice and for which guidance does not exist [12]. By incorporating clinician views into priority-setting and the development of key clinical questions in a standardised way, we may create more useful and implementable guidelines.…”

Section: Introductionmentioning

confidence: 99%

Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

Chakraborty

Brijnath

Dermentzis

et al. 2020

Health Res Policy Sys

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Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.

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Clinicians’ Perspectives on Barriers to Discussing Infertility and Fertility Preservation With Young Women With Cancer

Abstract: This qualitative study uses interviews with 22 Canadian clinicians to examine the perceived barriers to discussing fertility and fertility preservation with young women with cancer.

Cited by 49 publications

References 39 publications

Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey

Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

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