How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care

Abstract

BACKGROUND Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services. SEARCH METHODS A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOMES A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices. WIDER IMPLICATIONS This analysis identifies core components for de...

Oncologists' and pediatric oncologists' perspectives and challenges for fertility preservation

“…To improve the current situation, it is imperative that effective strategies to address this situation are implemented in cancer care. A recent review, identified eight established oncofertility models of care and their key components including clinician education about FP, collaboration with fertility specialists, established referral pathways, educational materials for patients, patient navigator and electronic notification. Promising results indicate that implementation of a multifaceted oncofertility program increased the frequency of documented fertility‐related discussions as well as referral rates to fertility specialists and the use of FP .…”

“…To improve the current situation, it is imperative that effective strategies to address this situation are implemented in cancer care. A recent review, 34 iden- to fertility specialists and the use of FP. 35 The development and implementation of multifaceted oncofertility programs appears to be a promising way forward towards high-quality FP care meeting patients' needs.…”

FERTILITY PRESERVATION: Testicular transplantation for fertility preservation: clinical potential and current challenges

“…However, fertility preservation is dependent on the clinician recognising the need for fertility preservation and providing appropriate counselling. This can often be a limiting factor for permitting patients to access fertility preservation services (Anazodo et al 2019). However, this option is dependent on prior establishment of spermatogenesis, the ability to obtain a semen sample and acceptability of this approach to the patient .…”

Preserving fertility in female patients with hematological malignancies: the key points

“…As recently reported by our coauthor Anazodo et al, international collaborations have defined the essential elements of a standard oncofertility model of care which includes communication, decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support, and ethical practice. This multidisciplinary oncofertility model of care that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is crucial to guarantee a high standard of care [21].…”