Oncofertility care for newly diagnosed girls with cancer in a national pediatric oncology setting, the first full year experience from the Princess Máxima Center, the PEARL study

Abstract

Background Childhood cancer patients often remain uninformed regarding their potential risk of gonadal damage. In our hospital we introduced a five step standard oncofertility care plan for all newly diagnosed female patients aiming to identify, inform and triage 100% of patients and counsel 100% of patients at high risk (HR) of gonadal damage. This observational retrospective study (PEARL study) evaluated the use of this standard oncofertility care plan in the first full year in a national cohort. Methods The steps consist of 1)timely (preferably before start of gonadotoxic treatment) identification of all new patients, 2)triage of gonadal damage risk using a standardized gonadal damage risk stratification tool, 3)informing all patients and families, 4)counseling of a selected subset of girls, and 5) fertility preservation including ovarian tissue cryopreservation (OTC) in HR patients using amended Edinburgh criteria. A survey of the medical records of all girls newly diagnosed with cancer the first year (1-1-2019 until 31-12-2019) was conducted. Results Of 261 girls, 228 (87.4%) were timely identified and triaged. Triage resulted in 151 (66%) low(LR), 32 (14%) intermediate(IR) and 45 (20%) high risk(HR) patients. Ninety-nine families were documented to be timely informed regarding gonadal damage risk. In total, 35 girls (5 LR, 5 IR, 25 HR) were counseled by an oncofertility expert. 16/25 HR patients underwent fertility preservation (1 ovariopexy + OTC, oocyte cryopreservation (1 with and 1 without OTC) and 13 OTC). Fertility preservation did not lead to complications or delay of cancer treatment in any patient. Conclusion We timely identified and triaged most girls (88%) with cancer with a high risk of gonadal damage to be counseled for fertility preservation. We aim to optimize the oncofertility care plan and the standardized gonadal damage risk stratification tool based on this experience and these may be of value to other pediatric oncology centers.

Effect of Genetic Variation in CYP450 on Gonadal Impairment in a European Cohort of Female Childhood Cancer Survivors, Based on a Candidate Gene Approach: Results from the PanCareLIFE Study

“…Although the age at menopause is found to occur only a few years earlier after unilateral ovariectomy [ 79 , 80 , 81 ], the procedure reduces the in situ ovarian reserve [ 81 ]. Therefore, it is of utmost importance to be able to determine who is at risk [ 82 ], which may include consideration of genetic factors in risk estimation in the near future. Pharmacogenetics is increasingly used in adjusting therapy to the personalized optimal dose for the patient and minimizing side effects [ 83 ].…”

Fertility after Cancer: Risks and Successes

“…Although the use of this technique has shown good results in adult patients, ex vivo maturation of ovarian tissue taken in childhood and the subsequent auto-transplantation is still considered experimental [126].…”

Fertility Preservation in Girls and Women: State of Art and Future Possibilities

“…In an observational retrospective study, the application of a standard oncofertility care plan was evaluated in a national paediatric care centre in Netherlands [18]. The aim of this study was to identify all the new patients diagnosed with cancer, to assess gonadal damage risks, to inform the patients on their risks and to preserve their fertility if possible.…”

“…The aim of this study was to identify all the new patients diagnosed with cancer, to assess gonadal damage risks, to inform the patients on their risks and to preserve their fertility if possible. As a result, 88% of patients were triaged for fertility preservation and implementing oncofertility care did not cause any delays in starting cancer treatments [18]. It is therefore important to provide information to cancer patients about the effects of cancer therapies over their reproductive health and their fertility, as stated in international guidelines [10][11][12].…”