The evolution of fertility preservation care models in a large pediatric cancer and blood disorders center

Abstract

Background: Children and adolescents who receive gonadotoxic treatments are at risk for future infertility. While there is a growing focus on integrating fertility preservation (FP) within pediatric cancer and blood disorder centers, wide variations in care models and methods exist across institutions. The purpose of this work is to describe the evolution of FP care models within a large pediatric hematology/oncology center. Methods: Models of care and associated timeframes are described, including a pre-FP program model, establishment of a formal FP program, integration of nurse navigators, and the addition of FP consult stratification based on urgency (urgent/nonurgent). The number of patient consults within each model, patient sex, diagnosis (oncologic/hematologic), and consult timing (pre-gonadotoxic treatment/posttreatment completion) were abstracted from the clinical database. Results: The number of annual consults increased from 24 during the pre-FP program model (2015) to 181 during the current care model (2020). Over time, the proportion of consults for females and patients with nonmalignant hematologic disorders increased.Patient stratification reduced the proportion of consults needing to be completed urgently from 75% at the advent of the FP program to 49% in the current model. Conclusions:The evolution of care models within our FP program allowed for growth in the number of consults completed, expansion of services to more patients with nonmalignant hematologic disorders, and more consults for female patients. Nurse navigators play a critical role in care facilitating referrals, coordination, and patient education.Urgency stratification has allowed FP team members to manage increasing FP-related encounters.

Contraceptive methods and fertility testing in young adult survivors of childhood cancer

“…The most common reason for not having completed fertility testing was that survivors ‘did not think of it.’ This may partially be due to their still rather young age (≤ 26 years) and not yet desiring to have children. However, considering the level of interest in testing, clinical programs should raise awareness of fertility testing options and incorporate counseling and referrals for interested survivors [ 35 , 36 ]. The cost of fertility testing may also be a barrier for some young adult cancer survivors, which varies between countries, and should be discussed during fertility-related counseling.…”