Quinn Gwendolyn P, Block Rebecca G, Clayman Marla L, Kelvin Joanne, Arvey Sarah R, Lee Ji-Hyun, Reinecke Joyce, Sehovic Ivana, Jacobsen Paul B, Reed Damon, Gonzalez Luis, Vadaparampil Susan T, Laronga Christine, Lee M Catherine, Pow-Sang Julio, Eggly Susan, Franklin Anna, Shah Bijal, Fulp William J, Hayes-Lattin Brandon
Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI
Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI.
J Oncol Pract. 2015 Mar;11(2):137-44. doi: 10.1200/JOP.2014.000786. Epub 2014 Dec 30.
The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers.
All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist.
Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001).
The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation.
青少年及青年（AYA）人群因独特的远期效应问题，尤其是未来生育问题，而未得到充分的医疗服务。本研究旨在确定四个癌症中心的AYA患者病历中关于不孕风险讨论、生育力保存（FP）方案讨论以及转介至生育专家的记录率。
所有中心审查了AYA患者四大疾病部位（乳腺癌、白血病/淋巴瘤、肉瘤和睾丸癌）的随机记录。符合条件的记录包括以下患者的记录：2011年确诊，此前未接受性腺毒性治疗；年龄在18至45岁之间；无多发原发性癌症；且记录不是二次诊断意见。采用优质肿瘤实践倡议方法评估不孕风险讨论、FP方案讨论以及转介至生育专家的记录情况。
在231份记录中，26%记录了不孕风险讨论，24%记录了FP方案讨论，13%记录了转介至生育专家。女性患者（分别为P = 0.030和0.004）以及乳腺癌患者（分别为P = 0.021和<0.001）的记录中更不可能包含不孕风险和FP方案讨论的证据。西班牙裔/拉丁裔患者的记录中更不可能包含不孕风险讨论的证据（P = 0.037）。年龄≥40岁的患者（分别为P < 0.001、<0.001和0.002）以及已经育有子女的患者（所有P < 0.001）的记录中更不可能记录不孕风险讨论、FP方案讨论以及转介至生育专家。
FP讨论的总体记录率较低，结果显示特定群体之间存在差异。尽管可能进行了更多的讨论，但仍需要采取干预措施来改善记录情况。
