癌症患儿生育力保存项目建立后的咨询和治疗结局。
Consult and procedure incidence outcomes following establishment of a fertility preservation program for children with cancer.
机构信息
Children's Research Center, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
出版信息
J Assist Reprod Genet. 2021 Feb;38(2):495-501. doi: 10.1007/s10815-020-02042-8. Epub 2021 Jan 3.
PURPOSE
Fertility is a quality of life outcome adversely affected by cancer therapy. Many childhood cancer patients, however, are not offered options to preserve their fertility. Providers acknowledge difficulty discussing impaired fertility to patients due to lack of knowledge of available options. Our objective was to review the impact of a pediatric multidisciplinary fertility preservation program on providers' fertility preservation counseling and discussion of options.
METHODS
A retrospective medical chart review was conducted for pediatric cancer patients prior to and following program establishment. Fertility preservation discussions, consults, and incidence were noted. Following filtering and stratification, 198 and 237 patients were seen prior to and following program establishment, respectively.
RESULTS
Following program establishment, provider-patient discussions of impaired fertility (p = 0.007), fertility preservation consults (p = 0.01), and incidence of fertility preservation procedures (p < 0.001) increased among patients. Furthermore, the number of patients who received fertility preservation consults after receiving gonadotoxic treatment decreased (p < 0.001). This trend was particularly noted in pre-pubertal and female patients, for whom fertility preservation options are limited without an established program.
CONCLUSION
The establishment of a formal program greatly improved access to fertility preservation consults and procedures in children with cancer.
目的
生育能力是生活质量的一个方面，会受到癌症治疗的影响。然而，许多儿童癌症患者并未被提供保留生育能力的选择。由于缺乏对现有选择的了解，提供者承认难以向患者讨论受损的生育能力。我们的目的是评估小儿多学科生育力保存计划对提供者生育力保存咨询和选择讨论的影响。
方法
对该计划建立前后的儿科癌症患者进行回顾性病历审查。记录生育力保护讨论、咨询和发生率。经过过滤和分层后，分别有 198 名和 237 名患者在该计划建立之前和之后接受了治疗。
结果
在该计划建立后，患者和提供者之间关于受损生育力的讨论（p = 0.007）、生育力保护咨询（p = 0.01）和生育力保护程序的发生率（p < 0.001）增加。此外，接受性腺毒性治疗后接受生育力保护咨询的患者数量减少（p < 0.001）。对于没有既定计划的青春期前和女性患者，这种趋势尤为明显，因为如果没有既定计划，他们的生育力保护选择有限。
结论
正式计划的建立极大地增加了癌症儿童获得生育力保护咨询和程序的机会。
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