Department of Oncology, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
J Adolesc Young Adult Oncol. 2022 Jun;11(3):275-283. doi: 10.1089/jayao.2021.0087. Epub 2021 Sep 7.
Increasing numbers of adolescents and young adults with cancer (AYACs) are surviving long term, highlighting the importance of effective oncofertility communication. We undertook this study to understand documentation of fertility discussions with AYACs, what options are offered, and how this differs for AYACs on treatment compared with those post-treatment. We reviewed the documentation of fertility discussions with 122 AYACs treated between 2000 and 2020: 72 AYACs on treatment and 50 AYACs at least 3 years post-treatment ("late effects" cohort). Diagnoses were split evenly between hematological and solid tumor diagnoses, and biological sex. Seventy-five percent of patients were diagnosed and treated by the AYAC team and 25% by the pediatric team. Median age at diagnosis was 19 years (range 4-24) for on-treatment patients and 16 years (range 3-25) for late effects patients. Fertility was discussed with 93% of on-treatment patients and 48% of late effects patients. Seventy-nine percent of on-treatment patients and 48% of late effects patients pursued a pre-treatment fertility preservation option. Post-treatment, 84% of late effects patients had a discussion and 57% pursued an option. Only four patients across both cohorts underwent oocyte or ovarian tissue cryopreservation. Those referred to specialist reproductive medicine clinics had more detailed documentation about fertility discussions. Nurse-led late effects clinics had a key role in facilitating post-treatment discussions. It is important to communicate oncofertility options to AYACs repeatedly throughout treatment. Referral to specialist oncofertility services and adequate information for both sexes is important pre-treatment, and can be facilitated post-treatment by a late effects service.
越来越多的青少年和青年癌症患者（AYACs）长期存活，这凸显了有效肿瘤生育沟通的重要性。我们进行这项研究是为了了解与 AYACs 进行生育讨论的记录，提供了哪些选择，以及在治疗期间与治疗后相比，这对 AYACs 有何不同。我们回顾了 2000 年至 2020 年间治疗的 122 名 AYAC 生育讨论的记录：72 名 AYAC 处于治疗中，50 名 AYAC 至少在治疗后 3 年（“晚期效应”队列）。诊断在血液系统和实体肿瘤诊断以及生物学性别之间平均分配。75%的患者由 AYAC 团队诊断和治疗，25%的患者由儿科团队诊断和治疗。治疗组患者的中位诊断年龄为 19 岁（范围为 4-24 岁），晚期效应组患者的中位诊断年龄为 16 岁（范围为 3-25 岁）。93%的治疗组患者和 48%的晚期效应组患者进行了生育讨论。79%的治疗组患者和 48%的晚期效应组患者选择了治疗前的生育保护方案。治疗后，84%的晚期效应组患者进行了讨论，57%的患者选择了方案。两个队列中只有 4 名患者接受了卵母细胞或卵巢组织冷冻保存。转诊至专科生殖医学诊所的患者，其生育讨论的记录更为详细。护士主导的晚期效应诊所在促进治疗后讨论方面发挥了关键作用。在治疗过程中，反复向 AYACs 传达肿瘤生育选择非常重要。在治疗前，向专科肿瘤生育服务机构转诊并为两性提供充足的信息非常重要，并且可以通过晚期效应服务在治疗后得到促进。
