Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplant, Children's Mercy Kansas City, Missouri, USA.
Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
J Adolesc Young Adult Oncol. 2023 Apr;12(2):259-265. doi: 10.1089/jayao.2022.0003. Epub 2022 Jun 8.
Infertility is an impactful late effect of cancer therapy. Options for fertility preservation exist, however, barriers remain. Within our division, we lacked a standard approach to discussing fertility preservation. During the time period of 2014-2020, a fertility preservation program was developed with program improvements implemented over time and provider comfort with fertility identified and addressed through educational intervention. To evaluate how our improvements affected frequency of documented reproductive health discussions, 474 pubertal pediatric patients with new oncological diagnoses were reviewed. Descriptive analysis of sociodemographic determinants was performed. One hundred seventy-five patients met inclusion criteria. Racial/ethnic composition was similar in those receiving and not receiving a fertility consult. Although 19.3% of Caucasians pursued fertility preservation, none of the eight African Americans or five Hispanic females did. Division feedback identified a lack of knowledge regarding available fertility preservation options and diagnoses that should prompt this conversation as barriers to the consulting fertility preservation team. Pre- and posteducation assessments demonstrated increased comfort in discussing fertility preservation and knowledge regarding diagnoses at higher risk of infertility. Integration of a standardized fertility preservation process and addressing barriers identified led to a 33.6% increase in fertility discussions. The establishment of a fertility preservation process and team and division-wide education has led to improvement in rates of fertility discussion in pediatric and adolescent and young adult cancer patients. Similar to young adult data, our data suggest that some racial health disparities may exist in the utilization of fertility preservation in the pediatric oncology population.
不孕是癌症治疗的一个重大晚期影响。虽然存在生育力保存的选择，但仍存在障碍。在我们的科室中，缺乏一种标准的方法来讨论生育力保存。在 2014 年至 2020 年期间，制定了生育力保存计划，并随着时间的推移实施了计划改进，通过教育干预确定并解决了提供者对生育力的关注和担忧。为了评估我们的改进如何影响记录生殖健康讨论的频率，我们回顾了 474 名患有新肿瘤诊断的青春期儿科患者。进行了社会人口决定因素的描述性分析。175 名患者符合纳入标准。在接受和未接受生育咨询的患者中，种族/民族构成相似。尽管 19.3%的白种人选择了生育力保存，但没有一名非裔美国人或五名西班牙裔女性这样做。科室反馈认为，缺乏有关可用生育力保存选择和应促使进行该对话的诊断的知识是咨询生育力保存团队的障碍。预教育和教育后评估显示，在讨论生育力保存和更易导致不孕的诊断方面的舒适度和知识有所提高。整合标准化的生育力保存流程并解决确定的障碍，使生育讨论的比例增加了 33.6%。生育力保存流程和团队的建立以及全科室教育的开展，提高了儿科和青少年及年轻成年癌症患者的生育讨论率。与年轻成年人的数据相似，我们的数据表明，在儿科肿瘤患者中，生育力保存的利用可能存在一些种族健康差异。
