Clinical Operations, Cancer Screening, University of Miami, Miami, FL, USA.
AYA Oncology, Cook Children's Medical Center, Fort Worth, TX, USA.
J Pediatr Hematol Oncol Nurs. 2024 May-Jun;41(3):212-219. doi: 10.1177/27527530231221134. Epub 2024 Mar 24.
As the majority of pediatric patients with cancer survive their disease, generating a population of over 500,000 childhood cancer survivors in the United States, it is imperative to minimize the lifelong consequences of treatment, which include temporary or permanent infertility caused by certain cancer treatments. A fertility consultation at diagnosis can provide patients and families with the opportunity to be informed regarding the likelihood of gonadal dysfunction and to consider fertility preservation. After our pediatric hospital started to offer tissue cryopreservation, we initiated this evidence-based interventional quality improvement project. Our primary aim was to ensure that all newly diagnosed prepubertal patients with cancer who met the criteria for fertility tissue preservation were correctly identified and offered an educational consultation and preservation. Between July 15, 2022 and October 30, 2022, 54 patients' treatment plans were evaluated to determine treatment-related infertility risk using the Oncofertility Consortium Pediatric Initiative Network's Risk Assessment tool. Fifteen patients were at a high level of significantly increased risk and 13 were eligible for consultation. Seven (46%) patients and their families received a consultation. Initiation of treatment before referral was the primary reason for lack of consultation. Six of seven patients receiving consultation (86%) elected to undergo preservation. Preservation procedures did not cause a delay in starting treatment for those patients. A fertility preservation program with established policies and processes can increase the likelihood that prepubertal patients at high risk for infertility are correctly identified, educated, and offered preservation.
由于大多数患有癌症的儿科患者能够幸存下来，美国目前有超过 50 万名儿童癌症幸存者，因此必须将治疗带来的终身影响降到最低，其中包括某些癌症治疗导致的暂时性或永久性不育。在诊断时进行生育咨询可以为患者及其家属提供了解性腺功能障碍可能性的机会，并考虑进行生育力保存。在我们的儿童医院开始提供组织冷冻保存后，我们启动了这项基于证据的干预性质量改进项目。我们的主要目标是确保所有符合生育组织保存条件的新诊断为青春期前的癌症患者都能被正确识别，并提供教育咨询和保存服务。2022 年 7 月 15 日至 10 月 30 日，我们使用 Oncofertility 联盟儿科倡议网络风险评估工具评估了 54 名患者的治疗计划，以确定与治疗相关的不孕风险。15 名患者处于高度显著增加的风险中，13 名患者有资格进行咨询。有 7 名（46%）患者及其家属接受了咨询。在转介前开始治疗是缺乏咨询的主要原因。接受咨询的 7 名患者中的 6 名（86%）选择进行保存。保存程序不会延迟这些患者开始治疗的时间。有明确政策和流程的生育力保存计划可以提高识别、教育和提供保存服务的高不孕风险青春期前患者的可能性。
