Naert Mackenzie, Sorouri Kimia, Lanes Andrea, Kempf Abigail M, Chen Lucy, Goldman Randi, Partridge Ann H, Ginsburg Elizabeth, Srouji Serene S, Walker Zachary
Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Cancer Med. 2025 Feb;14(3):e70529. doi: 10.1002/cam4.70529.
Given the known detrimental impact of cancer treatment on fertility, fertility preservation (FP) is recommended for reproductive age patients who are newly diagnosed with cancer. However, the rate of referral to fertility specialists remains suboptimal. The objective of this study was to determine the impact of a dedicated Nurse Navigator Program (NNP) on the rate of referrals and utilization of FP services.
A retrospective cohort study of all women ≥ 18 years old referred for FP consultation with a known cancer diagnosis from 2007 to 2021 at a single, large academic center was conducted. FP referrals for non-cancer indications were excluded. Descriptive statistics were performed including comparing referrals received per 30 days and FP utilization rates pre-NNP (October 2007-September 2013) to post-NNP (October 2013-December 2021).
A total of 176 patients were included pre-NNP and 990 patients post-NNP. Overall, the mean age at the time of referral was 31.5 ± 6.9 years. The referral rates post-NNP were higher among those without prior exposure to chemotherapy/radiation (0.33 pre-NNP vs. 2.75 post-NNP per 30 days, p < 0.01) and lower among those with prior exposure to chemotherapy/radiation (1.26 pre-NNP vs. 0.70 post-NNP per 30 days, p < 0.01).
After the launch of a dedicated fertility preservation nurse navigation program at our institution, we observed a higher number of referrals for FP as well as greater use of FP overall. While not the only variable that changed during this period, this program has optimized patient care and clinical workflow at our institution and serves as a model for such improvement.
鉴于癌症治疗对生育能力已知的有害影响，对于新诊断出癌症的育龄患者，建议进行生育力保存（FP）。然而，转介至生育专家处的比例仍不理想。本研究的目的是确定专门的护士导航计划（NNP）对FP服务的转介率和利用率的影响。
对2007年至2021年在一个大型学术中心因已知癌症诊断而被转介进行FP咨询的所有≥18岁女性进行回顾性队列研究。排除非癌症指征的FP转介。进行描述性统计，包括比较NNP实施前（2007年10月至2013年9月）和NNP实施后（2013年10月至2021年12月）每30天收到的转介数量和FP利用率。
NNP实施前共纳入176例患者，NNP实施后共纳入990例患者。总体而言，转介时的平均年龄为31.5±6.9岁。在未接受过化疗/放疗的患者中，NNP实施后的转介率更高（NNP实施前每30天为0.33，NNP实施后为2.75，p<0.01）；在接受过化疗/放疗的患者中，NNP实施后的转介率更低（NNP实施前每30天为1.26，NNP实施后为0.70，p<0.01）。
在我们机构启动专门的生育力保存护士导航计划后，我们观察到FP的转介数量增加，总体上对FP的使用也更多。虽然这不是在此期间唯一发生变化的变量，但该计划优化了我们机构的患者护理和临床工作流程，并成为此类改进的典范。
