Stal Julia, Yi Serena Y, Roche Charleen I, Freyer David R, Kim Sue E, Milam Joel E, In Gino K, Miller Kimberly A
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
J Cancer Surviv. 2025 Jun 19. doi: 10.1007/s11764-025-01850-0.
This study aims to explore the integration of American Society of Clinical Oncology (ASCO) guidelines for fertility discussion in clinical practice.
A concurrent triangulation mixed methods design was used. We recruited oncologists from an NCI-designated Comprehensive Cancer Center who treat adolescents and young adults (AYAs) at risk for infertility to participate in a semi-structured qualitative interview and conducted a thematic analysis. Simultaneously, self-report fertility-related data were collected from AYAs (age 18-39) diagnosed at the same institution via self-report survey and were analyzed using descriptive statistics.
Themes reported by oncologists (N = 12; 66.7% female, on average in practice for 14.3 years) included a lack of oncofertility-related training and limited knowledge surrounding fertility discussion guidelines. Those who were aware of guidelines stated that they informed their discussions. Oncologists' perceptions of fertility discussion guidelines were largely positive, though reservations were expressed. Discussions were primarily informed by patient needs and research/literature, but seldom by oncologists' explicit training or experience in oncofertility. Among AYAs (N = 58; 53.5% female, 35.1% Hispanic, on average 32.0 years at diagnosis), 82.3% had a fertility discussion, 62.6% of which occurred with their oncologist. Fertility discussions occurred at some visits (66.7%), and AYAs were very (39.4%) or moderately (27.3%) satisfied with counseling received. Components of ASCO guidelines most often discussed were the timing of preservation and consideration of individual factors in fertility preservation (66.7% each). Patient advocacy resources (33.3%) and informing them that their cancer history does not increase risk of cancer or birth defects in a child (30.3%) were least often discussed.
Awareness of fertility discussion guidelines among oncologists was low, and more than half of AYAs reported only two components of ASCO guidelines were included in fertility discussions with their oncologists. Despite this, AYAs' overall satisfaction with discussions was moderate to high, suggesting adherence to all guideline components may not be necessary for AYAs to derive benefit. While oncologists reported largely positive perceptions of fertility discussion guidelines, several shared that the guidelines themselves may hinder implementation if they do not capture diverse patient scenarios and/or are outdated.
Findings suggest a need to improve oncologists' knowledge surrounding guidelines, refine recommendations to optimize oncofertility counseling, and subsequently improve their integration in practice to ensure AYAs are provided with desired and actionable information to support goal-concordant reproductive decisions.
本研究旨在探讨美国临床肿瘤学会（ASCO）关于生育力讨论的指南在临床实践中的整合情况。
采用同步三角互证混合方法设计。我们从一家美国国立癌症研究所指定的综合癌症中心招募治疗有不孕风险的青少年和青年成人（AYA）的肿瘤学家，让他们参与半结构化定性访谈，并进行主题分析。同时，通过自我报告调查从在同一机构确诊的AYA（年龄18 - 39岁）中收集与生育力相关的自我报告数据，并使用描述性统计进行分析。
肿瘤学家（N = 12；66.7%为女性，平均从业14.3年）报告的主题包括缺乏与肿瘤生育学相关的培训以及围绕生育力讨论指南的知识有限。那些知晓指南的人表示他们会将指南内容纳入讨论。肿瘤学家对生育力讨论指南的看法总体上是积极的，不过也表达了一些保留意见。讨论主要依据患者需求以及研究/文献，但很少依据肿瘤学家在肿瘤生育学方面的明确培训或经验。在AYA（N = 58；53.5%为女性，35.1%为西班牙裔，确诊时平均年龄32.0岁）中，82.3%进行了生育力讨论，其中62.6%是与他们的肿瘤学家进行的。生育力讨论在部分就诊时进行（66.7%），AYA对所接受的咨询非常满意（39.4%）或中度满意（27.3%）。ASCO指南中最常被讨论的内容是保存时机以及生育力保存中个体因素的考量（各占66.7%）。患者宣传资源（33.3%）以及告知他们癌症病史不会增加孩子患癌症或出生缺陷的风险（30.3%）最少被讨论。
肿瘤学家对生育力讨论指南的知晓度较低，超过一半的AYA报告称与肿瘤学家的生育力讨论中仅包含ASCO指南的两个部分。尽管如此，AYA对讨论的总体满意度为中度到高度，这表明AYA要获得益处可能并不需要遵循所有指南部分。虽然肿瘤学家对生育力讨论指南的看法总体上是积极的，但也有一些人指出，如果指南不能涵盖不同患者的情况和/或过时，可能会阻碍其实施。
研究结果表明需要提高肿瘤学家对指南的了解，完善建议以优化肿瘤生育学咨询，并随后加强其在实践中的整合，以确保为AYA提供期望的且可操作的信息，以支持符合目标的生殖决策。
