Purpose

Fertility is a quality of life outcome adversely affected by cancer therapy. Many childhood cancer patients, however, are not offered options to preserve their fertility. Providers acknowledge difficulty discussing impaired fertility to patients due to lack of knowledge of available options. Our objective was to review the impact of a pediatric multidisciplinary fertility preservation program on providers’ fertility preservation counseling and discussion of options.

Methods

A retrospective medical chart review was conducted for pediatric cancer patients prior to and following program establishment. Fertility preservation discussions, consults, and incidence were noted. Following filtering and stratification, 198 and 237 patients were seen prior to and following program establishment, respectively.

Results

Following program establishment, provider–patient discussions of impaired fertility (p = 0.007), fertility preservation consults (p = 0.01), and incidence of fertility preservation procedures (p < 0.001) increased among patients. Furthermore, the number of patients who received fertility preservation consults after receiving gonadotoxic treatment decreased (p < 0.001). This trend was particularly noted in pre-pubertal and female patients, for whom fertility preservation options are limited without an established program.

Conclusion

The establishment of a formal program greatly improved access to fertility preservation consults and procedures in children with cancer.

中文翻译：

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为癌症儿童制定生育力保留计划后，咨询并处理发病率结果

 目的

生育能力是一种受到癌症治疗不利影响的生活质量结果。然而，许多儿童癌症患者没有获得保留生育能力的选择。医疗服务提供者承认，由于缺乏对可用选择的了解，很难讨论患者的生育能力受损问题。我们的目的是回顾儿科多学科生育力保存计划对提供者的生育力保存咨询和选项讨论的影响。

 方法

在计划建立之前和之后对儿科癌症患者进行了回顾性病历审查。记录了生育力保存讨论、咨询和发生率。经过筛选和分层后，在计划建立之前和之后分别接待了 198 名患者和 237 名患者。

 结果

计划建立后，患者中关于生育能力受损 ( p = 0.007)、生育力保留咨询 ( p = 0.01) 和生育力保留手术发生率 ( p < 0.001) 的提供者与患者讨论有所增加。此外，接受性腺毒性治疗后接受生育力保留咨询的患者数量有所减少 ( p < 0.001)。这种趋势在青春期前和女性患者中尤其明显，因为如果没有既定的计划，她们的生育力保留选择就很有限。

 结论

正式计划的建立极大地改善了癌症儿童获得生育力保留咨询和手术的机会。