Who should be offered sperm banking for fertility preservation? A survey of UK oncologists and haematologists

BACKGROUND

Fertility after cancer therapy is a significant quality-of-life concern for many patients, their partners and families. Authoritative guidance states that men whose fertility may be affected by impending therapies should be offered sperm banking. Yet some patients are not offered this opportunity and are thereby disadvantaged. We sought to understand oncologists' and haematologists' decision making concerning sperm-banking referrals.

DESIGN

We surveyed all oncologists and haematologists on the Royal College of Radiotherapists' Faculty of Oncology and British Society for Haematology circulation lists.

RESULTS

From 2357 across all specialties, 499 responses were received: 253 haematologists and 246 oncologists (21% response rate). Twenty-one percent of respondents were unaware of local policies on sperm banking and 42% considered that sperm banking should be offered to more patients. Respondents' decisions reveal either assumptions about patients' needs based on characteristics such as age, sexual orientation and severity of illness or the influence of their own moral conclusions upon their patients. The survey identified paucity of training for clinicians, information for patients and systematic recording of discussions about fertility.

CONCLUSIONS

A robust care infrastructure supporting male fertility storage is needed urgently to include targeted information for cancer clinicians and patients, identified individuals responsible for coordination and documentation of discussions with patients.

The impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation

OBJECTIVE

To determine the impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation.

METHODS

From January 1, 1993, to April 30, 2009, a total of 525 cardiac transplants were performed. Ventricular assist devices were placed as a bridge to transplant in 110 patients. We focused our analysis on the 2 most common causes of end-stage heart failure requiring transplantation: idiopathic dilated cardiomyopathy (n = 201) and coronary artery disease (n = 213). Data including gender, age, date of transplant, cause of heart failure, prior heart transplant, placement of a ventricular assist device, type of ventricular assist device, and panel-reactive antibody sensitization were analyzed to derive Kaplan-Meier survival probabilities and multivariable Cox regression models.

RESULTS

In patients with idiopathic dilated cardiomyopathy who received a ventricular assist device as a bridge to transplant, survival was decreased at 1 year (P = .008) and 5 years (P = .019), but not at 10 years, posttransplant. In patients with coronary artery disease, the use of a ventricular assist device as a bridge to transplant did not influence survival at 1, 5, and 10 tears posttransplant. In patients with idiopathic dilated cardiomyopathy who received a Heartmate I (Thoratec Corp, Pleasanton, Calif) ventricular assist device as a bridge to a cardiac transplant, elevation in the pretransplant panel-reactive antibody correlated with a decrease in long-term survival.

CONCLUSION

In patients with idiopathic dilated cardiomyopathy, placement of a Heartmate I ventricular assist device as a bridge to a cardiac transplant is associated with an elevation in the pretransplant panel-reactive antibody and a decrease in 1- and 5-year survivals after cardiac transplantation.

Second solid cancers after radiotherapy for breast cancer in SEER cancer registries

Background:

Radiotherapy for breast cancer reduces disease recurrence and breast cancer mortality. However, it has also been associated with increased second cancer risks in exposed sites.

Methods:

We evaluated long-term second cancer risks among 182 057 5-year survivors of locoregional invasive breast cancer diagnosed between 1973 and 2000 and reported to US NCI-SEER Program cancer registries. Multivariate Poisson regression was used to estimate the relative risk (RR) and excess cases of second cancer in women who had surgery and radiotherapy, compared with those who had surgery alone. Second cancer sites were grouped according to doses received from typical tangential breast fields.

Results:

By the end of 2005 (median follow-up=13.0 years), 15 498 second solid cancers had occurred, including 6491 contralateral breast cancers. The RRs for radiotherapy were 1.45 (95% confidence interval (CI)=1.33–1.58) for high-dose second cancer sites (1+ Gy: lung, oesophagus, pleura, bone and soft tissue) and 1.09 (1.04–1.15) for contralateral breast cancer (≈1 Gy). These risks decreased with increasing age and year of treatment. There was no evidence of elevated risks for sites receiving medium (0.5–0.99 Gy, RR=0.89 (0.74–1.06)) or low doses (<0.5 Gy, RR=1.01 (0.95–1.07)). The estimated excess cases of cancer in women treated with radiotherapy were as follows: 176 (95% CI=69–284) contralateral breast cancers or 5% (2–8%) of the total in all 1+year survivors, and 292 (222–362) other solid cancers or 6% (4–7%) of the total.

Conclusions:

Most second solid cancers in breast cancer survivors are not related to radiotherapy.

Performing a myocardial biopsy in a cardiac transplant patient with a persistent left superior vena cava

The life expectancy of patients with congenital heart disease is increasing. Thus, as the prevalence of adults with congenital heart disease increases, invasive cardiologists will have more exposure to these patients and will benefit from expertise in the anatomy of congenital heart defects. We present a case of performing right heart catheterization and myocardial biopsy in a cardiac transplant patient with a history of multiple congenital defects including a persistent left superior vena cava.

Adverse Histopathologic Effects of Chemotherapeutic Agents in Childhood Leukemia and Lymphoma

Pathologic material from 84 children with leukemia or lymphoma who died and were autopsied at the University of Wisconsin Hospital between 1967 and 1980 was reviewed to assess the adverse tissue changes due to the chemotherapy administered. In each case the histopathologic findings were correlated with the chemotherapy given. Individual drug dosage is administered (per m2) correlated with the adverse tissue findings at autopsy. Data presented suggest that the drug dose administered should be correlated not only with tumor response but also with tissue effects (some of which produce no noticeable, immediate, clinically apparent changes) to decrease the likelihood of producing irreversible tissue changes.