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Reproductive options for female cancer patients: balancing hope and realistic expectation. Curr Opin Oncol 2015; 26:501-7. [PMID: 25046204 DOI: 10.1097/cco.0000000000000105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To review currently available options in fertility preservation in cancer patients, report on emerging techniques, and highlight the importance of time sensitivity and recording of outcomes. RECENT FINDINGS Fertility preservation in cancer patients is a rapidly expanding area of medicine. Recent success with experimental techniques such as oocyte cryopreservation and ovarian tissue cryopreservation exemplify the need for follow-up data collection. SUMMARY Results of fertility outcomes in cancer patients should form an integral and important part of the pretreatment counselling process for cancer patients but limited published data from larger cohorts exist. The formation of a growing fertility preservation database would, therefore, allow ease of data analysis and more robust results.
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Brezina PR, Kutteh WH, Bailey AP, Ding J, Ke RW, Klosky JL. Fertility Preservation in the Age of Assisted Reproductive Technologies. Obstet Gynecol Clin North Am 2015; 42:39-54. [DOI: 10.1016/j.ogc.2014.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vadaparampil ST, Hutchins NM, Quinn GP. Reproductive health in the adolescent and young adult cancer patient: an innovative training program for oncology nurses. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:197-208. [PMID: 23225072 PMCID: PMC3610840 DOI: 10.1007/s13187-012-0435-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In 2008, approximately 69,200 adolescents and young adults (AYAs) were diagnosed with cancer, second only to heart disease for males in this age group. Despite recent guidelines from professional organizations and clinical research that AYA oncology patients want information about reproductive health topics and physician support for nurses to address these issues with patients, existing research finds few oncology nurses discuss this topic with patients due to barriers such as lack of training. This article describes an innovative eLearning training program, entitled Educating Nurses about Reproductive Issues in Cancer Healthcare. The threefold purpose of this article is to: (1) highlight major reproductive health concerns relevant to cancer patients, (2) describe the current status of reproductive health and oncology communication and the target audience for the training, and (3) present a systematic approach to curriculum development, including the content analysis and design stages as well as the utilization of feedback from a panel of experts. The resulting 10-week curriculum contains a broad-based approach to reproductive health communication aimed at creating individual- and practice-level change.
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Quinn GP, Knapp CA, Malo TL, McIntyre J, Jacobsen PB, Vadaparampil ST. Physicians' undecided attitudes toward posthumous reproduction: fertility preservation in cancer patients with a poor prognosis. ACTA ACUST UNITED AC 2012; 10:160-5. [PMID: 22266153 DOI: 10.1016/j.suponc.2011.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/02/2011] [Accepted: 09/16/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Society for Clinical Oncology (ASCO) established guidelines for fertility preservation for cancer patients. In a national study of US oncologists, we examined attitudes toward the use of fertility preservation among patients with a poor prognosis, focusing on attitudes toward posthumous reproduction. METHOD A cross-sectional survey was administered via mail and Internet to a stratified random sample of US oncologists. The survey measured demographics, knowledge, attitude, and practice behaviors regarding posthumous reproduction and fertility preservation with cancer patients of childbearing age. RESULTS Only 16.2% supported posthumous parenting, whereas the majority (51.5%) did not have an opinion. Analysis of variance indicated that attitudes toward posthumous reproduction were significantly related to physician practice behaviors and were dependent on oncologists' knowledge of ASCO guidelines. CONCLUSIONS Physician attitudes may conflict with the recommended guidelines and may reduce the likelihood that some patients will receive information about fertility preservation. Further education may raise physicians' awareness of poor-prognostic patients' interest in pursuing this technology.
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Affiliation(s)
- Gwendolyn P Quinn
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
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Fertility Preservation Options for Females. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:9-28. [DOI: 10.1007/978-94-007-2492-1_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Quinn GP, Vadaparampil ST, Lee JH, Jacobsen PB, Bepler G, Lancaster J, Keefe DL, Albrecht TL. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol 2009; 27:5952-7. [PMID: 19826115 DOI: 10.1200/jco.2009.23.0250] [Citation(s) in RCA: 292] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Cancer survival rates are improving, and the focus is moving toward quality survival. Fertility is a key aspect of quality of life for cancer patients of childbearing age. Although cancer treatment may impair fertility, some patients may benefit from referral to a specialist before treatment. However, the majority of studies examining patient recall of discussion and referral for fertility preservation (FP) show that less than half receive this information. This study examined the referral practices of oncologists in the United States. METHODS This study examined oncologists' referral practice patterns for FP among US physicians using the American Medical Association Physician Masterfile database. A 53-item survey was administered via mail and Internet to a stratified random sample of US physicians. RESULTS Forty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist. Referrals were more likely among female physicians (P = .004), those with favorable attitudes (P = .043), and those whose patients routinely ask about FP (odds ratio = 2.09; 95% CI, 1.31 to 3.33). CONCLUSION Less than half of US physicians are following the guidelines from the American Society of Clinical Oncology, which suggest that all patients of childbearing age should be informed about FP.
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Affiliation(s)
- Gwendolyn P Quinn
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
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Discussion of fertility preservation with newly diagnosed patients: oncologists' views. J Cancer Surviv 2008; 1:146-55. [PMID: 18648955 DOI: 10.1007/s11764-007-0019-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Although physician discussion with patients regarding fertility preservation (FP) options prior to cancer treatment can provide important information for survivors concerning their future fertility, little is known about the extent to which physicians discuss FP with patients. This qualitative study sought to identify current physician FP communication practices and determine factors that may impact communication efforts regarding FP. MATERIALS AND METHODS Qualitative data were collected using semi structured interviews with 16 physicians practicing at a major cancer center in the South. RESULTS All providers were board certified in medical oncology, radiation oncology or surgical oncology. The main factors that emerged from qualitative analysis included distinct variations in quality of discussion about FP, knowledge of FP resources, attitudes, practice behaviors and perceptions of patient characteristics. DISCUSSION While most physicians discussed potential fertility loss as a side effect of cancer treatment, few provided information to patients about preserving fertility. Patient characteristics such as gender and cancer site may impact the discussion, as well as system factors such as costs of procedures and access to FP resources. Education and training for physicians about FP options for cancer patients, particularly females, may promote discussion of FP. In addition, system barriers related to availability and affordability of FP resources must also be addressed. IMPLICATIONS FOR CANCER SURVIVORS Physicians should consider providing patients with timely, understandable information related to their FP options, prior to the administration of treatment. Such discussions may lead to improved quality of life for individuals as they transition from patients to survivors.
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Bashore L. Semen Preservation in Male Adolescents and Young Adults With Cancer: One Institution's Experience. Clin J Oncol Nurs 2007; 11:381-6. [PMID: 17623622 DOI: 10.1188/07.cjon.381-386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Semen preservation is a feasible procedure for male adolescents and young adults who may become infertile as a result of cancer therapy. Treatment for several pediatric malignancies puts adolescents and young adults at a significant risk for fertility dysfunction. Eligible male adolescents and young adults (N = 32) treated from January 2004 to June 2005 at Cook Children's Medical Center were offered semen preservation at the time of diagnosis or presentation to the center for treatment. Fifteen (47%) young men were successful in semen preservation. Two (6%) adolescents did not participate because of parental refusal. Seven (22%) were too ill, and eight (25%) failed to produce an adequate sample. Several patients were not successful because of time constraints, lack of counseling, and parental anxiety. Efforts for success in semen preservation should include private discussions between nurses and adolescents. In addition, information on infertility needs to be given to families early in the diagnostic phase to provide them with an opportunity to ask questions.
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Affiliation(s)
- Lisa Bashore
- Cook Children's Medical Center, Fort Worth, TX, USA.
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GILANI MM, HASANZADEH M. Protecting female fertility in cancer patients. Asia Pac J Clin Oncol 2006. [DOI: 10.1111/j.1743-7563.2006.00060.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ginsberg JP, Womer RB. Preventing organ-specific chemotherapy toxicity. Eur J Cancer 2005; 41:2690-700. [PMID: 16243514 DOI: 10.1016/j.ejca.2005.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 05/18/2005] [Indexed: 11/25/2022]
Abstract
Recent advances in treatment for pediatric cancers has increased overall survival rates. As more and more survive pediatric cancer, we continue to see the emergence of late effects of treatment within pediatric and the growing adult survivor population. The evaluation of late effects was initiated approximately two decades ago, and has become an extremely important facet of pediatric oncology. This review delves into several of the most serious organ-specific late effects of pediatric cancer treatment, outline what we know and what we do not currently understand about preventing or reducing them. Clinical and bench research are necessary to develop interventions that will avoid or mitigate late effects and improve the health of pediatric cancer survivors.
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Affiliation(s)
- Jill P Ginsberg
- The Division of Oncology, Department of Paediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA
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Chatterjee R, Kottaridis PD. Treatment of gonadal damage in recipients of allogeneic or autologous transplantation for haematological malignancies. Bone Marrow Transplant 2002; 30:629-35. [PMID: 12420200 DOI: 10.1038/sj.bmt.1703721] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Management of iatrogenic gonadal reproductive failure and sexual morbidity assumes a priority, especially in young recipients of high-dose chemotherapy and stem cell transplantation (SCT). Hormone replacement treatment (HRT) is beneficial for correction of sexual symptoms and osteoporosis in both sexes, especially in females. Sperm banking is the standard technique for preservation of fertility in adult and sexually mature adolescent males. Testicular tissue cryopreservation has a place in well-selected azoospermic adults and in mentally and sexually competent adolescents. In vitro fertilisation using superovulation with embryo-cryopreservation (for future embryo transfer) is the most tried method in female SCT recipients with good results. In mentally and sexually competent adolescents and adults without a partner, ovarian cortical tissue cryopreservation has a place for subsequent re-implantation to orthotopic or heterotopic sites. Gonadotrophin releasing hormone (GnRH) co-treatment during chemotherapy, is a promising method for the future. Although generally reassuring, continued monitoring of the offspring of SCT survivors and follow-up of all recipients of SCT is important for return of spontaneous or induced fertility.
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Affiliation(s)
- R Chatterjee
- Department of Obstetrics, University College London Medical School, London, UK
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Abstract
This study reviews the common long-term sequalae of childhood cancer and its therapy. It discusses the clinical and research challenges posed by such late effects. The authors address related topics of late effects research and clinical care, methodological issues, barriers and directions for the future.
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Affiliation(s)
- Debra L Friedman
- Division of Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 98117, USA.
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Burton KA, Wallace WHB, Critchley HOD. Female reproductive potential post-treatment for childhood cancer. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2002; 63:522-7. [PMID: 12357853 DOI: 10.12968/hosp.2002.63.9.1946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Survival post-treatment for childhood malignancy is now in excess of 70%. Hence female reproductive potential following treatment must be addressed. Issues concerning subsequent uterine and ovarian function, fertility options and importantly the ethics and safety of treatment approaches are discussed herein.
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Affiliation(s)
- Kevin A Burton
- Department of Obstetrics and Gynaecology, Glasgow Royal Infirmary, Glasgow
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Poirot C, Vacher-Lavenu MC, Helardot P, Guibert J, Brugières L, Jouannet P. Human ovarian tissue cryopreservation: indications and feasibility. Hum Reprod 2002; 17:1447-52. [PMID: 12042259 DOI: 10.1093/humrep/17.6.1447] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The cryopreservation of ovarian tissue may enable women exposed to gonadotoxic treatments to have children at a later date. METHODS Between April 1998 and October 2000, we evaluated the feasibility of long-term ovarian tissue cryopreservation in 51 women who were all at risk of becoming sterile following treatment. RESULTS Ovarian tissue was not cryopreserved in 20 cases because of the woman's age or premature ovarian failure. In 31 patients, ovarian tissue was frozen by a slow cooling technique using DMSO and sucrose as cryoprotectants. The patients were aged 2.7-34 years and 16 of them were <18 years old. Cryopreservation could be performed in all cases. Ovarian cortex histology was performed for all patients to evaluate the concentration of follicles. The mean number of primordial and primary follicles per mm(2) was 20.36 +/- 19.03 before 10 years of age, 4.13 +/- 2.9 between 10 and 15 years of age and 1.63 +/- 3.35 after 15 years of age. An average mean number of 26 +/- 8.2 ovarian fragments (range 13-50) were cryopreserved per patient for future autografts or for in-vitro growth of follicles. CONCLUSION Cryopreservation of ovarian tissue may be systematically proposed to young women and girls at risk of becoming sterile as a result of gonadotoxic treatment.
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Affiliation(s)
- Catherine Poirot
- Laboratoire de Biologie de la Reproduction, Groupe Hospitalier Pitié-Salpêtrière, Université Paris VI, 75013 Paris, France.
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Letur-Könirsch H, Guis F, Delanian S. Uterine restoration by radiation sequelae regression with combined pentoxifylline-tocopherol: a phase II study. Fertil Steril 2002; 77:1219-26. [PMID: 12057732 DOI: 10.1016/s0015-0282(02)03120-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether combined pentoxifylline (PTX) and tocopherol (vitamin E) treatment can improve uterine radiation-induced sequelae, resulting in an improved embryo implantation rate. DESIGN Retrospective phase II clinical trial. SETTING Volunteers in an oocyte donation program in a public hospital. PATIENT(S) Six women aged 31 +/- 4 years, who were irradiated 25 years previously for childhood cancer with 20 to 40 Gy including the pelvic area. INTERVENTION(S) Four women had taken hormone replacement therapy for primary amenorrhea, and two had retained their natural cycle. Treatment consisted of at least 12 months of pentoxifylline at 800 mg/day combined with 1000 IU/day of tocopherol. MAIN OUTCOME MEASURE(S) Endometrial thickness, uterine volume, and uterine artery blood flow were assessed by ultrasonography before and after pentoxifylline-tocopherol treatment, under usual estrogen-progesterone (OP) administration. RESULT(S) This treatment was well tolerated. All six patients improved significantly in endometrial thickness (6.2 +/- 0.6 vs. 3.2 +/- 1.1 mm), myometrial dimensions (44 [+/- 5] x 30 [+/- 3] x 20 [+/- 2] vs. 30 [+/- 7] x 22 [+/- 3] x 16 [+/- 2] mm), and diastolic uterine artery flow. CONCLUSION(S) In young women who want to bear children, the combination of pentoxifylline and vitamin E can reduce fibroatrophic uterine lesions after childhood irradiation.
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Affiliation(s)
- Hélène Letur-Könirsch
- Fertility Center, Department of Obstetrics and Assisted Reproductive Technics, Institut Mutualiste Montsouris, Paris, France.
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McLaughlin EA. Cryopreservation, screening and storage of sperm the challenges for the twenty-first century. HUM FERTIL 2002; 5:S61-5. [PMID: 11897918 DOI: 10.1080/1464727022000199941] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The advent of HIV and the serious nature of the sequelae resulted in a major reassessment of artificial insemination practices in the UK. The development of human semen cryopreservation had enormous impact on reproductive medicine and the availability of cryopreserved quarantined donor semen became a mainstay for the treatment of male infertility in the UK. The regulation and accreditation of assisted reproductive technologies and the introduction of peer-reviewed guidelines have largely standardized clinical and laboratory practice. The introduction of assisted fertilization techniques such as intracytoplasmic sperm injection, testicular sperm retrieval and improved oncology treatments have placed pressure on reproductive biologists and cryobiologists to design and use cryopreservation protocols for the optimum survival of sperm.
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Affiliation(s)
- Eileen A McLaughlin
- University of Bristol Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol BS2 8EG, UK
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Moore HC. Fertility and the impact of systemic therapy on hormonal status following treatment for breast cancer. Curr Oncol Rep 2000; 2:587-93. [PMID: 11122897 DOI: 10.1007/s11912-000-0114-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Issues of long-term toxicity from treatment for breast cancer, including the induction of premature ovarian failure, appear to be of increasing importance for breast cancer survivors. The incidence of treatment-related amenorrhea is related to patient age and to the treatment regimen. Whereas the induction of ovarian failure may be advantageous with respect to breast cancer outcome, it is not clear that there is any advantage to permanent menopause over reversible hormonal manipulations. In addition, menopause may be associated with a variety of adverse health effects. Although nonhormonal therapies are available to manage many of the consequences of menopause, avoidance of chemotherapy-related ovarian toxicity may provide the best prospects for fertility after treatment. Pregnancy after breast cancer is a realistic consideration for some breast cancer survivors and is not clearly detrimental to either the mother or her offspring.
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Affiliation(s)
- H C Moore
- Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Glaser A, Wilkey O, Greenberg M. Sperm and ova conservation: existing standards of practice in North America. MEDICAL AND PEDIATRIC ONCOLOGY 2000; 35:114-8. [PMID: 10918233 DOI: 10.1002/1096-911x(200008)35:2<114::aid-mpo5>3.0.co;2-k] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PROCEDURE Rapid advances have occurred in both reproductive medicine and survival from childhood cancer. To establish the current level of best clinical practice for sperm, ovarian, and prepubertal tissue collection and storage, a cross-sectional survey of a major pediatric oncology collaborative study group (Pediatric Oncology Group, POG) was performed. RESULTS Of the 110 centers surveyed, 69 questionnaires (63%) were completed. No responding center had guidelines regarding which young people should be offered sperm, ovarian, or prepubertal testicular tissue conservation; 93% centers had offered sperm and 10% ova conservation; 15% had offered sperm conservation to males prior to completion of sexual development and 3% to girls prior to sexual maturation. All centers were more likely to offer sperm conservation than ova conservation for any given disease. The most common diseases for which conservation was offered were Hodgkin and non-Hodgkin lymphoma, and sarcomas. Fertility counseling was offered in a variety of settings by 71% of centers by health care professionals, including doctors, nurses, social workers, psychologists, and geneticists. CONCLUSION There was little agreement regarding appropriate indications for, and method of, gamete preservation in children's cancer centers. It is hard to establish best clinical practice from these data. Unresolved medical, legal, and ethical issues necessitate the development of a voluntary code of practice and guidelines in order to ensure good clinical practice.
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Affiliation(s)
- A Glaser
- Division of Oncology, Hospital for Sick Children, Toronto, Canada.
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