Reproductive health in the adolescent and young adult cancer patient: an innovative training program for oncology nurses

Meeting proceedings: International Society for Fertility Preservation Tokyo, 15-17 November, 2024

The 8 th International Congress of the ISFP was held in Tokyo, Japan, from November 15 to 17, 2024. The theme of this year's Congress was "Rethinking Personalized Fertility Preservation and Cancer Survivors-Opening a New Frontier". The congress featured special lectures, keynote addresses, and 25 sessions-including a dedicated session on nursing and oral presentations by young doctors and researchers-making it one of the largest and most comprehensive events in the ISFP's history. Additionally, the program incorporated sessions featuring the Japanese, Korean, and Chinese Societies for Fertility Preservation, providing a convenient platform for international participants from across the globe to showcase their work and discuss the unique characteristics and challenges of these areas within Asia. Participants also had the opportunity to attend workshops on ovarian tissue cryopreservation and oocyte cryopreservation, conducted by leaders in their respective fields exploring the latest technological and clinical advances and translational prospects for the future.

Impact of a Nurse Navigator Program on Referral Rates and Use of Fertility Preservation Among Female Cancer Patients: A 14-Year Retrospective Cohort Study

INTRODUCTION

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

"Management of andrological disorders from childhood and adolescence to transition age: guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS) in collaboration with the Italian Society for Pediatric Endocrinology and Diabetology (SIEDP)-Part-1"

PURPOSE

Andrological pathologies in the adulthood are often the results of conditions that originate during childhood and adolescence and sometimes even during gestation and neonatal period. Unfortunately, the reports in the literature concerning pediatric andrological diseases are scares and mainly concerning single issues. Furthermore, no shared position statement are so far available.

METHODS

The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving the Italian Society of Pediatric Endocrinology and Diabetology (SIEDP) to provide an updated guideline on the diagnosis and management of andrological disorders from childhood and adolescence to transition age. Derived recommendations were based on the grading of recommendations, assessment, development, and evaluation (GRADE) system.

RESULTS

A literature search of articles in English for the term "varicoceles", "gynecomastia", "fertility preservation", "macroorchidism", "precocious puberty" and "pubertal delay" has been performed. Three major aspects for each considered disorder were assessed including diagnosis, clinical management, and treatment. Recommendations and suggestions have been provided for each of the mentioned andrological disorders.

CONCLUSIONS

These are the first guidelines based on a multidisciplinary approach that involves important societies related to the field of andrological medicine from pediatric to transition and adult ages. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving andrological and general health of the transitional age.

Clinicians' perspectives on barriers and facilitators to sperm banking in adolescent males with cancer: a mixed-methods study

PURPOSE

To examine processes, barriers, and facilitators to sperm banking counseling and decision-making for adolescent males newly diagnosed with cancer from the perspective of clinicians who completed Oncofertility communication training. We also identify opportunities for improvement to inform future interventions and implementation.

METHODS

A survey (N=104) and subsequent focus groups (N=15) were conducted with non-physician clinicians practicing in pediatric oncology who completed Oncofertility communication training.

RESULTS

Most survey participants were confident in communicating about the impact of cancer on fertility (n=87, 83.7%) and fertility preservation options (n=80, 76.9%). Most participants reported never/rarely using a sperm banking decision tool (n=70, 67.3%), although 98.1% (n=102) said a decision tool with a family-centered approach would be beneficial. Primary themes in the subsequent focus groups included variable processes/workflows (inconsistent approaches to consult initiation; involvement of adolescents, caregivers, and various clinician types; assessment of puberty/sexual experience), structural and psychosocial barriers (cost and logistics, developmental, cultural, clinical acuity/prognosis), and facilitators (educational materials, alternative options for banking). Opportunities and strategies for improvement (including fertility preservation in existing research protocols; additional staffing/resources; oncologist education and buy-in; and development of decision tools) were informed by challenges identified in the other themes.

CONCLUSION

Barriers to adolescent sperm banking remain, even among clinicians who have completed Oncofertility training. Although training is one factor necessary to facilitate banking, structural and psychosocial barriers persist. Given the complexities of offering sperm banking to pediatric populations, continued efforts are needed to mitigate structural barriers and develop strategies to facilitate decision-making before childhood cancer treatment.

For the LOvE of Reproductive Health Communication: Assessment of the LGBT Oncofertility Education (LOvE) Module

Purpose: The lesbian, gay, bisexual, transgender, and queer (LGBTQ) Oncofertility Education (LOvE) module aims to improve knowledge on providing inclusive and affirming care for LGBTQ adolescents and young adults (AYAs) with cancer. The objective of this study is to evaluate the role of the module in improving reproductive health communication for the care of LGBTQ AYAs with cancer. Methods: A 10-item multiple-choice pre-test and post-test assessed learner knowledge, with total knowledge scores ranging from 0 (no correct responses) to 10 (all correct responses). A post-module survey and open-ended questions assessed relevance of the module, quality, and appropriateness to professional practice. Paired t-tests analyzed changes in knowledge before and after the module. Content analysis was applied to qualitative responses. Results: Thirty-seven learners completed both the pre-test and post-test. Around 8.1% correctly answered all pre-test questions; 59.5% correctly answered all posttest questions. The average pre-test score was 8.3, versus posttest score of 9.5 (p < 0.0001). Eighty-nine percent of learners strongly agreed that LOvE Enriching Communication Skills for Health Professionals in Oncofertility was relevant to their work; 95% strongly agreed that it was easy to understand and navigate. Open-ended responses highlighted how the module helped learners strengthen the provider-patient relationship in the context of oncofertility, create a safe space for patients, and understand the relevance of educational materials about fertility to LGBTQ patients. Conclusions: We found significant improvement in knowledge of reproductive health care for LGBTQ AYAs with cancer after completing the module. Improving provider knowledge may improve confidence in providing inclusive and affirming care for LGBTQ AYAs with cancer, resulting in improved whole-person care.

Perceptions of Oncology Nurses Regarding Fertility Preservation and Providing Oncofertility Services for Men of Childbearing Age with Cancer

This study investigated the knowledge, thoughts, and attitudes of oncology nurses in China regarding fertility preservation for male cancer patients of childbearing age, and for offering counseling or oncofertility services for the men in their care. Data was collected from 18 oncology nurses in Southwest China through voluntary self-report and in-depth interviews. The qualitative interview data were analyzed using a descriptive phenomenology method based on the lived experience of the nurses. The interviewees commonly reported 6 main concerns regarding fertility preservation (FP): their insufficient knowledge and inadequate nursing education; the importance of offering such services to cancer patients; legal vulnerability if FP information is withheld from patients; the role of the nurse in counseling; and barriers to discussing FP in practice. Nurses had a positive attitude toward FP, but most had no practical role in routinely informing male patients of their options, and the nurses believed that discussion of FP was outside their scope of practice. This study offers insight into the perceptions of oncology nurses in a developing country regarding the provision of FP services for adult male cancer patients. These results lead us to recommend that local fertility nurses should be given new training regarding FP. Furthermore, nurse-led clinics are desirable. Future research should focus on the effectiveness of nurse participation in FP counseling and referral, and how to improve the professional confidence of oncology nurses for addressing FP issues.

"Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research

This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.

Oncofertility Knowledge Among Internal Medicine Residents in an Academic Center in Mexico

Guidelines recommend discussing fertility preservation with patients with cancer. In Mexico, internists frequently are the primary care provider (PCP) for adults in reproductive age. The knowledge of oncofertility among PCPs in low and middle income countries is poorly known. Internal medicine residents in a tertiary care hospital in Mexico City participated in a survey regarding fertility concepts in cancer patients. Sixty-three residents participated; their median age was 27. Thirty percent reported 0% self-perceived confidence for providing counseling about fertility issues, and 26% reported more than 50% self-perceived confidence. Twenty-eight percent reported not asking patients in reproductive age about satisfied parity/paternity. Eighty-one percent correctly identified patients that should receive fertility counseling, and 68% identified alkylating chemotherapy as having the highest risk of infertility. Fifty-four percent were able to name at least one fertility preservation (FP) strategy for males, whereas 49% were able to name at least one strategy in females. Residents who reported at least 50% self-perceived confidence for providing fertility counseling were more likely to name at least one FP strategy for men (64.7%) versus those who reported less than 50% self-perceived confidence (52.1%), but this result was not statistically significant (p = 0.378). This was similar for FP strategies in women, with 64.7% of more confident residents naming at least one, compared with 43.4% of less confident residents (p = 0.134). Knowledge of FP in patients with cancer is insufficient among internal medicine residents in our institution. Inclusion of oncofertility concepts in the internal medicine program is needed.

Development and pilot testing of a training for bilingual community education professionals about hereditary breast and ovarian cancer among Latinas: ÁRBOLES Familiares

Cancer health disparities remain a significant problem in the USA, compounded by lack of access to care, language barriers and systemic biases in health care. These disparities are particularly evident in areas such as genetics/genomics. For example, Latinas at high risk for hereditary breast and ovarian cancer (HBOC) have extremely low rates of genetic counseling/testing. Long-standing barriers and inequities in access to services such as genetic counseling and testing require innovative solutions. One solution can involve training community outreach and education professionals (CORE-Ps) to bridge the gap between underserved communities and genetic specialists. We sought to develop and pilot test a training program for English-Spanish bilingual CORE-Ps to reduce disparities in access to and uptake of genetic services among Latino populations. Guided by Adult Learning Theory and with input from multiple stakeholders, we developed ÁRBOLES Familiares (Family Trees), an in-person and online training program for bilingual CORE-Ps to facilitate identification, referral, and navigation of Latinas to genetic counseling/testing. We conducted a pilot test of 24 CORE-Ps recruited from across the United States and assessed knowledge, genetic literacy, and self-efficacy at baseline and follow-up. At follow-up, participants in the pilot with complete baseline and follow-up data (N = 15) demonstrated significant improvements in HBOC knowledge, genetic literacy, self-efficacy and reports of fewer barriers to identify/navigate Latinas (ps < .05). Qualitative assessment identified ways to improve the training curriculum. Pilot results suggest ÁRBOLES is a promising approach for training CORE-Ps to identify and refer high-risk Latinas to genetic services. Next steps involve further refinement of ÁRBOLES, development of an online toolkit, and adaptation for virtual delivery.

Fex-Talk: a Short Educational Intervention Intended to Enhance Nurses' Readiness to Discuss Fertility and Sexuality with Cancer Patients

Sexual and reproductive health is known to generally be insufficiently addressed by health care personnel working in cancer care. We hence developed a short educational intervention, Fex-Talk, to overcome the barriers to communicate about sexuality and fertility. The present study sought to evaluate the Fex-Talk intervention, which aims to enhance nurses' readiness to discuss fertility and sexuality issues with cancer patients. The educational intervention involves a single session with an optional follow-up session, and it includes different components in accordance with Kolb's experiential learning cycle. The evaluation was based on participants' oral and written feedback regarding the content and organization of the intervention, as well as on teachers' field notes from five educational events involving nurses who work with cancer patients (n = 140). The data were analyzed using a thematic approach. Four themes were identified, namely increased awareness, need for knowledge, challenging discomfort, and dealing with external obstacles. The intervention increased participants' awareness of patients' need to discuss sexuality and fertility and of their own need for additional knowledge. The role-play exercise was said to challenge personal discomfort, although the participants still felt it helped to boost their courage to, in the future, engage in such conversations. Several external obstacles to initiate a conversation about sexuality or fertility were identified, and possible strategies for overcoming them were discussed. In conclusion, the Fex-Talk intervention was experienced positively by the participating nurses. The results indicate that the intervention increased nurses' understanding of patients' needs related to sex and fertility and overcome barriers to initiate discussions about sex and fertility with patients.

CNS Tumors in Adolescents and Young Adults: The Need for a Holistic Specialized Approach

CNS tumors are one of the most common causes of cancer-related death in the 15- to 39-year-old age group. The management of adolescents and young adults (AYAs) who are diagnosed with brain tumors presents unique endocrine, developmental, and psychosocial issues. AYAs are frequently diagnosed late, after a prolonged period of misdiagnosis. The epidemiology, biology, prognosis, and overall management of these tumors differ from those of both older and younger age groups. AYAs are usually in a transitional phase in their lives, and brain tumors in this age group carry a better prognosis than in older adults; thus, special attention should be paid to survivorship care. Fertility and other treatment-related sequelae that affect the quality of life, as well as the increased risk of secondary malignancies in long-term survivors, are such examples. Although most AYAs are managed by adult or, to a lesser extent pediatric, oncologists, a multidisciplinary approach in the setting of specialized centers with increased participation in clinical trials is preferable. End-of-life and palliative care remain an unmet need for these patients, because most physicians lack the training to discuss such issues with young patients.

Exploring patient and provider perspectives on the intersection between fertility, genetics, and family building

OBJECTIVE

Adolescent and young adult (AYA) cancer patients have distinct medical and psychosocial needs and fertility is a key concern. Early age of onset is a risk factor for hereditary cancer and AYAs are more likely to experience reduced fertility. This has implications for future family building decisions and fertility preservation (FP) and genetic testing/counseling (GT/GC) education.

METHODS

Patients diagnosed with cancer between the ages of 18 and 39 and health care providers (HCPs) who treat AYA cancer patients were recruited from a single institution. Qualitative interviews explored AYA patients' and HCPs' concerns regarding their experiences discussing genetics and FP.

RESULTS

The majority of patients (n = 17) were female (59%), and the majority of HCPs (n = 18) were male (67%). Overall, participants had differing perceptions of FP and GT/GC-related information provided during the clinical visit. Patients indicated initiating the conversation about FP and did not recall HCPs discussing GT/GC with them. HCPs indicated patients were often overwhelmed with too much information and comprehension of this discussion is limited. HCPs also felt patients' emotions/beliefs determined their information-seeking behavior specific to FP and GT/GC. Participants felt educational materials should be developed and delivered in a video format depicting a patient-provider interaction or patient testimonial.

CONCLUSION

AYA patients are often overwhelmed by a cancer diagnosis; the complexity/volume of information regarding FP and GT/GC may hinder understanding and decision-making about family building. Educational materials that help patients understand what questions to ask HCPs about FP and GT/GC should be developed to improve knowledge, psychosocial well-being, and future family building decisions.

The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation

BACKGROUND

Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play.

MATERIALS AND METHOD

A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility-related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care.

RESULTS

The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, with gradual implementation of different components of care. A total of 92.8% of the 108 agreed competencies also had agreement between high and middle income participants.

CONCLUSION

FP guidelines establish best practice but do not consider the skills and requirements to implement these guidelines. The competency framework gives HCPs and services a structure for the training of HCPs and implementation of care, as well as defining a model for prioritizing oncofertility service development.

IMPLICATIONS FOR PRACTICE

Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. The competency framework gives 108 competencies that will allow health care professionals (HCPs) and services a structure for the development of oncofertility care, as well as define the role HCPs play to provide care and support. The framework also proposes a three-tier oncofertility service development model which prioritizes the development of components of oncofertility care into essential, enhanced, and expert services, giving clear recommendations for service development. The competency framework will enhance the implementation of FP guidelines, improving the equitable access to medical and psychological oncofertility care.

Comparing fertility preservation resources and policies between NCCN member and non-member institutions

PURPOSE

The National Comprehensive Cancer Network (NCCN) created guidelines to facilitate implementation of fertility preservation (FP) discussions and referrals for adolescent and young adult patients. We assessed if availability of workplace FP resources and referral policies differed among learners in the Educating Nurses about Reproductive Health in Cancer Healthcare (ENRICH) training program based on NCCN membership.

METHODS

Learners completed a baseline application, including demographic information and the availability of FP resources and referral policies. Learners were categorized as either NCCN members or non-members and chi-square tests compared resources between the two groups.

RESULTS

Learners from NCCN institutions reported the highest rates of established FP referral guidelines (p < .01), reproductive endocrinologist and infertility specialist (REI) on staff (p < .01), partnerships with REI, educational materials for staff (p < .05), and patients (p < .01).

CONCLUSION

FP resources and referral policies were highest among learners from NCCN member institutions, but areas for development with fertility issues still exist and learners from non-member institutions may assist their workplaces in improving rates of discussions and referrals based on their ENRICH training.

PRACTICE IMPLICATIONS

The variation of available resources and referral policies between groups suggests more FP education and training; focusing on implementation programs is needed to make steps towards impactful institutional level resources and policies.

Impact of a web-based reproductive health training program: ENRICH (Educating Nurses about Reproductive Issues in Cancer Healthcare)

OBJECTIVE

Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH) is a web-based training program to assist oncology nurses with timely communication and relevant information regarding reproductive health issues (eg, risk of infertility, fertility preservation, and sexual health) to adolescent and young adult (AYA) patients and survivors. This manuscript describes impact on knowledge, perceived communication skills, and practice behaviors.

METHODS

The eight-module course incorporated didactic content and an interactive applied learning component on the following reproductive health topics: overview, men, women, family building options, pediatrics, sexual health, communication, and practical applications. A 14-question pretest and posttest was administered to assess changes in knowledge. Additionally, participants received a follow-up survey addressing communication skills and practice behaviors.

RESULTS

Over a 3-year period, 233 nurses completed the training. The mean pretest to posttest total score increased significantly (P < .001). Nurses rated their communication skills regarding risk of infertility with males as 7.5 and females as 7.4, based on a 10-point scale. Half of participants noted that they often or always discuss risk of infertility and fertility preservation options. Two-thirds indicated they refer patients to reproductive specialists, and majority (72%) indicated they document those referrals.

CONCLUSIONS

ENRICH is a successful intervention for oncology nurses caring for AYA patients and survivors by increasing knowledge, communication skills, and frequency of discussion of reproductive health.

How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care

BACKGROUND

Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs.

OBJECTIVE AND RATIONALE

The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services.

SEARCH METHODS

A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

OUTCOMES

A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices.

WIDER IMPLICATIONS

This analysis identifies core components for delivery of oncofertility MOC. The provision of oncofertility services requires planning to ensure services have safe and reliable referral pathways and that they are age-appropriate and include medical and psychological oncofertility care into the survivorship period. In order for this to happen, collaboration needs to occur between clinicians, allied HCPs and executives within paediatric and adult hospitals, as well as fertility clinics across both public and private services. Training of both cancer and non-cancer HCPs is needed to improve the knowledge of HCPs, the quality of care provided and the confidence of HCPs with these consultations.

Sexuality and cancer: The experience of adolescents and young adults

There are many components affecting the experience of sexuality for adolescents and young adults living with and beyond cancer. For patients, the interruption to normal socialization creates gaps in information and experience that potentially hinder development. In clinical practice, conversations relating to sexual consequences of illness or treatment are rare, as are age-appropriate assessment and intervention. In service design, the collaborative approach of oncofertility has yet to be replicated for sexuality. This paper considers how these obstacles can be overcome through local service development to address unmet need and promote sexual well-being for this group of patients.

New Trends and Recent Care Approaches in Pediatric Oncology Nursing

Increased incidence of children diagnosed with cancer and survivors was an impact on changes in pediatric hemato-oncology nursing care. In this review article, it is aimed to investigate the new trends and recent care approaches in pediatric oncology nursing. The recent care topics were common in the literature as family-centered care, technology-based care, program development, primary care of child, health-care provider, survivors and home care, and nonpharmacological care. All of the topics contribute to perform evidence-based care for health promotion and well-being in pediatric hemato-oncology nursing. Research reviews showed that many current topics for the care of children and their parents have entered in the literature. There is a need for more randomized controlled studies to improve the level of evidence of new nursing approaches.

Contraception: the Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care

Little is known about oncology provider recommendations regarding best practices in contraception use during cancer treatment and through survivorship for adolescent and young adult (AYA) cancer patients. This review examined the literature to identify related studies on contraception recommendations, counseling discussions, and methods of contraception in the AYA oncology population. A literature review was conducted using PubMed, including all peer-reviewed journals with no publication date exclusions. A systematic review of the literature was conducted using combinations of the following phrases or keywords: "oncology OR cancer" AND "contraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agents, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization" AND "young adult OR adolescent" AND "young adult AND adolescent". Reviewers assessed articles using the "Quality Assessment Tool for Quantitative Studies" which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. A total of five articles were included and all studies were quantitative. Results showed no consistent recommendations among providers, references to guidelines, or methods of contraceptive types. Provider guidelines for discussions with AYA patients should be expanded to provide comprehensive, consistent, and quality cancer care in the AYA population.

Nurse Perspectives on Referrals for Oncology Patients to Reproductive Endocrinologists: Results of a Learning Activity

BACKGROUND

Although concern about future fertility for adolescents and young adults (AYAs) with cancer is high, referrals to reproductive endocrinologists (REI) are low. Oncology nurses are well positioned to facilitate these referrals but may lack the knowledge and training. This report describes a learning activity in the Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH) program whereby oncology nurses interviewed REIs.

METHOD

Participants were instructed to conduct an interview with an REI using a semistructured guide and provided a written report of the discussion. We examined responses to each question using qualitative content analysis.

RESULTS

Seventy-seven participants across 15 states provided a summary. Learner summaries highlighted four themes related to FP, including Cost, Time, Lack of Information or Referrals, and Learning About Available Options.

CONCLUSION

Oncology nurses have an opportunity for a partnership to ensure that concerns about fertility among AYA patients are addressed. J Contin Educ Nurs. 2016;47(8):376-384.

Development of an Instrument to Examine Nursing Attitudes Toward Fertility Preservation in Oncology

PURPOSE/OBJECTIVES

To develop an instrument to measure staff nurse perceptions of the barriers to and benefits of addressing fertility preservation (FP) with patients newly diagnosed with cancer. 
.

DESIGN

A prospective, nonrandomized instrument development approach. 
.

SETTING

Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center in Dallas. 
.

SAMPLE

224 RNs who care for patients with cancer. 
.

METHODS

The instrument was developed with content experts and field-tested with oncology staff nurses. Responses to a web-based survey were used in exploratory factor analysis. After refining the instrument, the authors conducted a confirmatory factor analysis with 230 web-based survey responses. 
.

MAIN RESEARCH VARIABLES

Self-perceived barriers to providing FP options to patients newly diagnosed with cancer.
.

FINDINGS

The results supported a 15-item instrument with five domains.

CONCLUSIONS

This instrument can be used to explore oncology nurses' attitudes toward FP in newly diagnosed people with cancer in their reproductive years. 
.

IMPLICATIONS FOR NURSING

A more comprehensive understanding of attitudes and barriers related to FP will guide the building of optimal systems that support effective FP options, resources, and programs for individuals with cancer.

New Promising Strategies in Oncofertility

INTRODUCTION

Approximately 70,000 adolescent and young adults (AYA) are diagnosed with cancer each year. While advancements in treatment have led to improved prognosis and survival for patients, these same treatments can adversely affect AYA reproductive capacity. Localized treatments such as surgery and radiation therapy may affect fertility by removing or damaging reproductive organs, and systemic therapies such as chemotherapy can be toxic to gonads, (ovaries and testicles), thus affecting fertility and/or endocrine function. This can be traumatic for AYA with cancer as survivors often express desire to have genetic children and report feelings of regret or depression as a result of infertility caused by cancer treatments.

AREAS COVERED

Emerging technologies in the field of assisted reproductive technology offer new promise for preserving the reproductive capacity of AYA cancer patients prior to treatment as well as providing alternatives for survivors. The following review revisits contemporary approaches to fertility preservation as well newly developing technologies.

EXPERT COMMENTARY

There are several advances in ART that hold promise for patients and survivors. However there are challenges that inhibit uptake including poor communication between providers and patients about risks and fertility preservation options; high costs; and lack of insurance coverage for fertility preservation services.

Fertility Preservation Care for Children and Adolescents with Cancer: An Inquiry to Quantify Professionals' Barriers

PURPOSE

There is a growing interest in fertility preservation as emerging research is highlighting the prevalence of infertility among young cancer survivors and its negative impact on quality of life. Previous qualitative research has identified barriers of fertility preservation care among professionals. The aim of this study was to assess the prevalence of these barriers among pediatric and adolescent oncology healthcare professionals and evaluate factors that influence them.

METHODS

Based on previously identified barriers and experts' input, a questionnaire was developed and sent to 88 professionals drawn from the multidisciplinary pediatric and adolescent oncology team of a large Principal Treatment Centre. Multivariate analysis was performed to evaluate which factors influence professional adherence to fertility preservation care.

RESULTS

In total, 48 (55%) professionals responded and were included in the analysis. All pediatric and adolescent oncology healthcare professionals reported at least one barrier to fertility preservation care. Even though some interdisciplinary differences were observed, the most frequently endorsed barriers were focusing on patients' characteristics (age, health status, urgency of cancer treatment, and lack of interest in fertility issues). The least frequently endorsed barriers were related to organizational aspects (availability of fertility specialists, time constrains, and ability to raise fertility issues). Nurses and allied healthcare professionals endorsed knowledge or policy gaps as barriers to a greater degree than medical doctors.

CONCLUSIONS

Results suggest that educational support provision, especially for nurses and allied healthcare professionals, and strengthening interdisciplinary collaborations could help overcome observed barriers and facilitate fertility discussions with pediatric and young cancer patients.

The Effectiveness of Psychoeducational Interventions Focused on Sexuality in Cancer

BACKGROUND

Although sexual health is a common concern for oncology patients, no practical guidelines to sexual intervention exist, perhaps because of a lack of systematic reviews or meta-analyses.

OBJECTIVES

The objectives of this study were to determine the effect size for psychoeducational intervention focused on sexuality and to compare effect sizes according to intervention outcomes and characteristic.

METHODS

We explored quantitative evidence for the effects of sexual intervention for cancer patients or partners by using the electronic databases. Among them, we considered 15 eligible articles.

RESULTS

The meta-analysis provided 133 effect sizes from 15 primary studies. The analysis revealed significant improvements after intervention, with a random-effects standardized mean difference of 0.75. Psychoeducational interventions focused on sexuality after cancer diagnosis were effective for compliance (2.40), cognitive aspect (1.29), and psychological aspect (0.83). Individual-based interventions (0.85) were more effective in improving outcomes than group approach and group combined with individual intervention. With regard to intervention providers, registered nurse only (2.22) and team approach including the registered nurse (2.38) had the highest effect size. Face-to-face intervention combined with telephone or the Internet (1.04) demonstrated a higher effect size than face-to-face (0.62) and telephone (0.58) independently.

CONCLUSION

We conducted an analysis of data from various subgroups of preexisting studies, obtained an overall estimate of the effectiveness of the intervention, and compared its effectiveness across variables that affect intervention outcomes.

IMPLICATIONS FOR PRACTICE

These results provide empirical data for evidence-based practice and inform the development of useful intervention programs through a comprehensive review and meta-analysis of the results.

Fertility Preservation after a Cancer Diagnosis: A Systematic Review of Adolescents', Parents', and Providers' Perspectives, Experiences, and Preferences

STUDY OBJECTIVE

Survival into adulthood is now a reality for many adolescents facing cancer. Fertility preservation (FP) is rapidly advancing, but oncology providers and health systems struggle to incorporate the newest FP technologies into the clinical care of adolescents. Our objective was to systematically review and synthesize the available data regarding the perspectives, experiences, and preferences of adolescents, parents, and oncology providers about FP to inform clinical implementation of FP technologies. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Five electronic databases (PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature, PsychInfo) were systematically searched for studies published between January 1999 and May 2014. Adolescents were defined as 12-18 years at the time of diagnosis or designated as pubertal/postpubertal and younger than 18 years of age. Studies were assessed for methodological quality, data were extracted using a standardized form, and results were synthesized using guidelines for a narrative syntheses of quantitative and qualitative data.

RESULTS

In total, 1237 records were identified, with 22 articles, representing 17 unique studies that met the inclusion criteria. The following topics were consistently observed across studies and populations: (1) fertility in trust; (2) decision-making challenges; (3) provider knowledge and practices; and (4) discrepancies between desired and actual experiences.

CONCLUSION

Despite the challenges associated with a new cancer diagnosis, adolescents and parents value the opportunity to discuss fertility concerns and preservation options. Providers play an important role in addressing these topics for families and efforts should be made to incorporate FP discussions into routine cancer care for all adolescents, with attention paid to the unique needs of adolescents and their parents.

ENRICH: A promising oncology nurse training program to implement ASCO clinical practice guidelines on fertility for AYA cancer patients

OBJECTIVE

We describe the impact of ENRICH (Educating Nurses about Reproductive Issues in Cancer Healthcare), a web-based communication-skill-building curriculum for oncology nurses regarding AYA fertility and other reproductive health issues.

METHODS

Participants completed an 8-week course that incorporated didactic content, case studies, and interactive learning. Each learner completed a pre- and post-test assessing knowledge and a 6-month follow-up survey assessing learner behaviors and institutional changes.

RESULTS

Out of 77 participants, the majority (72%) scored higher on the post-test. Fifty-four participants completed the follow-up survey: 41% reviewed current institutional practices, 20% formed a committee, and 37% gathered patient materials or financial resources (22%). Participants also reported new policies (30%), in-service education (37%), new patient education materials (26%), a patient navigator role (28%), and workplace collaborations with reproductive specialists (46%).

CONCLUSION

ENRICH improved nurses' knowledge and involvement in activities addressing fertility needs of oncology patients. Our study provides a readily accessible model to prepare oncology nurses to integrate American Society of Clinical Oncology guidelines and improve Quality Oncology Practice Initiative measures related to fertility.

PRACTICE IMPLICATIONS

Nurses will be better prepared to discuss important survivorship issues related to fertility and reproductive health, leading to improved quality of life outcomes for AYAs.

Fertility preservation and cancer: challenges for adolescent and young adult patients

PURPOSE OF REVIEW

With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to treatment.

RECENT FINDINGS

Several barriers prevent fertility from being adequately addressed in the clinical context. Providers' and patients' incomplete or inaccurate understanding of infertility risks exacerbate patients' reproductive concerns. For female patients in particular, making decisions about fertility preservation before treatment often leads to decision conflict, reducing the likelihood of making informed, value-based decisions, and posttreatment regret and distress. Recent empirically based interventions to improve provider training around fertility issues and to support patient decision-making about fertility preservation show promise.

SUMMARY

Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in fertility preservation options.

Expanding the Oncofertility Workforce: Training Allied Health Professionals to Improve Health Outcomes for Adolescents and Young Adults

As cancer survivors live longer, fertility and reproductive health become important health concerns. Like other secondary effects of cancer treatment, these anticipated health risks should be addressed before the initiation of cancer treatment. While existing and emerging technologies may prevent or reduce risk of infertility (e.g., sperm, oocyte, embryo, or tissue banking), the lack of a trained workforce knowledgeable about oncology and reproductive health poses a barrier to care. The allied health professional (AHP) is a target of opportunity because of the direct and sustained patient relationships. Thus, developing tailored educational programs for nurses, social workers, psychologists, and physician assistants is an urgent unmet need toward field building. In this report, we outline results from a pilot study evaluating AHP perceptions of an oncology and reproductive health curriculum originally developed for nurses and adapted to meet the needs of several other AHP groups.

Fertility preservation in young patients with cancer

Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients’ wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.

Advanced practice nurses: Improving access to fertility preservation for oncology patients

Cancer therapies such as chemotherapy, radiation therapy and surgery may place the future fertility of both children and young adults at risk. Oncofertility is a rapidly evolving area that involves increasing access to fertility preservation (FP) information and services. This manuscript aims to: a) highlight the fertility risks associated with cancer therapy and its psychosocial impact, b) describe FP options, c) discuss the unique challenges of FP in distinct cancer populations, and d) illustrate the pivotal role of APNs in oncofertility counselling and education.

Young Adults' Access to Fertility Preservation Services at National Cancer Institute Community Oncology Research Program Minority/Underserved Community Sites: A Qualitative Study

PURPOSE

This qualitative study aims to characterize the factors that influence access to fertility preservation (FP) resources and services after cancer diagnosis at NCI Community Oncology Research Program (NCORP) minority/underserved community sites, which serve patient populations comprising at least 30% racial/ethnic minorities or rural residents.

METHODS

Phone interviews were conducted from 2014 to 2015 with interested and knowledgeable healthcare providers practicing at NCORP minority/underserved community sites, using a semi-structured interview guide. Data were transcribed, de-identified, and analyzed using qualitative analysis software, Dedoose, to determine the most common themes in access to FP resources and services.

RESULTS

Interviews were conducted with 10 board-certified physicians practicing at 10 of the 12 NCORP minority/underserved community sites; five respondents identified as oncologists, and five were reproductive endocrinology/infertility specialists (n = 4) or obstetricians/gynecologists (n = 1). Findings revealed highly variable access to FP resources at each site. Notable barriers to FP services were cost, time, provider education, lack of clinical guideline application, and perceptions among healthcare providers that negatively affect the discussion of options and risks with eligible patients.

CONCLUSION

Clinical FP guidelines and resources for cancer patients and healthcare providers need to be better integrated into existing cancer networks that serve minority and underserved patient populations. Providers need more education regarding timely provision of FP services to all newly diagnosed cancer patients of reproductive age.

Medical consultations about fertility preservation with haematological patients of childbearing age: A qualitative study

PURPOSE

Oncological treatments can cause serious long-term consequences, including effects on patients' fertility. Communication about possible fertility impairment is essential for cancer patients who want to have children. When oncologists initiate this discussion in a timely manner, patients can be referred to fertility specialists and avail themselves of fertility preservation methods. The oncologist plays a key role in this context.

METHODS

30 cancer patients of childbearing age (21-43 years) took part in semi-structured interviews between March 2011 and April 2012 about fertility and their desire to have children. Interview transcripts were thematically analyzed.

RESULTS

Physician-patient consultations broached the issue as a central theme in almost all patients. A few consultations were patient initiated, and the majority took place before the beginning of treatment. Almost half of the patients were satisfied with their consultations and were referred to a fertility specialist. The ideal setting for these conversations is in the presence of the patient's partner, in a private space, before the beginning of treatment.

CONCLUSIONS

All patients should be informed about the possibility of their fertility being impaired due to treatments, even if they have not explicitly expressed wanting children. The oncologist is the first and most important contact for the patient and, hence, should bring up the issue of family planning and fertility. An interdisciplinary communication and collaboration between oncologists and fertility specialists can improve patient care.

Adoption and cancer survivors: Findings from a learning activity for oncology nurses

BACKGROUND

To the authors' knowledge, little is known regarding the rate at which cancer survivors successfully adopt a child or about their experiences negotiating a costly, and perhaps discriminatory, process regarding the prospective parent's health history. The current study describes the results of a learning activity in which nurses contacted an adoption agency to learn more about the process for survivors with the goal of helping nurses provide patients with accurate information for making a well-informed decision regarding adoption.

METHODS

Training program participants identified an adoption agency (local, state, or international) and conducted an interview using a semistructured guide. After the interview, participants created a summary of responses to the questions. The authors examined responses to each question using qualitative content analysis.

RESULTS

A total of 77 participants (98% completion rate) across 15 states provided a summary. Responses were distributed across the following categories: adoption costs, steps required for survivors seeking adoption, challenges for survivors seeking adoption, birth parents' reservations, and planned institutional changes to increase adoption awareness. The majority of respondents reported improving their knowledge of adoption and cancer, increased challenges for survivors, and the need to educate patients concerning the realities of adoption policies. The need for a letter stating the survivor was 5 years cancer free was identified as a significant obstacle for survivors.

CONCLUSIONS

Nurses are charged with following practice guidelines that include recommendations for appropriate reproductive health referrals. Cancer survivors would benefit from a health care provider who can provide education and concrete information when patients are making a decision about fertility and adoption.

Female Sexual Health Training for Oncology Providers: New Applications

Introduction

Sexual health care remains an unmet need for women with cancer. Many barriers are described, such as provider discomfort and lack of training; however, there is little evidence-based guidance regarding how to effectively address these obstacles.

Aim

This pilot study was performed to determine whether brief, targeted sexual health training for oncology providers results in improved provider comfort level and frequency of addressing female cancer-related sexual issues.

Methods

A brief (30–45 minute), targeted sexual health training program focused on improving comfort level, knowledge and communication skills when addressing breast cancer–related sexual issues was developed by the primary author. Using a pretest-posttest format, this educational program was provided to oncology providers (physicians and nurses/other allied health) from a suburban health-care system. Surveys based on 5-point Likert scales were provided before and 3–6 month post training.

Main Outcome Measures

Primary endpoints were changes in mean Likert scores for provider comfort level and self-reported frequency of addressing sexual issues. A secondary endpoint was change in mean Likert scores for perception of access to sexual health resources/referrals.

Results

Eligible respondents included 8 oncologists, 4 surgeons, and 62 nurses/other allied health. For total respondents, comparison of mean Likert scores for survey 1 (n = 71) and survey 2 (n = 36) demonstrated statistically significant increases for all parameters queried, including provider comfort level with bringing up (Pre mean Likert score = 3.4, Post = 4.3, P < 0.0001) and coordinating care (Pre = 3.5, Post = 4.6, P < 0.0001), and frequency of addressing sexual issues for both diagnosis/treatment and surveillance phase (Pre = 2.4, Post = 3.3, P ≤ 0.0052).

Conclusion

Brief, targeted sexual health training for oncology providers positively correlated with improved provider comfort level and frequency of addressing female cancer-related sexual issues.

Development and psychometric evaluation of a sexual health care knowledge scale for oncology nurses

OBJECTIVE

The purpose of this study was to develop a sexual health care knowledge scale for oncology nurses and to evaluate its psychometric properties using Rasch analysis and the known-groups technique.

BACKGROUND

Although sexual oncology has become a popular topic and sexual health care is now promoted, there has been a lack of instruments supported by psychometric evaluations to measure nurses' knowledge of sexual health issues.

METHODS

The initial 72 items were compiled to form the Sexual Health Care Scale - Knowledge (SHCS-K) for oncology nurses using a literature review and analysis of existing research tools. After a specialist panel verified content validity, the questionnaire was shortened to 58 items. The data were analyzed using a Rasch model to investigate the items with respect to unidimensionality of fit and difficulty and reliability distribution. Discriminant validity was examined using the known-groups technique.

RESULTS

Two items did not fit with the Rasch model. Person and item separation-index ratios were 3.33 and 9.45, respectively, which confirmed that the SHCS-K functioned well. The reliability was good, at 0.99. Significant differences in marital status, levels of education, and participation in SHC training were observed between groups. The final version of the questionnaire consisted of 55 items, with a total score range of 0-55.

CONCLUSIONS

The SHCS-K was found to be a valid and reliable measure for evaluating levels of sexual health care knowledge among this sample of oncology nurses.

An interprofessional web-based approach to providing breast cancer education

This paper describes the process that nursing, social work, and pharmacy faculty at a state university undertook to develop interprofessional web-based breast cancer education modules for incorporation into required curriculum. Eight web modules initially developed to educate baccalaureate nursing students on breast cancer were revised and expanded at each health professional school to include discipline-specific information pertinent to social work and pharmacy scope of practice. A specialized internet-accessible web-delivered application was constructed consisting of eight reusable learning objects, or modules, including epidemiology, risk factors and screening, diagnosis, staging and grading, treatment, survivorship, disparities, and metastatic breast cancer. These modules were organized for easy integration into existing courses and allowed for an efficient means of providing expert, evidence-based content. Innovative methods to integrate nursing, social work, and pharmacy education are needed to achieve an effective interprofessional educational approach to teaching breast cancer content.

Improving communication between oncologists and reproductive specialists to promote timely referral of patients with cancer

By empowering oncology care providers to facilitate discussion and referral of patients of reproductive age, the updated 2013 ASCO Guidelines provide an opportunity to strengthen communication between oncology care providers and their reproductive specialist colleagues.