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Stukaite-Ruibiene E, van der Perk MEM, Vaitkeviciene GE, Bos AME, Bumbuliene Z, van den Heuvel-Eibrink MM, Rascon J. Evaluation of oncofertility care in childhood cancer patients: the EU-Horizon 2020 twinning project TREL initiative. Front Pediatr 2023; 11:1212711. [PMID: 37565239 PMCID: PMC10411952 DOI: 10.3389/fped.2023.1212711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Background The 5-year survival rate of childhood cancer exceeds 80%, however, many survivors develop late effects including infertility. The aim of this study was to evaluate the current status of oncofertility care at Vilnius University Hospital Santaros Klinikos (VULSK) within the framework of the EU-Horizon 2020 TREL project. Methods All parents or patients aged 12-17.9 years treated from July 1, 2021 until July 1, 2022 were invited to complete an oncofertility-care-evaluation questionnaire. After completing the questionnaire, patients were triaged to low-risk (LR) or high-risk (HR) of gonadal damage using a risk stratification tool (triage). Data was assessed using descriptive statistics. Results Questionnaires were completed by 48 parents and 13 children triaged as 36 (59%) LR and 25 (41%) HR patients. Most HR respondents (21/25, 84%) were not counseled by a fertility specialist. Six boys (4 HR, 2 LR) were counseled, none of the girls was counseled. Three HR boys underwent sperm cryopreservation. Only 17 (27.9%, 9 HR, 8 LR) respondents correctly estimated their risk. All counseled boys (n = 6) agreed the risk for fertility impairment had been mentioned as compared to 49.1% (n = 27) of uncounseled. All counseled respondents agreed they knew enough about fertility (vs. 42%). Conclusions Respondents counseled by a fertility specialist were provided more information on fertility than uncounseled. HR patients were not sufficiently counseled by a fertility specialist. Based on the current experience oncofertility care at VULSK will be improved.
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Affiliation(s)
| | | | - Goda Elizabeta Vaitkeviciene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Zana Bumbuliene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Jelena Rascon
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Crespi C, Adams L, Gray TF, Azizoddin DR. An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2021; 48:491-505. [PMID: 34411081 DOI: 10.1188/21.onf.491-505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Adolescents and young adults (AYAs) with cancer commonly report future fertility as an important issue in care. Despite long-standing guidelines on fertility counseling and the trusting relationship between nurses and patients, little is known about the nurse's role in fertility preservation (FP) for AYAs with cancer. LITERATURE SEARCH The authors conducted a literature search of articles published through 2020 focused on nursing involvement in FP for AYAs with cancer. DATA EVALUATION 85 studies were identified. In total, 11 articles met inclusion criteria and were critically appraised in the review. SYNTHESIS Although well positioned to improve FP care among AYAs with cancer, nurses currently have a minimal role because of provider, institutional, and patient-related barriers. IMPLICATIONS FOR PRACTICE Interventions to enhance nurses' knowledge about FP, improvements in electronic health record documentation, and facilitation of institutional support are needed to support the nurse's role in FP for AYAs with cancer.
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Mulder RL, Font-Gonzalez A, Green DM, Loeffen EAH, Hudson MM, Loonen J, Yu R, Ginsberg JP, Mitchell RT, Byrne J, Skinner R, Anazodo A, Constine LS, de Vries A, Jahnukainen K, Lorenzo A, Meissner A, Nahata L, Dinkelman-Smit M, Tournaye H, Haupt R, van den Heuvel-Eibrink MM, van Santen HM, van Pelt AMM, Dirksen U, den Hartogh J, van Dulmen-den Broeder E, Wallace WH, Levine J, Tissing WJE, Kremer LCM, Kenney LB, van de Wetering MD. Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e57-e67. [PMID: 33539754 DOI: 10.1016/s1470-2045(20)30582-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Male patients with childhood, adolescent, and young adult cancer are at an increased risk for infertility if their treatment adversely affects reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of interventions that preserve fertility. As part of the PanCareLIFE Consortium, in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in male patients who are diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. Recognising the need for global consensus, this clinical practice guideline used existing evidence and international expertise to rigorously develop transparent recommendations that are easy to use to facilitate the care of male patients with childhood, adolescent, and young adult cancer who are at high risk of fertility impairment and to enhance their quality of life.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Richard Yu
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
| | - Jill P Ginsberg
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Rod T Mitchell
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, NY, USA
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Helsinki, Finland
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Meissner
- Center for Reproductive Medicine, Amsterdam UMC, location AMC, Amsterdam, Netherlands; Department of Urology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marij Dinkelman-Smit
- Division of Andrology, Department of Urology, Erasmus MC, Rotterdam, Netherlands
| | - Herman Tournaye
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and Livebirth Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Ans M M van Pelt
- Laboratory for Reproductive Biology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organization (VOX), Nieuwegein, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
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Oncofertility: Pharmacological Protection and Immature Testicular Tissue (ITT)-Based Strategies for Prepubertal and Adolescent Male Cancer Patients. Int J Mol Sci 2019; 20:ijms20205223. [PMID: 31640294 PMCID: PMC6834329 DOI: 10.3390/ijms20205223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/12/2019] [Accepted: 10/18/2019] [Indexed: 01/15/2023] Open
Abstract
While the incidence of cancer in children and adolescents has significantly increased over the last decades, improvements made in the field of cancer therapy have led to an increased life expectancy for childhood cancer survivors. However, the gonadotoxic effect of the treatments may lead to infertility. Although semen cryopreservation represents the most efficient and safe fertility preservation method for males producing sperm, it is not feasible for prepubertal boys. The development of an effective strategy based on the pharmacological protection of the germ cells and testicular function during gonadotoxic exposure is a non-invasive preventive approach that prepubertal boys could benefit from. However, the progress in this field is slow. Currently, cryopreservation of immature testicular tissue (ITT) containing spermatogonial stem cells is offered to prepubertal boys as an experimental fertility preservation strategy by a number of medical centers. Several in vitro and in vivo fertility restoration approaches based on the use of ITT have been developed so far with autotransplantation of ITT appearing more promising. In this review, we discuss the pharmacological approaches for fertility protection in prepubertal and adolescent boys and the fertility restoration approaches developed on the utilization of ITT.
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Jayasena CN, Luo R, Dimakopoulou A, Dearing C, Clarke H, Patel N, Stroud T, Seyani L, Ramsay J, Dhillo WS. Prevalence of abnormal semen analysis and levels of adherence with fertility preservation in men undergoing therapy for newly diagnosed cancer: A retrospective study in 2906 patients. Clin Endocrinol (Oxf) 2018; 89:798-804. [PMID: 30204263 DOI: 10.1111/cen.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sperm cryopreservation (freezing) should be offered to all men with cancer due to risk of infertility. However, many men with cancer already have impaired spermatogenesis prior to sperm cryopreservation. Furthermore, physical ill-health may hinder attendance of freeze visits. Investigating both the distribution of sperm functions and freeze attendance rates in men with newly diagnosed cancer, may identify patients benefiting from targeted reproductive fertility support. METHODS We performed a retrospective study of 2906 male patients undergoing sperm cryopreservation prior to cancer therapy at a single UK tertiary centre between 1989 and 2013; all patients were asked to attend three hospital semen collection visits prior to cancer therapy. RESULTS Fifteen per cent (433/2906) of men with newly diagnosed cancer had severely impaired semen quality (i.e., sperm total motile count, TMC < 1 million) during the first semen collection visit. However, patients with severely impaired semen quality had the poorest attendance of subsequent semen collection visits despite being requested to do so (non-attendance in TMC < 1 million: 43.4%; TMC < 1-30 million: 35.7%, P < 0.05 vs. <1 million; TMC > 30 million: 33.2%, P < 0.01 vs. <1 million). CONCLUSIONS This study expands understanding of the semen quality of men with newly diagnosed cancer, and their ability to adhere to fertility preservation recommendations. Our data suggest that patients with the poorest semen quality paradoxically suffer the poorest attendance rates of sperm cryopreservation appointments prior to commencing cancer therapy. We suggest that additional support may be of clinical benefit to men with newly diagnosed cancer and TMC < 1 million sperm.
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Affiliation(s)
- Channa N Jayasena
- Department of Andrology, Hammersmith Hospital, London, UK
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Rong Luo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Anastasia Dimakopoulou
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Chey Dearing
- School of Health Science and Nursing, Eastern Institute of Technology, Taradale, New Zealand
| | - Holly Clarke
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Nandita Patel
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Thomas Stroud
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Lataban Seyani
- Department of Clinical Biochemistry, Charing Cross Hospital, London, UK
| | | | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Dubois C, Seigneur E, Pacquement H, Laurence V, Brugières L, Flahault C. Cryopréservation de sperme chez les adolescents atteints de cancer — Partie II : Étude de l’expérience subjective rétrospective des patients. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0634-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Armuand G, Nilsson J, Rodriguez‐Wallberg K, Malmros J, Arvidson J, Lampic C, Wettergren L. Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden. Psychooncology 2017; 26:1684-1690. [PMID: 28734133 PMCID: PMC5656910 DOI: 10.1002/pon.4507] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions. METHODS A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility. RESULTS More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17). CONCLUSIONS Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology.
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Affiliation(s)
- G.M. Armuand
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - J. Nilsson
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - K.A. Rodriguez‐Wallberg
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Reproductive MedicineKarolinska University HospitalStockholmSweden
| | - J. Malmros
- Paediatric Oncology Unit, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - J. Arvidson
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - C. Lampic
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - L. Wettergren
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
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Flink DM, Sheeder J, Kondapalli LA. A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services. J Adolesc Young Adult Oncol 2016; 6:31-44. [PMID: 27529573 DOI: 10.1089/jayao.2015.0065] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The American Society of Clinical Oncology issued practice guidelines in 2006 to provide critical information about fertility impact to adolescents and young adults (AYA) at the time of cancer diagnosis. Survivors continue to express concerns about their long-term reproductive health after cancer therapy even as treatment options for fertility preservation evolve. An underutilization of fertility preservation methods by cancer patients continues to persist. A review of the literature cites barriers and challenges that limit fertility information and preservation options for AYA cancer patients. METHODS A review of medical literature was conducted to examine current practice for patients receiving fertility information and the barriers to patients receiving fertility preservation services. RESULTS A total of 69 publications were included in this review. The review summarizes (1) patient experiences with receiving fertility information and (2) patient desires, barriers, and challenges to utilizing fertility preservation services. CONCLUSIONS Despite advances in fertility preservation, there are challenges for patients to utilizing fertility preservation services. Barriers include the following: urgency to initiate treatment, inadequate information, clinic time constraints, and perceptions around patients' gender, age, cost, parity, race, relationship, and sociodemographic status influence whether patients receive fertility preservation consultation. Patients report a lack of adequate information to make informed fertility decisions.
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Affiliation(s)
- Dina M Flink
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
| | - Jeanelle Sheeder
- 2 Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
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Ben-Aharon I, Abir R, Perl G, Stein J, Gilad G, Toledano H, Elitzur S, Avrahami G, Ben-Haroush A, Oron G, Freud E, Kravarusic D, Ben-Arush M, Herzel G, Yaniv I, Stemmer SM, Fisch B, Ash S. Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program. BMC Cancer 2016; 16:620. [PMID: 27506811 PMCID: PMC4979150 DOI: 10.1186/s12885-016-2584-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Current evidence indicates sub-optimal incidence of fertility preservation (FP) in eligible patients. We present herein our designated multidisciplinary program for FP in pediatric and adolescent population and present our data on FP in female patients. Methods Pediatric patients (age 0–18) who were candidate for highly gonadotoxic treatments were referred to FP program for a multidisciplinary discussion and gonadal risk-assessment followed by either oocyte cryopreservation or ovarian cryopreservation (OCP) for female patients, and sperm banking for male patients. The OCP protocol consists of aspiration of oocytes from small antral follicles and in-vitro maturation followed by cryopreservation, as well as ovarian tissue cryopreservation. Results The establishment of a designated FP program resulted in a significant increase in referral and subsequent FP procedures of all eligible patients. Sixty-two female patients were referred for FP discussion during a period of 36 months; 41 underwent OCP; 11 underwent oocyte cryopreservation and six were declined due to parental decision. The median age was 13.2y (range 18 months-18y). Thirty-two (51.6 %) were chemotherapy-naïve. Seventeen patients (27 %) had sarcoma, 16 patients (26 %) had acute leukemia. The mean number of mature oocytes that were eventually vitrified was significantly higher in chemotherapy-naïve patients compared with chemotherapy-exposed patients (mean 12 oocytes (1–42) versus 2 (0–7)). Conclusion Multidisciplinary programs that encompass experts of all relevant fields, skilled laboratory resources and a facilitated path appear to maximize the yield. We observed a considerable higher referral rates following launching a designated program and earlier OCP in chemo-naïve patients that culminated in a better fertility preservation procedure.
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Affiliation(s)
- Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - R Abir
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Stein
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Gilad
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Toledano
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Elitzur
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Avrahami
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Ben-Haroush
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Oron
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Freud
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kravarusic
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Ben-Arush
- Division of Pediatric Hematology Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - G Herzel
- Department of Pediatric Hematology Oncology, Ha'Emek Hospital, Afula, Israel
| | - I Yaniv
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Fisch
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Ash
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barlevy D, Wangmo T, Elger BS, Ravitsky V. Attitudes, Beliefs, and Trends Regarding Adolescent Oncofertility Discussions: A Systematic Literature Review. J Adolesc Young Adult Oncol 2016; 5:119-34. [DOI: 10.1089/jayao.2015.0055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Dorit Barlevy
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Vardit Ravitsky
- Bioethics Program, School of Public Health, University of Montreal, Montreal, Canada
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12
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Wyns C, Collienne C, Shenfield F, Robert A, Laurent P, Roegiers L, Brichard B. Fertility preservation in the male pediatric population: factors influencing the decision of parents and children. Hum Reprod 2015; 30:2022-30. [DOI: 10.1093/humrep/dev161] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022] Open
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de Lambert G, Poirot C, Guérin F, Brugières L, Martelli H. La préservation de la fertilité dans les cancers de l’enfant. Bull Cancer 2015; 102:436-42. [DOI: 10.1016/j.bulcan.2015.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 12/11/2022]
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Ku JY, Park NC, Jeon TG, Park HJ. Semen Analysis in Cancer Patients Referred for Sperm Cryopreservation before Chemotherapy over a 15-Year Period in Korea. World J Mens Health 2015; 33:8-13. [PMID: 25927057 PMCID: PMC4412009 DOI: 10.5534/wjmh.2015.33.1.8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/15/2014] [Accepted: 10/18/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose This study evaluated the demographics and semen parameters of males with cancer who banked their sperm prior to chemotherapy. Materials and Methods This is a retrospective study of 66 cases referred for sperm banking prior to initiation of chemotherapy over a 15-year period (1999~2014). Patients who had previously received cancer treatment including chemotherapy or radiotherapy were not included in this study. Results We studied a total of 66 cancer patients referred for cryopreservation of sperm prior to chemotherapy. The mean age of the patients at the time of banking was 32.0±7.9 years (range, 19~58 years). The types of cancer were testicular cancer (31 cases, 47.0%), non-Hodgkin's disease (10 cases, 15.1%), Hodgkin's disease (5 cases, 7.6%), leukemia (8 cases, 12.1%), gastrointestinal malignancy (5 cases, 7.6%), and musculoskeletal malignancy (5 cases, 7.6%). There were significant differences in sperm concentration and viability among the various types of cancer, but no significant difference in semen volume or sperm motility and morphology. Conclusions In this study we found that sperm quality could decrease even before chemotherapy. Because chemotherapy can also negatively affect spermatogenesis, sperm cryopreservation prior to treatment should be strongly recommended for cancer patients of reproductive age.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Tae Gyeong Jeon
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Daudin M, Rives N, Walschaerts M, Drouineaud V, Szerman E, Koscinski I, Eustache F, Saïas-Magnan J, Papaxanthos-Roche A, Cabry-Goubet R, Brugnon F, Le Lannou D, Barthélémy C, Rigot JM, Fréour T, Berthaut I, Giscard d'Estaing S, Touati F, Mélin-Blocquaux MC, Blagosklonov O, Thomas C, Benhamed M, Schmitt F, Kunstmann JM, Thonneau P, Bujan L. Sperm cryopreservation in adolescents and young adults with cancer: results of the French national sperm banking network (CECOS). Fertil Steril 2014; 103:478-86.e1. [PMID: 25527232 DOI: 10.1016/j.fertnstert.2014.11.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/23/2014] [Accepted: 11/10/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the feasibility of fertility preservation in adolescent males with cancer. DESIGN Large multicenter retrospective study of male patients ≤20 years from 23 centers of a national network of sperm banks over a 34-year period. SETTING Sperm banks. PATIENT(S) A total of 4,345 boys and young men aged 11 to 20 years. INTERVENTION(S) Age, cancer diagnosis, feasibility of sperm banking, and sperm parameters. MAIN OUTCOME MEASURE(S) Description of patients, and success of their fertility preservation. RESULT(S) We observed a mean yearly increase in referred patients of 9.5% (95% confidence interval, 9.1%-9.8%) between 1973 and 2007. Over the study period, the percentage of younger cancer patients who banked their sperm increased, especially in the 11-14 year age group, rising from 1% in 1986 to 9% in 2006. We found that 4,314 patients attempted to produce a semen sample, 4,004 succeeded, and sperm was banked for 3,616. The mean total sperm count was 61.75 × 10(6) for the 11-14 year age group, and 138.81 × 10(6) for the 18-20 year age group. It was noteworthy that intercenter variations in practices involving young patients seeking to preserve their fertility before cancer therapy were observed within this national network. CONCLUSION(S) Our results emphasize the need for decisive changes in public health policy to facilitate the access to reproductive health-care for young cancer patients.
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Affiliation(s)
- Myriam Daudin
- CECOS Midi-Pyrénées, University Hospital of Toulouse, Hôpital Paule de Viguier, Toulouse, France; Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Université de Toulouse-UPS, Toulouse, France.
| | - Nathalie Rives
- CECOS Haute-Normandie, Reproductive Biology Laboratory and EA 4308 (Spermatogenesis and Male Gamete Quality), Rouen University Hospital, Rouen, France
| | - Marie Walschaerts
- Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Université de Toulouse-UPS, Toulouse, France
| | - Véronique Drouineaud
- CECOS de Dijon, Reproductive Biology Laboratory, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Ethel Szerman
- CECOS de Caen, Département de Biologie, Unité de Biologie de la Reproduction, CHU de Caen, Caen, France
| | - Isabelle Koscinski
- CECOS Alsace, Laboratoire de Biologie de la Reproduction, CHU de Strasbourg, Schiltigheim, and Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Institut National de Santé et de Recherche Médicale (INSERM) U964/Centre National de Recherche Scientifique (CNRS) UMR 1704/Université de Strasbourg, Strasbourg, France
| | - Florence Eustache
- CECOS-Service d'Histologie-Embryologie-Cytogénétique, Hôpital Jean Verdier (AP-HP), Bondy, France
| | - Jacqueline Saïas-Magnan
- CECOS de Marseille, Laboratoire de Biologie de la Reproduction, Hôpital de la Conception, AP-HM, Marseille, France
| | - Aline Papaxanthos-Roche
- CECOS Aquitaine, Service de Biologie de la Reproduction, CHU de Bordeaux, Université Bordeaux II, Maternité Pellegrin, Bordeaux, France
| | - Rosalie Cabry-Goubet
- CECOS Picardie, Cytogenetic and Reproductive Biology and Medicine Department, University Hospital of Amiens, and Unité INERIS EA 4285-UMI 01, UFR Médecine d'Amiens, Amiens, France
| | - Florence Brugnon
- CECOS Auvergne, Assistance Médicale à la Procréation, CHU Estaing, and Biologie de la Reproduction (EA 975), Université d'Auvergne, Clermont-Ferrand, France
| | - Dominique Le Lannou
- CECOS de l'Ouest, Unité Biologie de la Reproduction, CHU Rennes, Rennes, France
| | - Claire Barthélémy
- CECOS Région Centre-Ouest, Laboratoire de Biologie de la Reproduction, Centre Olympe de Gouges, CHU Bretonneau, Tours, France
| | - Jean-Marc Rigot
- CECOS Nord, Andrologie, Hôpital Calmette, CHRU de Lille, and EA 4308 Université Lille Nord, Lille, France
| | - Thomas Fréour
- CECOS de Nantes, Médecine et Biologie et Médecine de la Reproduction, CHU de Nantes, Nantes, France
| | - Isabelle Berthaut
- CECOS Paris-Tenon, Service d'Histologie-Biologie de la Reproduction, Hôpital Tenon (AP-HP), Paris, France
| | - Sandrine Giscard d'Estaing
- CECOS de Lyon, Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Bron, and Université Claude Bernard, Biologie Humaine, Lyon, France
| | - Françoise Touati
- CECOS de Nancy, Biologie du Développement et de la Reproduction, CHU Nancy, Maternité Régionale, Nancy, France
| | - Marie-Claude Mélin-Blocquaux
- CECOS Champagne-Ardennes, Service de Génétique, Biologie de la Reproduction, CECOS, CHU Reims, Hôpital Maison Blanche, Reims, France
| | - Oxana Blagosklonov
- CECOS Franche-Comté-Bourgogne, Service de Génétique Biologique, Histologie, Biologie du Développement et de la Reproduction, CHU Besançon, and Sciences Médicales et Pharmaceutiques de Besançon, Université de Franche-Comté, Besançon, France
| | - Claire Thomas
- CECOS de Grenoble, Laboratoire d'Aide à la Procréation, CHU Grenoble, Hôpital Couple-Enfant, Grenoble, France
| | - Mohamed Benhamed
- CECOS de Nice, Hôpital Archet, CHU Nice, INSERM U895, Nice, France
| | - Françoise Schmitt
- CECOS Alsace, Laboratoire de Microbiologie, Centre Hospitalier de Mulhouse, Mulhouse, France
| | - Jean-Marie Kunstmann
- CECOS Paris-Cochin, Hôpital Cochin (AP-HP), Université Paris Descartes, Paris, France
| | - Patrick Thonneau
- Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Université de Toulouse-UPS, Toulouse, France
| | - Louis Bujan
- CECOS Midi-Pyrénées, University Hospital of Toulouse, Hôpital Paule de Viguier, Toulouse, France; Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Université de Toulouse-UPS, Toulouse, France
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Fernbach A, Lockart B, Armus CL, Bashore LM, Levine J, Kroon L, Sylvain G, Rodgers C. Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed With Cancer. J Pediatr Oncol Nurs 2014; 31:211-222. [PMID: 24799444 PMCID: PMC5213740 DOI: 10.1177/1043454214532025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
As survival rates improve for pediatric cancers, increased attention has been paid to late effects of cancer therapy, in particular, infertility. Fertility preservation options are available for pre- and postpubertal cancer patients; however, many providers lack knowledge regarding options. The aim of this article is to provide a comprehensive synthesis of current evidence and recommendations regarding fertility preservation options for children, adolescents, and young adults undergoing cancer treatment. A systematic search was performed to identify fertility preservation evidence. Fifty-three studies and 4 clinical guidelines were used for the review. Final recommendations consisted of 2 strong and 1 weak recommendation for both female and male fertility preservation options. The treatment team should be knowledgeable about fertility preservation so that they can educate patients and families about available fertility preservation options. It is important to consider and discuss all available fertility options with patients at the time of diagnosis.
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Affiliation(s)
| | | | - Cheryl L Armus
- MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI, USA
| | - Lisa M Bashore
- Life After Cancer Program, Cook Children's Medical Center, Fort Worth, TX, USA
| | | | - Leah Kroon
- Seattle Children's Hospital, Seattle, WA, USA
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17
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Mitwally MFM. Fertility preservation and minimizing reproductive damage in cancer survivors. Expert Rev Anticancer Ther 2014; 7:989-1001. [PMID: 17627459 DOI: 10.1586/14737140.7.7.989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent advances in oncology have helped in the survival and cure of increasing numbers of childhood cancer patients and those during their reproductive age period. This has increased the need to improve existing technology, and prompted the search for new technologies, to minimize the gonadotoxic effects of cancer treatment and preserve human fertility. Conservative surgical approaches for cancer treatment have been widely accepted following progress in early detection of cancer and accumulating long-term outcome safety data. Gonadal suppression to increase resistance to cancer treatment by gonadotropin analogues and sex hormones has been suggested. However, while this is unlikely to be effective in males, there is no general consensus on its success in the female. Fertility preservation options for both male and female patients include cryopreservation of embryos, gametes and gonads. While embryo cryopreservation is a well-established and successful technique, there are several obvious limitations. Gamete cryopreservation is very successful in males (sperm freezing) while still experimental in females (oocyte freezing), with growing evidence suggesting its potential success. Gonadal cryopreservation is still in its early stages of experimental development, both in males (testicular tissue cryopreservation and in vitro spermatogenesis) and female (ovarian tissue cryopreservation and in vitro follicular maturation).
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18
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Klonoff-Cohen H. Establishing a fertility preservation database: no time like the present. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Keene DJ, Sajjad Y, Makin G, Cervellione R. Sperm Banking in the United Kingdom is Feasible in Patients 13 Years Old or Older with Cancer. J Urol 2012; 188:594-7. [DOI: 10.1016/j.juro.2012.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Indexed: 11/26/2022]
Affiliation(s)
- David J.B. Keene
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Yasmin Sajjad
- Department of Andrology and Fertility, St. Mary's Hospital, and School of Cancer and Enabling Sciences, Faculty of Medical and Human Sciences, Manchester Cancer Research Center, Manchester Academic Health Sciences Center, University of Manchester, Manchester, United Kingdom
| | - Guy Makin
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - R.M. Cervellione
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
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20
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Gilbert E, Adams A, Mehanna H, Harrison B, Hartshorne GM. Who should be offered sperm banking for fertility preservation? A survey of UK oncologists and haematologists. Ann Oncol 2010; 22:1209-1214. [PMID: 21030380 DOI: 10.1093/annonc/mdq579] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- E Gilbert
- Warwick Medical School, University of Warwick
| | - A Adams
- Warwick Medical School, University of Warwick
| | - H Mehanna
- Warwick Medical School, University of Warwick; Institute of Head and Neck Studies and Education
| | | | - G M Hartshorne
- Warwick Medical School, University of Warwick; Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
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21
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Fertility preservation for cancer patients: a review. Obstet Gynecol Int 2010; 2010:160386. [PMID: 20379357 PMCID: PMC2850134 DOI: 10.1155/2010/160386] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 03/02/2010] [Indexed: 02/04/2023] Open
Abstract
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 fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation.
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22
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Crawshaw MA, Sloper P. 'Swimming against the tide'--the influence of fertility matters on the transition to adulthood or survivorship following adolescent cancer. Eur J Cancer Care (Engl) 2010; 19:610-20. [PMID: 20088919 DOI: 10.1111/j.1365-2354.2009.01118.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Psychosocial research into cancer-related fertility has concentrated on fertility preservation or adult survivors' concerns. This study reports on its hitherto unreported impact over the time from diagnosis to survivorship. Thirty-eight men and women aged<30, diagnosed as teens, were recruited to an exploratory qualitative study. Analysis used the constant comparison method, considered conceptually within a lifespan approach. Four key experiences of managing fertility matters influenced, or were influenced by, the aftermath of cancer treatment: (1) prioritising 'normality' and marginalising fertility; (2) fertility concerns compromising 'normality'; (3) ongoing impairments/health concerns mediating fertility matters; (4) fertility concerns dominating the cancer legacy. Professional and social networks provided few opportunities to ask questions, receive information, process feelings or develop handling strategies. Beliefs about the extent of fertility damage did not necessarily relate to information received. For some, fertility matters affected identity, well-being and life planning as well as reproductive function. This was not restricted to particular ages, life stages, gender or time since treatment ended and was heightened by associated stigma and silence. Opportunities for dialogue should be offered regularly across health and social work disciplines given fertility's psychological and social as well as medical significance.
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Affiliation(s)
- M A Crawshaw
- Department of Social Policy and Social Work, University of York, York, UK.
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23
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Huyghe E, Martinetti P, Sui D, Schover LR. Banking on Fatherhood: pilot studies of a computerized educational tool on sperm banking before cancer treatment. Psychooncology 2009; 18:1011-4. [PMID: 19061198 DOI: 10.1002/pon.1506] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We conducted pilot studies of the feasibility and efficacy of an interactive, computerized educational tool, Banking on Fatherhood (BOF). METHODS Two small randomized trials were conducted, with 20 male cancer patients eligible to bank sperm in Study 1 and 19 oncology fellows or residents in Study 2. In each trial, half of the subjects viewed BOF before completing questionnaires, and half viewed it afterward. Outcome measures included a knowledge test in both trials and a Decisional Conflict scale in the patient trial. All participants, plus a panel of 10 experts, ultimately viewed BOF and completed a form evaluating its usability and value. RESULTS Patients who completed questionnaires after viewing BOF had significantly less decisional conflict about banking sperm than those who had not viewed it (P=0.0065), but knowledge scores were not significantly different between groups. Physicians who filled out questionnaires after viewing BOF scored significantly higher on the knowledge test (P<0.006). Patients, physicians and experts rated BOF as easy to use, informative and addressing important psychosocial concerns, with videos and animations adding to the value of the educational tool. CONCLUSION Pilot studies suggest that BOF is a feasible intervention that could enhance decisions about sperm banking. Research with larger groups is needed to validate its effectiveness.
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Affiliation(s)
- Eric Huyghe
- Human Fertility Research Group (EA 3694), Urology and Andrology Department, Paul Sabatier University, Toulouse, France
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Abstract
The increased survival rates for pediatric cancer patients and for some malignancies that are common in young adults, such as testicular cancer and Hodgkin disease have led to an increased focus on preserving fertility. Research on the psychosocial aspects of cancer-related infertility is a recent development, but we know that both young men and women value parenthood after cancer. At least 75% of survivors who were childless at diagnosis would like future offspring. For those who do not become parents, long-term distress is common. Younger teens may have difficulty assessing whether parenthood will be important to them in the future, and informed consent protocols need to respect their desires rather than deferring too much to parents. We do not know whether parenting a non-biological child (adopted, conceived through third-party reproduction, or a stepchild) reduces distress as much as being able to have one's own genetic offspring. Survivors often have exaggerated concerns about their children's health risks, but still prefer to have biological children if possible. More research is needed on whether participating in fertility preservation reduces long-term distress about cancer-related fertility. Better evidence-based programs to educate families and reduce decisional conflict are needed.
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Affiliation(s)
- Leslie R Schover
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1439, USA.
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25
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Crawshaw MA, Glaser AW, Pacey AA. The use of pornographic materials by adolescent male cancer patients when banking sperm in the UK: Legal and ethical dilemmas. HUM FERTIL 2009; 10:159-63. [PMID: 17786648 DOI: 10.1080/14647270701418922] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Increased awareness of the importance of fertility concerns to teenage cancer survivors is leading to growing numbers of male teenagers being offered sperm banking at the time of diagnosis. This is now extending to males diagnosed with other conditions where gonadotoxic agents are used in treatment. The storage of sperm in these circumstances is a challenging aspect of health care, given the complex issues and timescale involved. UK law has been enacted to protect legal minors from the potentially harmful effects of exposure to pornographic materials, yet there is reason to suppose that their use in this context could have therapeutic benefit in aiding successful masturbation. This paper uses material gained through consultation with the eleven largest UK sperm banks and 94 male teenage cancer survivors, to discuss the associated legal and ethical dilemmas, including those around the role of parents/carers. Findings suggest that there is variable practice in sperm banks, that almost a quarter of teenage males wanted access to soft porn when banking sperm, and half wanted to bring in their own materials. It concludes that there is an urgent need for any legal barriers to the therapeutic use of pornographic materials to be understood and examined.
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Affiliation(s)
- Marilyn A Crawshaw
- Department of Social Policy & Social Work, University of York, York, UK.
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26
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Crawshaw MA, Crawshaw MA, Glaser AW, Hale JP, Sloper P. Young males' experiences of sperm banking following a cancer diagnosis – a qualitative study. HUM FERTIL 2009; 11:238-45. [DOI: 10.1080/14647270802132752] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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CRAWSHAW M, GLASER A, HALE J, SLOPER P. Male and female experiences of having fertility matters raised alongside a cancer diagnosis during the teenage and young adult years. Eur J Cancer Care (Engl) 2009; 18:381-90. [DOI: 10.1111/j.1365-2354.2008.01003.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Klosky JL, Randolph ME, Navid F, Gamble HL, Spunt SL, Metzger ML, Daw N, Morris EB, Hudson M. Sperm cryopreservation practices among adolescent cancer patients at risk for infertility. Pediatr Hematol Oncol 2009; 26:252-60. [PMID: 19437327 PMCID: PMC2801903 DOI: 10.1080/08880010902901294] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To assess sperm cryopreservation among males newly diagnosed with cancer aged 13 years and older, attending oncologists assigned infertility risk (yes/no) to patients and reported whether their patients engaged in sperm cryopreservation. Only 28.1% of informed at-risk patients banked sperm. Utilization of sperm banking was significantly associated with a diagnosis of central nervous system (CNS) malignancy or non-CNS solid tumor diagnosis, higher socioeconomic status, and not being a member of an Evangelical religious group. These results suggest that sperm banking is underutilized among adolescent males newly diagnosed with cancer, and that strategies to increase the engagement in this fertility preservation method are needed.
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30
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Fertility issues: the perceptions and experiences of young men recently diagnosed and treated for cancer. J Adolesc Health 2007; 40:69-75. [PMID: 17185208 DOI: 10.1016/j.jadohealth.2006.07.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To explore fertility issues for young men who had been diagnosed and treated for cancer and to examine communication problems surrounding these fertility issues. METHOD Narrative interviews were conducted with 21 young men previously treated for cancer in the United Kingdom. Eighteen talked about fertility issues at some length. A qualitative interpretive approach was taken, combining thematic analysis with constant comparison. RESULTS Communication about sperm storage was sometimes difficult and embarrassing. Young men wanted the opportunity to bank their sperm but decisions were often rushed. Some would have appreciated counseling and were unprepared for the process of sperm banking and criticized facilities. Uncertainty about fertility status caused worries for the future. CONCLUSIONS More still needs to be done to help young men with cancer to address issues of fertility. All adolescents and young men treated for cancer should be offered sperm banking if their fertility may be affected. They should be offered counseling at every stage by professionals who feel comfortable talking about the subject. Interactive, educational CD-ROMs or websites may be useful. Physical facilities for sperm banking should be improved.
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31
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Burns KC, Boudreau C, Panepinto JA. Attitudes regarding fertility preservation in female adolescent cancer patients. J Pediatr Hematol Oncol 2006; 28:350-4. [PMID: 16794502 DOI: 10.1097/00043426-200606000-00006] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infertility is a devastating side effect of cancer treatment. Advances in fertility research have brought new preservation techniques to the forefront for women. The implication of this research in the field of pediatric oncology has not been reported. The objective of this study was to determine whether female adolescents with a diagnosis of cancer and their parents were interested in trying to preserve fertility. We conducted a cross-sectional survey of female patients, aged 10 to 21 years, and their parents. There were 39 parent/adolescent pair responses, 3 parent-only responses, and 8 adolescent-only responses. We found that adolescents and parents had thought about the future and were interested in research treatments to help preserve fertility, but not willing to postpone cancer therapy. Achieving a state of good health was most important to the adolescent group (P<0.001). There was no statistical difference between attitudes of parents and adolescents. In summary, parents and female adolescents are interested in options to help preserve fertility during cancer treatments, but they are not willing to postpone treatment for this purpose.
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Affiliation(s)
- Karen C Burns
- Pediatric Hematology/Oncology/Bone Marrow Transplant, Medical College of Wisconsin and The Children's Research Institute of the Children's Hospital of Wisconsin, Milwaukee, WI, USA.
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Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, Beck LN, Brennan LV, Oktay K. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006; 24:2917-31. [PMID: 16651642 DOI: 10.1200/jco.2006.06.5888] [Citation(s) in RCA: 1302] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. METHODS An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. RESULTS The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. RECOMMENDATIONS As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. CONCLUSION Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.
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Abstract
BACKGROUND Semen cryopreservation is a widely available method of maintaining fertility in male cancer patients. However this facility is not always used. AIMS To identify the barriers to successful sperm banking in a group of adolescent and young adult patients. METHODS Questionnaires were administered to 55 patients aged 13-21 years who had received potentially gonadotoxic therapy between 1997 and 2001 and had been offered sperm banking. RESULTS Forty five questionnaires were completed; 67% of respondents were able to bank sperm. Those who had been unsuccessful were younger and described higher levels of anxiety at diagnosis and greater difficulty in talking about fertility. They also described less understanding of sperm banking at the time of diagnosis. CONCLUSION Most adolescent cancer patients who have been offered fertility preservation are able to bank sperm. Younger patients may be helped by the provision of high quality information and more open discussion of the technique.
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Affiliation(s)
- B Edge
- Faculty of Medical and Human Sciences, University of Manchester, UK
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