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- Title
The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options.
- Authors
Lewin, Jeremy; Ma, Justin; Mitchell, Laura; Tam, Seline; Puri, Natasha; Stephens, Derek; Srikanthan, Amirrtha; Bedard, Philippe; Razak, Albiruni; Crump, Michael; Warr, David; Giuliani, Meredith; Gupta, Abha; Ma, Justin Ming Zheng
- Abstract
<bold>Purpose: </bold>Minimal data exist regarding documentation of therapy-associated infertility risk (IR) and fertility preservation (FP) options during the initial oncology consultation prior to systemic therapy. This study investigated factors affecting IR/FP documentation and assessed the effect of implementation of an Adolescent and Young Adult (AYA) program on documentation rates.<bold>Methods: </bold>A retrospective review of charts of patients receiving gonadotoxic therapy was undertaken for documentation of IR/FP pre- and post-implementation of an AYA program. Change in documentation rates was assessed using univariate and multiple logistic regression.<bold>Results: </bold>A total of 173 charts were reviewed. On univariate analysis, IR/FP documentation was less likely if patients had metastatic disease (P < 0.01, P < 0.01), by tumor type (P < 0.01, P < 0.01), received less intensive chemotherapy (P = 0.03, P = 0.06), were older (P = 0.14, P < 0.01), had more children (P < 0.01, P < 0.01), or lacked AYA program involvement (P < 0.01, P < 0.01). FP discussion was more common in males (P = 0.02). On multivariable analysis, more children (P = 0.01, P = 0.03), older age (P < 0.01, P < 0.01), tumor type (P < 0.01, P = 0.01), stage (P = 0.02, NS), relationship (P = 0.03, NS), and lack of AYA involvement (P < 0.01, P < 0.01) were associated with lower rates of IR/FP documentation. Following AYA program implementation, IR/FP rates increased from 56% (CI 46-65%) to 85% (CI 74-92%, P < 0.01) and 54% (CI 45-64%) to 86% (CI 75-93%, P < 0.01), respectively. The effect of AYA program implementation on IR/FP documentation was most noticeable in leukemia, lymphoma, and breast groups (P < 0.01).<bold>Conclusions: </bold>Implementing an AYA consultation service at an adult cancer institution had a positive effect on the rates of IR/FP documentation. Specific programming can improve service delivery to AYA cancer patients, and fertility counseling should be integrated for patients undergoing gonadotoxic therapy.
- Subjects
HUMAN fertility -- Social aspects; RISK factors in infertility; FERTILITY preservation; CANCER patients; INFERTILITY; COUNSELING; DOCUMENTATION; RETROSPECTIVE studies; PSYCHOLOGY; DIAGNOSIS
- Publication
Supportive Care in Cancer, 2017, Vol 25, Issue 6, p1915
- ISSN
0941-4355
- Publication type
journal article
- DOI
10.1007/s00520-017-3597-8