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Although recently diagnosed adolescent males rank fertility as a top concern in their lives post-cancer treatment, less than half recall discussing sperm cryopreservation before their treatment. Indeed, one national survey found that less than half of oncologists routinely discuss sperm cryopreservation with their eligible male patients.
Why? A recent article in Oncology Issues identified several barriers to conversations between oncologists and their adolescent and young adult (AYA) male patients about the potential effects of cancer therapies on fertility. Some of the factors that deter physicians from discussing fertility preservation include preconceptions based on patient characteristics (e.g., socioeconomic status); lack of knowledge about local facilities and treatment options; and perceived high costs of sperm cryopreservation. Institutional barriers to fertility discussions with AYA male patients include lack of methods for recording discussions; lack of educational resources or materials; and lack of financial support.
The authors of the Oncology Issues article note that, in the United States, models of care delivery for AYA oncology patients and the resources available to each institution vary widely. Therefore, methods of providing oncofertility services must be tailored to each individual program. To meet this need, researchers at the University of California Los Angeles (UCLA) Mattel Children’s Hospital developed an oncofertility initiative as part of the hospital’s larger goal of creating an AYA oncology program. After assessing the hospital’s current oncofertility practices, the researchers developed methods and tools to facilitate fertility preservation discussions with newly diagnosed AYA males.
As with other hospitals, the researchers at UCLA Mattel Children’s Hospital found suboptimal rates of documented fertility preservation discussions and sperm cryopreservation. Researchers were able to identify several opportunities for improvement within their hospital’s AYA program: 1) patient education could be improved with AYA-oriented written materials to supplement provider-led fertility preservation discussions, 2) physician documentation could be improved by creating a specific place to document fertility preservation discussions in the EHR, 3) nursing education could be improved by making training opportunities for AYA-specific oncofertility issues more widely available, and 4) there could be standard operating procedures for descriptions of available sperm cryopreservation facilities and referral steps.
Researchers described the steps they took to counteract the obstacles they identified:
Fertility preservation is a significant concern for AYA males diagnosed with cancer. For any institution interested in developing an AYA program, it is essential that fertility preservation be addressed and continually assessed.
This post is adapted from “Improving Fertility Preservation Discussions for Adolescent and Young Adult Male Oncology Patients” in Oncology Issues (September/October 2018).