Enabling Fertility Discussions with Young Adult Male Oncology Patients

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 anoncofertility 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:

• Created and distributed patient education materials: As a supplement to provider-led discussions and to guide patients in fertility preservation, UCLA Mattel Children’s Hospital produced an AYA-oriented brochure, “Banking on the Future: The Basics of Sperm Banking.” Although it does not replace an in-depth conversation with a provider, the brochure covers topics that patients may feel uncomfortable discussing and allows patients and family members to return with questions. The printed brochure, available in English and Spanish, addresses causes of infertility, sperm cryopreservation procedures, and basic information about costs.
• Enabled physician documentation: To prompt physician-led discussions and provide one systematic location for maintaining fertility preservation discussion records, UCLA Mattel Children’s Hospital modified the standardized chemotherapy consent documentation template used in the hospital’s EHR. The template now includes a fertility preservation section as a clinical decision-support tool.
• Provided specialized nursing education: By providing opportunities for nursing education in AYA oncofertility topics, UCLA Mattel Children’s Hospital has empowered nurses to effectively discuss fertility preservation with patients and advocate for sperm cryopreservation at the bedside.
• Enabled patient access to fertility specialists: Key stakeholders at UCLA Mattel Children’s Hospital developed standard operating procedures (SOPs) that outline the steps for semen collection and storage at the cryobank. The oncofertility team collaborated with the community’s cryobank team to give patients specific contact information for cryobank patient coordinators. The SOP was uploaded to the hospital’s intranet along with cryobank information and example documents, including directions, financial assistance applications, and cost descriptions.

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.
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This post is adapted from “Improving Fertility Preservation Discussions for Adolescent and Young Adult Male Oncology Patients” in Oncology Issues (September/October 2018).