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Fertility preservation for people with cancer

Oncofertility service provision

Clinical Question

What is the best practice approach for developing and implementing oncofertility services in relation to referral pathways and models of care?

There is very little research into how to provide the best oncofertility services in terms of referral pathways and models of care. Despite this, studies of interventions initiated at a small number of institutions indicate that establishment of oncofertility programs has a positive impact on referrals to fertility specialists and use of fertility preservation services. Examples of these include:

  • The establishment of a designated multidisciplinary fertility preservation program at the Davidoff Center in Israel resulted in a significant increase in referral and subsequent fertility preservation procedures.[1]
  • Patients were more likely to have documented discussion of risk of infertility, documented referral to fertility specialists and documented fertility preservation outcomes following introduction of a bundled intervention including quality indicators, fertility preservation resources, and targeted education in five cancer centres in Australia.[2]
  • Establishment of a multidisciplinary, hospital-wide Fertility Preservation Service at the Children's Hospital of Philadelphia saw the number of referrals double.[3]
  • A dedicated oncofertility clinic at the Massachusetts General Hospital (MGH) Cancer Center saw an increase in the number of patients referred for a fertility preservation consultation.[4]
  • An intervention as simple as distribution of a patient education brochure at the H. Lee Moffitt Cancer Center increased the number of calls to the reproductive endocrinologist/infertility clinic by nine times the number before distribution of the brochure.[5]
  • The development of a dedicated pediatric fertility preservation program has also been described.[6]

A large systematic scoping review of oncofertility models of care identified a number of areas for improvement to services: patient communication on fertility risk and fertility preservation options; provision of oncofertility care in a timely manner; access to age-appropriate care and improving communication between health care professionals. The review also called for increased education of health professional in oncofertility care.[7]

Further work from this group has led to the development of an ‘International Oncofertility Competency Framework’ which defines components of care across 10 domains of health care (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 as well as the roles that health care professionals play in the provisions of oncofertility health care.(https://pubmed.ncbi.nlm.nih.gov/31147490/)

Consumers' experience of oncofertility care in Australia has informed the development of the Australasian Oncofertility Consortium Charter which contains eight key elements of quality oncofertility care. These elements include discussion of fertility with all patients, referral to a fertility specialist, data collection, training for health professionals, affordability of services, psycho-social support and information on reproductive health.[8]

With the establishment of Australasian Oncofertility Registry there is the potential to track local and national oncofertility referral patterns, uptake of fertility preservation and track complications and outcomes (https://pubmed.ncbi.nlm.nih.gov/30655118/). The collection of data on the Australasian Oncofertility Registry will allow for benchmarking of uptake and utilisation of oncofertility care against the Australasian Oncofertility Charter recommendations.

Evidence Summary

Evidence summaryLevelReferences
Provision of a dedicated oncofertility program within an oncology service is associated with improved referral pathways for timely fertility preservation discussion and treatment if required.II, IV[1], [2], [3], [4], [9], [7]

Recommendation

Evidence-based recommendationGrade
Cancer services should establish referral pathways with fertility preservation services to enable rapid referral of newly diagnosed cancer patients for fertility preservation discussion and procedures. Services planning on establishing their own oncofertility program are encouraged to refer to the International Oncofertility Competency Framework and the Australasian Oncofertility Consortium Charter.C


References

  1. Ben-Aharon I, Abir R, Perl G, Stein J, Gilad G, Toledano H, et al. Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program. BMC Cancer 2016 Aug 9;16:620 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27506811.
  2. Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28934554.
  3. Carlson CA, Kolon TF, Mattei P, Hobbie W, Gracia CR, Ogle S, et al. Developing a Hospital-Wide Fertility Preservation Service for Pediatric and Young Adult Patients. J Adolesc Health 2017 Nov;61(5):571-576 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28917444.
  4. Hariton E, Bortoletto P, Cardozo ER, Hochberg EP, Sabatini ME. The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists. J Patient Exp 2016 Dec;3(4):131-136 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28725849.
  5. Quinn GP, Vadaparampil ST, Gwede CK, Reinecke JD, Mason TM, Silva C. Developing a referral system for fertility preservation among patients with newly diagnosed cancer. J Natl Compr Canc Netw 2011 Nov;9(11):1219-25 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22056654.
  6. Moravek MB, Confino R, Smith KN, Kazer RR, Klock SC, Lawson AK, et al. Long-term outcomes in cancer patients who did or did not pursue fertility preservation. Fertil Steril 2018 Feb;109(2):349-355 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29338854.
  7. Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, et al. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2018 Nov 20 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30462263.
  8. Anazodo AC, Gerstl B, Stern CJ, McLachlan RI, Agresta F, Jayasinghe Y, et al. Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter. J Adolesc Young Adult Oncol 2016 Sep;5(3):232-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26981709.
  9. Quinn GP, Murphy D, Knapp C, Stearsman DK, Bradley-Klug KL, Sawczyn K, et al. Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature. J Adolesc Health 2011 Oct;49(4):337-46 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21939862.

Body of evidence

What is the best practice approach for developing and implementing oncofertility services in relation to referral pathways and models of care?

CitationLevel of EvidenceQuality of EvidenceSize of EffectNumber of PatientsRelevance of Evidence
Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, et al. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2018 Nov 20 Available from:http://www.ncbi.nlm.nih.gov/pubmed/30462263IVMediumN/AN/AN/A
Anazodo AC, Gerstl B, Stern CJ, McLachlan RI, Agresta F, Jayasinghe Y, et al. Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter. J Adolesc Young Adult Oncol 2016 Sep;5(3):232-9 Available from:http://www.ncbi.nlm.nih.gov/pubmed/26981709N/AMedium1N/AN/A
Ben-Aharon I, Abir R, Perl G, Stein J, Gilad G, Toledano H, et al. Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program. BMC Cancer 2016 Aug 9;16:620 Available from:http://www.ncbi.nlm.nih.gov/pubmed/27506811IVLow162N/A
Blough K, Mansfield C, Kondapalli LA. Seamless integration of clinical care and research in an innovative fertility preservation program: the Colorado Oncofertility Program model. J Cancer Surviv 2014 Dec;8(4):533-8 Available from:http://www.ncbi.nlm.nih.gov/pubmed/24806262IVLow31261
Bowman-Curci M, Quinn GP, Reinecke J, Reich RR, Vadaparampil ST, ENRICH Working group.. Comparing fertility preservation resources and policies between NCCN member and non-member institutions. Support Care Cancer 2018 Sep 22 Available from:http://www.ncbi.nlm.nih.gov/pubmed/30244291IVLowN/AN/AN/A
Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from:http://www.ncbi.nlm.nih.gov/pubmed/28934554IIMediumN/A476N/A
Carlson CA, Kolon TF, Mattei P, Hobbie W, Gracia CR, Ogle S, et al. Developing a Hospital-Wide Fertility Preservation Service for Pediatric and Young Adult Patients. J Adolesc Health 2017 Nov;61(5):571-576 Available from:http://www.ncbi.nlm.nih.gov/pubmed/28917444IILowN/AN/AN/A
Chatterton F, Kay V. An audit of Ninewells Hospital fertility preservation service. J Obstet Gynaecol 2018 Jul;38(5):732 Available from:http://www.ncbi.nlm.nih.gov/pubmed/29944041IVLowN/A296N/A
Hariton E, Bortoletto P, Cardozo ER, Hochberg EP, Sabatini ME. The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists. J Patient Exp 2016 Dec;3(4):131-136 Available from:http://www.ncbi.nlm.nih.gov/pubmed/28725849IVLow11502
Quinn GP, Vadaparampil ST, Gwede CK, Reinecke JD, Mason TM, Silva C. Developing a referral system for fertility preservation among patients with newly diagnosed cancer. J Natl Compr Canc Netw 2011 Nov;9(11):1219-25 Available from:http://www.ncbi.nlm.nih.gov/pubmed/22056654IVLowN/AN/AN/A
Rashedi AS, de Roo SF, Ataman LM, Edmonds ME, Silva AA, Scarella A, et al. Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe. J Glob Oncol 2018 Sep;(4):1-16 Available from:http://www.ncbi.nlm.nih.gov/pubmed/30241167IVLow2632
Sigismondi C, Papaleo E, Viganò P, Vailati S, Candiani M, Ottolina J, et al. Fertility preservation in female cancer patients: a single center experience. Chin J Cancer 2015 Jan;34(1):56-60 Available from:http://www.ncbi.nlm.nih.gov/pubmed/25556619IVLow5961
Winkelman WD, Rosen MP, Mok-Lin E. Fertility Preservation Services for Women With Newly Diagnosed Cancer: A National Assessment. Am J Clin Oncol 2018 Oct;41(10):1031-1035 Available from:http://www.ncbi.nlm.nih.gov/pubmed/29315172IVLow1992
Yee S, Buckett W, Campbell S, Yanofsky R, Barr RD. A national study of the provision of oncofertility services to female patients in Canada. J Obstet Gynaecol Can 2012 Sep;34(9):849-858 Available from:http://www.ncbi.nlm.nih.gov/pubmed/22971454IVLowN/AN/AN/A
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Cancer Council Australia