Determinants of utilization of cryopreservation of germ cells in adolescent cancer patients in four European countries
Infertility is a relevant late-effect following cancer treatment; yet, a large proportion of survivors cannot recall having been informed of this risk. In an intervention study, we examined if and how supportive patient information material on fertility/fertility-preserving measures influences utilization of cryopreservation in adolescent cancer patients. The control group, recruited 03/2014–01/2016, received the usual patient education at initial diagnosis. The intervention group, recruited 04/2016–10/2017, received patient education supported by a fertility flyer and brochure. Patients and parents were each asked questions on utilization of cryopreservation in a questionnaire 3 and 6 months after initial diagnosis. Patient core and therapy data were obtained from medical records. Overall, cryopreservation rates showed no significant difference between the control (32.7%, n = 37/113) and intervention group (36.6%, n = 37/101). In the control group, cryopreservation was associated with gender (OR 0.100, CI 0.023–0.427), age (OR 1.559, CI 1.077–2.258) and recalling information on fertility protection (OR 33.663, CI 2.100–539.574); in the intervention group, cryopreservation was related to gender (OR 0.093, CI 0.026–0.330) and the estimated infertility risk (OR 43.665, CI 2.157–883.974).
What is Known:
•Infertility is a relevant late-effect following adolescent cancer.
•Guidelines recommend to offer fertility protection before cancer treatment.
•A relevant proportion of adolescents with cancer are not aware of this risk.
•Fertility protection seems under-used in cancer patients at risk for infertility.
What is New:
•Information material on fertility and protection in adolescents did not increase overall rates of cryopreservation.
•Cryopreservation rates were improved according to individual risk for infertility.
•Our flyers and brochures on fertility in cancer patients are available in various languages.
KeywordsPatient education Childhood and adolescent cancer Fertility impairment Fertility protection Cryopreservation Patient empowerment
MB: study concept and design, data acquisition, data interpretation, manuscript preparation, editing, revision and proof. RS: study concept and design, data acquisition, quality control of data and algorhythms; data analysis and interpretation; statistical analysis, manuscript editing, revisiona and proof. JB: study concept and design, manuscript editing. UD: data acquisition, manuscript editing. HC: data acquisition, manuscript editing. MJFG: manuscript editing. TK: data acquisition, manuscript editing. EK: study concept and design, data acquisition, quality control of data and algorhythms, manuscript editing. JK: data acquisition, manuscript editing. MK: data acquisition, manuscript editing. HL: data acquisition, manuscript editing. TL: data acquisition, manuscript editing. MSZ: data acquisition, manuscript editing. JS: data acquisition, manuscript editing. GS: data acquisition, manuscript editing. AB: study concept and design, data acquisition, data interpretation, manuscript editing.
This project received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602030 (PanCareLIFE). The study was also supported by Berliner Krebsgesellschaft e.V. (EKPS201607) and KINDERHILFE - Hilfe für krebs- und schwerkranke Kinder e.V. Dr. Balcerek is being supported by the Clinician Scientist Programme of Charité–Universitätsmedizin Berlin and the Berlin Institute of Health (BIH). Special thanks go to our young patients and their parents for participating in this study. We also thank the participating clinics in this study for the good cooperation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The coordinating study centre Charité-Universitätsmedizin Berlin received approval from their local ethics committee on 04/04/2014 (EA2/155/11). All data providers received approval for the study from their respective ethics committees.
Informed consent was obtained from all participants included in the study.
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