Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview

Abstract

Purpose

Fertility-related services in pediatric oncology are increasing, but barriers to care remain and few structured programs are described in the literature. Therefore, the study objectives were (1) to characterize fertility-related services in a large pediatric oncology center and (2) to discuss recommendations for fertility-related services across the pediatric cancer continuum.

Methods

Medical records of all cases referred to our Fertility Preservation Clinic within a 3-year period were reviewed, which included 292 patients/survivors with malignant disease. Approximately half (n = 152/292, 52.1%) were cancer patients referred prior to treatment (n = 92/152) or while on active therapy (n = 60/152). The other half (n = 140/292; 47.9%) were survivors who had completed treatment.

Results

Referrals more than doubled over 3 years. Most patients referred before treatment were offered and opted for FP (72.8% attempted; 58.9% completed). More male than female patients opted for FP (77.6% vs. 22.4%), but completion rates were higher among females (93.3% vs. 76.9%). Rates of FP before treatment did not increase over time (p = .752). Many patients on-treatment were referred for infertility risk counseling, demonstrating information/support needs in this group. Referred survivors questioned their fertility post-treatment and completed fertility assessments, indicating intact fertility among few (~ 15%).

Conclusions

This review demonstrated the acceptance and increasing need for fertility-related services in pediatric oncology across the cancer continuum, including FP before treatment, counseling during treatment, and fertility assessment in survivorship. Based on our experiences, current recommendations are discussed and include standardized procedures, streamlined referrals, adequate communication/education (of providers and families), and meeting specific needs of young cancer patients/survivors.

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Funding

No specific external funding was used to support this medical record review and manuscript preparation, but support to St Jude Children’s Research Hospital is provided by the Cancer Center Support (CORE) grant (CA21765, PI: Roberts) and the American Lebanese Syrian Associated Charities.

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Correspondence to Vicky Lehmann.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board (IRB) of St. Jude Children’s Research Hospital (#FWA00004775) and with the 1964 Helsinki Declaration and its later amendments and comparable ethical standards.

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Due to the nature of this retrospective medical chart reviews and no direct patient involvement with the study, and in accordance with our IRB, no additional informed consent was obtained from participants.

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Lehmann, V., Kutteh, W.H., Sparrow, C.K. et al. Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview. Support Care Cancer 28, 3955–3964 (2020). https://doi.org/10.1007/s00520-019-05248-4

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Keywords

  • Fertility preservation
  • Fertility assessments
  • Pediatric neoplasms
  • Cancer survivor
  • Cryopreservation
  • Infertility