Building a Pediatric Oncofertility Practice

Abstract

The rate of cure for childhood cancer is now over 80% due to tremendous therapeutic advances over the past 50 years. Many survivors experience late effects related to their prior cancer and/or therapy. Gonadotoxicity and infertility are among these potential late effects. Even the youngest patients now have options to preserve fertility prior to starting cancer therapy. A pediatric/adolescent/young adult fertility team can address fertility concerns and potential preservation options via a multidisciplinary approach. This chapter outlines the various members of a comprehensive team, as well as the necessary steps in the consultation process. Insights from the experience of the team at Cincinnati Children’s Hospital are also provided.

Review Questions and Answers

• Q1. True or false: Fertility preservation procedures are usually covered by insurance.

• A1. False. Most insurance policies do not cover fertility preservation. However, there may be financial assistance programs available, both on a national and local level. It is important to know what is available in your area.

• Q2. Which of the following describe aspects of care that are unique to pediatric patients/families considering fertility preservation?

• (a) Parents must consent for patients under the age of 18.

• (b) There is often not much time between diagnosis and start of therapy with pediatric malignancies.

• (c) All of the above.

• (d) None of the above.

• A2. (c)

• Q3. True or false: Visual aids may help a family process information during the fertility preservation consultation.

• A3. True. Our team uses both an animated video and written material during the consultation process.

• Q4. Name several modalities a consulting team might use to reach the fertility team (and thus make obtaining a consult easy).

• A4. Our team uses the following methods: specific pager, EMR order set and consult order, specific fertility email, specific fertility phone number, and on-call fertility team member listed on hospital call list. There are certainly other ways of reaching the fertility team, and institutions should use the methods that work best in their system.