Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
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DOI：
10.1200/jco.2013.49.2678
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发表时间：
2013-07-01
影响因子：
45.3
通讯作者：
Oktay, Kutluk
中科院分区：
文献类型：
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作者：
Loren, Alison W.;Mangu, Pamela B.;Oktay, Kutluk
目的更新卫生服务提供者关于成人和儿童癌症患者生育力保护的指南。方法利用MEDLINE和Cochrane协作图书馆对2006年3月至2013年1月发表的文献进行系统综述。一个更新小组审查了证据并更新了推荐语言。结果有222篇新出版物符合纳入标准。大多数是观察性研究、队列研究和病例系列或报告，很少有随机临床试验。在审查了新的证据后，更新小组得出结论，没有必要对2006年美国临床肿瘤学会的建议进行重大的实质性修订，但增加了澄清。建议作为癌症治疗前教育和知情同意的一部分，医疗保健提供者(包括内科肿瘤学家、放射肿瘤学家、妇科肿瘤学家、泌尿科医生、血液学家、儿科肿瘤学家和外科医生)应该考虑在育龄期间(或与儿童的父母或监护人一起)接受治疗的患者出现不孕不育的可能性，并准备讨论保留生育能力的选择和/或将所有潜在患者转介给适当的生殖专家。尽管患者最初可能专注于他们的癌症诊断，但更新小组鼓励提供者在治疗过程中尽早向患者建议对生育的潜在威胁，以便允许最广泛的选择来保留生育能力。讨论应该被记录下来。精子和胚胎冷冻保存以及卵母细胞冷冻保存被认为是标准做法，并得到广泛应用。其他保留生育能力的方法应被认为是调查性的，并应由具有必要专业知识的提供者执行。
Purpose To update guidance for health care providers about fertility preservation for adults and children with cancer.Methods A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language.Results There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added.Recommendations As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise.