Fertility preservation before and after cancer treatment in children, adolescents, and young adults.
Fertility preservation before and after cancer treatment in children, adolescents, and young adults.
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儿童、青少年和年轻人癌症治疗前后的生育能力保留。
作者：
Yang,EmilyH;Strohl,HarmonieB;Su,HIrene
生育能力是许多被诊断为儿童、青少年和青年（CAYA）的癌症幸存者最关心的问题。生育保留（FP）治疗是有效的，基于证据的干预措施，以支持他们的家庭建设目标。生育讨论是贯穿整个癌症治疗连续体的高质量肿瘤治疗的一部分。近20年来，临床指南建议在诊断时及时向患者咨询不孕的可能性，并根据需要提供计划生育选择和转诊。现在有多个指南推荐治疗后咨询。不育风险因癌症治疗和年龄的不同而不同，使风险分层成为计划生育护理的核心部分。为了支持计划生育决策，可以使用女性风险评估的在线工具。在诊断时，女性可以进行成熟卵母细胞/胚胎冷冻保存、卵巢组织冷冻保存、GnRH激动剂抑制卵巢、体外卵母细胞成熟和/或妇科癌症的保守治疗。治疗后，一些人群可能会考虑进行卵母细胞/胚胎冷冻保存。男性幸存者的标准护理FP治疗以癌症治疗前的精子冷冻保存为中心，治疗后没有相同的配子冷冻保存适应症。在实践中，计划生育护理需要系统化的流程，以常规筛查计划生育需求，将肿瘤转介到生育，提供及时的生育咨询和计划生育治疗，并支持财务导航。美国16个州通过了法律，要求健康保险公司为计划生育治疗提供保险福利，但法律和下游实施的差异是获得计划生育治疗的障碍。为了保护CAYA幸存者的生殖未来，需要研究改善风险分层、计划生育选择和计划生育护理的提供。
Fertility is a top concern for many survivors of cancer diagnosed as children, adolescents and young adults (CAYA). Fertility preservation (FP) treatments are effective, evidence‐based interventions to support their family building goals. Fertility discussions are a part of quality oncology care throughout the cancer care continuum. For nearly 2 decades, clinical guidelines recommend counseling patients about the possibility of infertility promptly at diagnosis and offering FP options and referrals as indicated. Multiple guidelines now recommend post‐treatment counseling. Infertility risks differ by cancer treatments and age, rendering risk stratification a central part of FP care. To support FP decision‐making, online tools for female risk estimation are available. At diagnosis, females can engage in mature oocyte/embryo cryopreservation, ovarian tissue cryopreservation, ovarian suppression with GnRH agonists, in vitro oocyte maturation, and/or conservative management for gynecologic cancers. Post‐treatment, several populations may consider undergoing oocyte/embryo cryopreservation. Male survivors’ standard of care FP treatments center on sperm cryopreservation before cancer treatment and do not have the same post‐treatment indication for additional gamete cryopreservation. In practice, FP care requires systemized processes to routinely screen for FP needs, bridge oncology referrals to fertility, offer timely fertility consultations and access to FP treatments, and support financial navigation. Sixteen US states passed laws requiring health insurers to provide insurance benefits for FP treatments, but variation among the laws and downstream implementation are barriers to accessing FP treatments. To preserve the reproductive futures of CAYA survivors, research is needed to improve risk stratification, FP options, and delivery of FP care.
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作者：
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DOI：
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DOI：
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发表时间：
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影响因子：
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作者：
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