Infrastructure of Fertility Preservation Services for Pediatric Cancer Patients: A Report From the Children's Oncology Group
Infrastructure of Fertility Preservation Services for Pediatric Cancer Patients: A Report From the Children's Oncology Group
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DOI：
10.1200/op.21.00275
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发表时间：
2022-03-01
影响因子：
4
通讯作者：
Levine, Jennifer
中科院分区：
文献类型：
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作者：
Frederick, Natasha N.;Klosky, James L.;Levine, Jennifer
目的：生育能力保存（FP）服务是新诊断癌症患者综合护理的一部分。向患有癌症的儿童和青少年提供这些服务的能力尚不清楚。方法对220家儿童肿瘤学小组成员机构进行横断面调查，了解计划生育服务的机构特点、结构和组织以及计划生育服务的障碍。对所有变量进行标准描述性统计。使用多变量逻辑回归检查特定地点因素与选定结果之间的关联。结果144个项目（65.5%）回访。53个（36.8%）报告了指定的FP个人或团队。135家（97.8%）机构提供精子库服务，37家（27.0%）机构提供睾丸组织冷冻保存服务。91家（67.9%）和62家（46.6%）机构提供卵母细胞和胚胎冷冻保存；64所（47.8%）机构提供卵巢组织冷冻保存。专门的计划生育人员的存在与提供卵母细胞或胚胎冷冻保存的能力独立相关（优势比[or]， 4.7; 95% CI， 1.7至13.5），卵巢组织冷冻保存（or, 2.7; 95% CI， 1.2至6.0）和睾丸组织冷冻保存（or, 3.3; 95% CI， 1.4至97.8）。只有26家（18.1%）参与机构提供了所有当前的非实验性计划生育干预措施。障碍包括成本（70.9%）、知识或培训不足（60.7%）、难以描述生育风险（50.4%）、人员配备不足（45.5%）和生殖专业的后勤（38%-39%）。结论：本研究为儿童和青少年癌症患者提供了最全面的计划生育基础设施的现状，并表明现有的基础设施不足以为患者提供全面的服务。我们讨论可修改的因素，以提高患者获得计划生育。(C)美国临床肿瘤学会2021
PURPOSE Fertility preservation (FP) services are part of comprehensive care for those newly diagnosed with cancer. The capacity to offer these services to children and adolescents with cancer is unknown.METHODS A cross-sectional survey was sent to 220 Children's Oncology Group member institutions regarding institutional characteristics, structure and organization of FP services, and barriers to FP. Standard descriptive statistics were computed for all variables. The association between site-specific factors and selected outcomes was examined using multivariable logistic regression.RESULTS One hundred forty-four programs (65.5%) returned surveys. Fifty-three (36.8%) reported a designated FP individual or team. Sperm banking was offered at 135 (97.8%) institutions, and testicular tissue cryopreservation at 37 (27.0%). Oocyte and embryo cryopreservation were offered at 91 (67.9%) and 62 (46.6%) institutions, respectively; ovarian tissue cryopreservation was offered at 64 (47.8%) institutions. The presence of dedicated FP personnel was independently associated with the ability to offer oocyte or embryo cryopreservation (odds ratio [OR], 4.7; 95% CI, 1.7 to 13.5), ovarian tissue cryopreservation (OR, 2.7; 95% CI, 1.2 to 6.0), and testicular tissue cryopreservation (OR, 3.3; 95% CI, 1.4 to 97.8). Only 26 (18.1%) participating institutions offered all current nonexperimental FP interventions. Barriers included cost (70.9%), inadequate knowledge or training (60.7%), difficulty characterizing fertility risk (50.4%), inadequate staffing (45.5%), and logistics with reproductive specialties (38%-39%).CONCLUSION This study provides the most comprehensive view of the current landscape of FP infrastructure for children and adolescents with cancer and demonstrates that existing infrastructure is inadequate to offer comprehensive services to patients. We discuss modifiable factors to improve patient access to FP. (C) 2021 by American Society of Clinical Oncology