Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview
Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview
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DOI：
10.1007/s00520-019-05248-4
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发表时间：
2019-12-23
影响因子：
3.1
通讯作者：
Klosky, James L.
中科院分区：
文献类型：
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作者：
Lehmann, Vicky;Kutteh, William H.;Klosky, James L.
目的儿科肿瘤学中与生育相关的服务正在增加，但护理障碍仍然存在，文献中描述的结构化计划很少。因此，本研究的目的是（1）描述大型儿科肿瘤中心的生育相关服务的特征，（2）讨论儿科癌症患者生育相关服务的建议。方法回顾性分析我院生殖功能保留门诊3年内收治的292例恶性肿瘤患者的临床资料。大约一半（n = 152/292，52.1%）为治疗前（n = 92/152）或活性治疗期间（n = 60/152）转诊的癌症患者。另一半（n = 140/292; 47.9%）为完成治疗的幸存者。结果3年内转诊人数增加了一倍多。大多数患者在治疗前转诊并选择FP（72.8%尝试; 58.9%完成）。选择FP的男性患者多于女性患者（77.6%比22.4%），但女性的完成率更高（93.3%比76.9%）。治疗前FP率并未随着时间的推移而增加（p = 0.752）。许多接受治疗的患者被转介接受不孕风险咨询，这表明该组需要信息/支持。转诊的幸存者在治疗后询问了他们的生育能力，并完成了生育能力评估，表明少数人（类似于15%）的生育能力完好无损。结论本综述表明，在整个癌症连续体中，儿科肿瘤学对生育相关服务的接受和需求日益增加，包括治疗前FP，治疗期间的咨询和生存期的生育评估。根据我们的经验，目前的建议进行了讨论，包括标准化的程序，简化转诊，充分的沟通/教育（供应商和家庭），并满足年轻癌症患者/幸存者的具体需求。
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 (similar to 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.