The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options
The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options
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DOI：
10.1007/s00520-017-3597-8
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发表时间：
2017-06-01
影响因子：
3.1
通讯作者：
Gupta, Abha
中科院分区：
文献类型：
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作者：
Lewin, Jeremy;Ma, Justin Ming Zheng;Gupta, Abha
在系统治疗前的初始肿瘤咨询期间，关于治疗相关不孕风险（IR）和生育保留（FP）选项的记录数据很少。本研究调查了影响IR/FP记录的因素，并评估了实施青少年和年轻成人（AYA）计划对记录率的影响。对接受性腺毒性治疗的患者进行了回顾性分析，以记录AYA计划实施前后的IR/FP。采用单因素和多因素logistic回归分析评估记录率的变化，共审查了173张图表。在单变量分析中，如果患者有转移性疾病，则IR/FP记录的可能性较小（P < 0.01，P < 0.01），按肿瘤类型（P < 0.01，P < 0.01），化疗强度较低（P = 0.03，P = 0.06）、年龄大（P = 0.14，P < 0.01）、子女多（P < 0.01，P < 0.01）或未参与AYA项目（P < 0.01，P < 0.01）。FP讨论在男性中更常见（P = 0.02）。在多变量分析中，（P = 0.01，P = 0.03），年龄较大（P < 0.01，P < 0.01），肿瘤类型（P < 0.01，P = 0.01），分期（P = 0.02，NS）、关系（P = 0.03，NS）和缺乏AYA参与（P < 0.01，P < 0.01）与IR/FP记录率较低相关。实施AYA项目后，IR/FP率分别从56%（CI 46-65%）增加到85%（CI 74- 92%，P < 0.01）和54%（CI 45-64%）增加到86%（CI 75- 93%，P < 0.01）。在白血病、淋巴瘤和乳腺癌组中，AYA项目的实施对IR/FP记录的影响最为显著（P < 0.01）。在成人癌症机构实施AYA咨询服务对IR/FP记录率有积极影响。具体的规划可以改善对AYA癌症患者的服务，生育咨询应纳入接受性腺毒性治疗的患者。
Minimal data exist regarding documentation of therapy-associated infertility risk (IR) and fertility preservation (FP) options during the initial oncology consultation prior to systemic therapy. This study investigated factors affecting IR/FP documentation and assessed the effect of implementation of an Adolescent and Young Adult (AYA) program on documentation rates.A retrospective review of charts of patients receiving gonadotoxic therapy was undertaken for documentation of IR/FP pre- and post-implementation of an AYA program. Change in documentation rates was assessed using univariate and multiple logistic regression.A total of 173 charts were reviewed. On univariate analysis, IR/FP documentation was less likely if patients had metastatic disease (P < 0.01, P < 0.01), by tumor type (P < 0.01, P < 0.01), received less intensive chemotherapy (P = 0.03, P = 0.06), were older (P = 0.14, P < 0.01), had more children (P < 0.01, P < 0.01), or lacked AYA program involvement (P < 0.01, P < 0.01). FP discussion was more common in males (P = 0.02). On multivariable analysis, more children (P = 0.01, P = 0.03), older age (P < 0.01, P < 0.01), tumor type (P < 0.01, P = 0.01), stage (P = 0.02, NS), relationship (P = 0.03, NS), and lack of AYA involvement (P < 0.01, P < 0.01) were associated with lower rates of IR/FP documentation. Following AYA program implementation, IR/FP rates increased from 56% (CI 46-65%) to 85% (CI 74-92%, P < 0.01) and 54% (CI 45-64%) to 86% (CI 75-93%, P < 0.01), respectively. The effect of AYA program implementation on IR/FP documentation was most noticeable in leukemia, lymphoma, and breast groups (P < 0.01).Implementing an AYA consultation service at an adult cancer institution had a positive effect on the rates of IR/FP documentation. Specific programming can improve service delivery to AYA cancer patients, and fertility counseling should be integrated for patients undergoing gonadotoxic therapy.