International guidelines recommend discussion and provision of written information about the impact of cancer treatment on fertility with all cancer treatments. In addition, FP options (freezing sperm, eggs or reproductive tissue) should be offered where appropriate prior to cancer treatment. Fertility discussions with paediatric and adolescent oncology patients can be difficult. Complex clinical, logistical and ethical issues present barriers to care. In 2013 a structured fertility program was implemented at The Royal Children’s Hospital. We report on the implementation and impact of the structured fertility program, including adherence to key performance indicators and the benefits of coordinated care.
Methods: Periodic clinical and institutional needs assessments were undertaken according to the Knowledge-to-Action implementation framework. A bi-directional, pre- and post-implementation study was undertaken between 2013 and 2019. All patients and families who had a fertility discussion between 1987 and 2019 were recruited.
Results: A formalised fertility program and audit was implemented in 2013. In 2018 a fertility nurse coordinator was introduced to the program. 500 participants (pre- and post-program) were recruited. Documented discussion rates increased from 6% (pre-program) to 38% in 2018, and 100% with the introduction of the oncofertility coordinator. The proportion of newly diagnosed patients who received written information reached 100% in 2018. Post-implementation fertility discussions occurred more commonly prior to treatment (p=.02), and with younger patients (median age 14.5 pre-program, 8.4yrs post-program). A total of 447 FP interventions had been undertaken with a median age of 8 years (range 0.1-18 years). The overwhelming majority of patients experienced no delay to cancer treatment (94.9%, n=203/214), and had no intra- or post-operative complications (94.4%, n=202/214).
Conclusions: Fertility programs in paediatric settings can be safely implemented with sufficient support. Coordinated care increased discussion rates. Appropriate fertility procedure selection occurs when educated and medical judgement and clinical ethics criteria are applied.