APHON Pediatric Chemotherapy-Biotherapy Renewal

may be offered to patients with the hope of reducing chemotherapy-induced ovarian insufficiency” (Oktay et al., 2018). Counseling Needs According to ASCO guidelines, all patients with a cancer diagnosis should be counseled about the impact that their disease and treatment regimen may have on their future fertility (Lee et al., 2006). Such counseling is best done immediately after diagnosis (which is admittedly a very stressful moment in the patient’s life) but before initiation of the treatment regimen. For preadolescent patients, it is recommended that the conversation involve one or both parents. However, for adolescent patients, it may be best to have the conversations without a parent present. Such conversations may be embarrassing, but the goal is to help patients understand their options, allow them to ask questions, gain their assent, and allow them to take an active role in their care. This counseling should start with their provider, who can then make referrals to specialists in fertility preservation: reproductive endocrinologists, surgeons, mental health professionals, urologists, and child life personnel (Klipstein et al., 2020).

Barriers Providers and Timing

The single most critical barrier to fertility preservation is the first consultation. The emotional stress, anxiety, and fear that accompany a new cancer diagnosis often provoke the desire to start the treatment regimen right away. However, beginning treatment before addressing fertility concerns may impair reproduction or limit reproduction options (Klipstein et al., 2020). A review of studies shows that providers do not hold these conversations with patients and families for a number of reasons. The barriers reported include providers’ lack of knowledge about treatment- induced fertility impairments and fertility preservation procedures, the perceived need to begin the patient’s treatment immediately, estimates of the patient’s likelihood of survival, discomfort discussing fertility, and sometimes even assumptions about their patients’ preferences (Lampic & Wettergren, 2019). The consequence of these barriers is a significant information gap for the patients. In one study, only half of the parents surveyed recalled receiving fertility information, and approximately one third expected normal fertility following the cancer treatment (van den Berg & Langeveld, 2008). Another study of adolescents with cancer revealed that 81% would want to proceed with investigational or research-based alternatives in an attempt to maintain their fertility (Burns et al., 2006). Economic Factors Cryopreservation can cost hundreds of dollars a year, and that is added to the cost of the collection process, depending on the option chosen (Klipstein et al., 2020). Fertility preservation is not covered by most insurance plans, so it is often an out-of-pocket expense for patients. This situation is changing in a number of states, where new legislation is mandating insurance coverage for fertility preservation (Halpern et al., 2020).