Infrastructure of Fertility Preservation Services for Pediatric Cancer Patients: A Report From the Children's Oncology Group

• Authors: Natasha N Frederick, Connecticut Children's Medical Center; James Klosky, Emory University; Lillian Meacham, Emory University; Gwendolyn P Quinn, New York University; Joanne Frankel Kelvin, Memorial Sloan Kettering Cancer Center; Brooke Cherven, Emory University; David R Freyer, Children's Hospital Los Angeles; Christopher C Dvorak, University of California San Francisco; Julienne Brackett, Baylor College of Medicine; Sameeya Ahmed-Winston, Center for Cancer and Blood Disorders, Children's National, Washington; Elyse Bryson, Childrens Healthcare Atlanta; Eric J Chow, Fred Hutchinson Canc Res Ctr; Jennifer Levine, Weill Cornell Medicine
• Journal Title: JCO ONCOLOGY PRACTICE
• Volume: Volume 18, Number 3
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2022-03-01, Pages 235-+
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1200/OP.21.00275
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; YOUNG-ADULT ONCOLOGY; INFERTILITY RISK; ADOLESCENT; SURVIVORS; ONCOFERTILITY; DOCUMENTATION; PROGRAM; RATES

Abstract

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.