Abstract
BackgroundDespite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy. The study objective was to compare fertility preservation training between Reproductive Endocrinology & Infertility (REI) and Gynecologic Oncology (GYN ONC) fellows and assess the need for additional education in this field.MethodsA 38-item survey was administered to REI and GYN ONC fellows in the United states in April 2014. Survey items included: 1) Clinical exposure, perceived quality of training, and self-reported knowledge in fertility preservation; 2) an educational needs assessment of desire for additional training in fertility preservation.ResultsSeventy-nine responses were received from 137 REI and 160 GYN ONC fellows (response rate 27%). REI fellows reported seeing significantly more fertility preservation patients and rated their training more favorably than GYN ONC fellows (48% of REI fellows versus 7% of GYN ONC fellows rated training as ‘excellent’, p < 0.001). A majority of all fellows felt discussing fertility preservation was ‘very important’ but fellows differed in self-reported ability to counsel patients, with 43% of REI fellows and only 4% of GYN ONC fellows able to counsel patients ‘all the time’ (p = 0.002). Seventy-six percent of all fellows felt more education in fertility preservation was required, and 91% felt it should be a required component of fellowship training.ConclusionSignificant variability exists in fertility preservation training for REI and GYN ONC fellows, with the greatest gap seen for GYN ONC fellows, both in perceived quality of fertility preservation training and number of fertility preservation patients seen. A majority of fellows in both disciplines support the idea of a standardized multi-disciplinary curriculum in fertility preservation.
Highlights
Despite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy
Published guidelines on fertility preservation from the American Society of Clinical Oncology (ASCO) acknowledge the need for such a multidisciplinary approach, targeting a diverse array of specialists including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons [14]. Both ASCO as well as the American Society for Reproductive Medicine (ASRM) specify that all patients should be informed about the potential for infertility resulting from cancer and its treatment and given the opportunity to speak with a fertility specialist to discuss options for fertility preservation as early as possible [1]
A total of 79 responses were received from the eligible 137 Reproductive Endocrinology & Infertility (REI) fellows and 160 GYN Gynecologic oncology (ONC) fellows in training in the United States in 2014, for an overall response rate of 27%
Summary
Despite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy. Published guidelines on fertility preservation from the American Society of Clinical Oncology (ASCO) acknowledge the need for such a multidisciplinary approach, targeting a diverse array of specialists including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons [14]. Both ASCO as well as the American Society for Reproductive Medicine (ASRM) specify that all patients should be informed about the potential for infertility resulting from cancer and its treatment and given the opportunity to speak with a fertility specialist to discuss options for fertility preservation as early as possible [1]. Several barriers to referral for fertility preservation services have been identified, including the concern that fertility preservation procedures may compromise cancer care, the notion that pursuing fertility is not appropriate for a cancer patient who might not survive the disease, as well as discomfort and lack of knowledge about fertility management options [13, 20]
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