Initiating the Conversation of Oncofertility: The Creation of a Dedicated BMT Oncofertility Nurse Coordinator in the Transplant and Cellular Therapy Patient Population

Abstract

Topic Significance & Study Purpose/Background/Rationale Patients undergoing hematopoietic stem cell transplantation face a high risk of infertility. Despite existing ASCO, ASRM and NCCN fertility preservation guidelines, as many as 68% of oncology patients report that fertility was not discussed prior to or during therapy. Since infertility in survivorship is known to increase distress and contribute to decreased quality of life, upfront oncofertility discussions must be more embedded into our programmatic education. To increase the prevalence and depth of fertility preservation counseling among Blood and Marrow Transplant (BMT) and cellular therapy patients, the BMT oncofertility coordinator role was developed. Methods, Intervention, & Analysis Two BMT advance practice providers and one transplant coordinator completed the ECHO (Enriching Communication Skills for Health Professionals in Oncofertility) training program through the Moffitt Cancer Center to deepen knowledge of oncofertility in our patient population. Through multidisciplinary working groups with institutional fertility specialists, the BMT team developed an algorithm and standardized workflow. A BMT oncofertility coordinator role was developed to ensure each BMT patient of reproductive age receives individual reproductive counseling, options to preserve, a same day referral to reproductive endocrinology, and support through complex coordination of care and financial support services once a fertility treatment option has been determined. If fertility preservation is not possible, the coordinator provides the information and counseling that increase patients' quality of life before, during and after cancer treatment. Findings & Interpretation Between September 2018 and September 2019, in the first year of this service the oncofertility coordinator has consulted with 102 patients of reproductive age. This role has assisted in addressing critical timeframes ensuring prompt referral to fertility preservation, access to fertility resources, as well as ensuring documentation of fertility preservation discussions in the medical record. Discussion & Implications The role of the BMT oncofertility coordinator has increased access to supportive oncofertility care at the time of cancer diagnosis for both BMT patients and patients across the health system as other clinics have begun consulting the BMT oncofertility coordinator. Increased awareness of the oncofertility services available is needed to ensure all patients of reproductive age are aware of their options for fertility preservation and are given the opportunity to have the family they may desire.