The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options.

Abstract

Minimal data exist regarding documentation of therapy-associated infertility risk (IR) and fertility preservation (FP) options during the initial oncology consultation prior to systemic therapy. This study investigated factors affecting IR/FP documentation and assessed the effect of implementation of an Adolescent and Young Adult (AYA) program on documentation rates. A retrospective review of charts of patients receiving gonadotoxic therapy was undertaken for documentation of IR/FP pre- and post-implementation of an AYA program. Change in documentation rates was assessed using univariate and multiple logistic regression. A total of 173 charts were reviewed. On univariate analysis, IR/FP documentation was less likely if patients had metastatic disease (P<0.01, P<0.01), by tumor type (P<0.01, P<0.01), received less intensive chemotherapy (P=0.03, P=0.06), were older (P=0.14, P<0.01), had more children (P<0.01, P<0.01), or lacked AYA program involvement (P<0.01, P<0.01). FP discussion was more common in males (P=0.02). On multivariable analysis, more children (P=0.01, P=0.03), older age (P<0.01, P<0.01), tumor type (P<0.01, P=0.01), stage (P=0.02, NS), relationship (P=0.03, NS), and lack of AYA involvement (P<0.01, P<0.01) were associated with lower rates of IR/FP documentation. Following AYA program implementation, IR/FP rates increased from 56% (CI 46-65%) to 85% (CI 74-92%, P<0.01) and 54% (CI 45-64%) to 86% (CI 75-93%, P<0.01), respectively. The effect of AYA program implementation on IR/FP documentation was most noticeable in leukemia, lymphoma, and breast groups (P<0.01). Implementing an AYA consultation service at an adult cancer institution had a positive effect on the rates of IR/FP documentation. Specific programming can improve service delivery to AYA cancer patients, and fertility counseling should be integrated for patients undergoing gonadotoxic therapy.