Cancer care

Oncofertility: collaborative approach needed for young cancer patients

Challenges in providing fertility preservation services to adolescents and young adults (AYA) with cancer include a lack of clear referral pathways, health professional training issues and out of pocket costs.

According to an article in the ANZ Journal of Obstetrics and Gynecology, oncofertility is still an emerging discipline, there is a paucity of Australian data and a low uptake of services.

However there are local clinical guidelines and initiatives such as the Australasian Oncofertility Consortium Charter providing a base from which to expand service provision.

The review article, led by clinicians at the Royal Prince Alfred Hospital, said local and international recommendations are for timely referral of cancer patients requiring treatment that could compromise their future fertility.

Local research had found most young people (75%) did have a discussion about fertility preservation options but fewer (59%) were offered a referral to a fertility specialist.

“Rates of referral for fertility consultation are considerably higher where a specific youth service or adolescent clinic is pre‐existing and as such, a global recommendation to establish more specialist youth fertility clinics would likely overcome the barrier of sub‐optimal referral pathways,” they said.

The review article said as low as 29% of clinicians involved in AYA oncology patients had undergone formal training in fertility and over 50% were seeking further education.

“While there is improved access to resources via the future fertility website and the National Framework guidelines provides a list of resources, often clinician awareness about these avenues is lacking.”

Multidisciplinary management should include the input of oncologists, surgeons, fertility specialists, psychologists, social workers and primary health physicians, the review said.

It added that 26% of families offered fertility preservation techniques could not proceed due to financial concerns.

While some services were Medicare rebated, others such as multiple cycles of IVF and pre-implantation genetic diagnosis (PGD) testing were not.

“While there is no significant increase in genetic or congenital anomalies among AYA oncology patients who successfully conceive, PGD enables patients who have been diagnosed with cancers with a known genetic inheritance such as BRCA I and II to later test the DNA in their stored embryos after extensive counselling.”

“Certainly, increasing the number of fertility preservation items that come under the Medicare benefits scheme would address the financial barriers faced by patients that preclude their uptake of services.”

“With increasing rates of cancer diagnoses, it is imperative that this emerging discipline become easily accessible and increased awareness should be promoted within the medical community. Specialised AYA clinics that incorporate a multi‐disciplinary approach with collaborative communication with oncologists is key to providing this service within Australia.”

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