A multidisciplinary oncofertility team that includes a nurse navigator and uses telemedicine can improve knowledge of and access to fertility preservation options for women of reproductive age with new cancer diagnoses who are geographically remote from a tertiary fertility clinic. This study was published in the Journal of Cancer Education.1

Fertility preservation is a common goal of reproductive-age patients with cancer. Guidelines from the American Society of Clinical Oncology (ASCO) include recommendations for addressing the potential for infertility soon after cancer diagnosis, as well as referral to reproductive specialists, for all interested patients.2

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Nevertheless, many barriers exist to achieving this goal, including lack of healthcare provider knowledge regarding the impact of cancer treatments on fertility, as well as fertility preservation options, time constraints, and financial and geographical issues.

In this study, a pilot oncofertility program was set up between the Regional Cancer Centre Northwest (RCCN) at the Thunder Bay Regional Health Sciences Centre in Thunder Bay, Ontario, Canada, and Mount Sinai Fertility (MSF) in Toronto, a fertility center almost 1400 km away from RCCN. Critical to the program was the development of a multidisciplinary oncofertility team between the two sites and the use of telemedicine. The multidisciplinary team included an oncofertility nurse navigator (ONN) and a gynecologist with expertise in oncofertility at RCCN who were trained at MSF, and endocrinology and fertility specialists, as well as an oncofertility nurse practitioner at MSF who had regular contact with the team members at RCCN.

Women of reproductive age at RCCN were identified for the program by the ONN who then provided initial fertility preservation counseling to the patient and her physician. For those patients wishing to further pursue fertility preservation options, the ONN would arrange an urgent remote teleconference between the patient and her care team and specialists at MSF. The ONN would also arrange appointments with a local gynecologist and specialists at MSF for those patients who choose to undergo fertility preservation procedures.

Pre- and posttreatment questionnaires related to fertility issues were completed by 22 women of reproductive age undergoing treatment at RCCN between February 2016 and January 2017. Sixty-eight percent of the women indicated that they did not want (more) children; 4 women, all of whom were nulliparous, participated in a fertility preservation teleconference with MSF specialists, 2 of whom traveled to MSF to undergo a fertility preservation procedure.

Questionnaires on experience with oncofertility and the pilot program were completed by 12 RCCN physicians before (pre-) and after (post-) the program. One preprogram questionnaire was excluded because more than half the questions were not answered, and one postprogram questionnaire was excluded because the respondent was not a physician. The 11 preprogram and 11 postprogram questionnaires included in the evaluation were not completed by all the same physicians at the 2 time points because of physician turnover and participation.

Physician responses indicated that 27.3% of respondents always or often discussed fertility concerns and fertility preservation options prior to the program; this increased to 72.7% of physicians responding to the postprogram questionnaire. Physician responses indicated a high level of consensus regarding the benefits of the oncofertility program, with 89% agreeing that the addition of the ONN to the multidisciplinary team improved access to services related to fertility preservation.

“More cancer centers should consider training nurses, and specifically nurse navigators, to be oncofertility champions. This would allow them to incorporate oncofertility navigation into their portfolios thereby capitalizing on technology to facilitate rapid fertility preservation consultations for oncology patients remote from an in vitro fertilization (IVF) clinic,” the authors concluded.

Reference

1. Zwingerman R, Melenchuk K, McMahon E, et al. Expanding urgent oncofertility services for reproductive age women remote from a tertiary level fertility centre by use of telemedicine and an on-site nurse navigator [published online February 28, 2019]. J Cancer Educ.  doi: 10.1007/s13187-019-01490-w

2. Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018;36(19):1994-2001.