Bundling Interventions Bridges Gender Gap in AYA Cancer Fertility Discussions

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For younger patients with cancer, fertility concerns can weigh heavily.
For younger patients with cancer, fertility concerns can weigh heavily.

Chemotherapy and radiotherapy may cause fertility loss, which may be particularly devastating for adolescents and young adults (AYAs). For some AYA patients with cancer the possibility of infertility may be more devastating than the cancer diagnosis itself.1 AYA patients may experience distress and regret if not given the opportunity to discuss the risk of treatment on fertility and possible fertility preservation options.2 Preserving fertility, means preserving the hope of a future. Having discussions about fertility preservation may be important to enhancing the later quality of life for young cancer survivors. Yet, AYA patients are less likely to receive information about fertility preservation. Female AYA patients, in particular are less likely than their male counterparts to receive information about fertility preservation.3

A recently published study found that bundled interventions may help to close the gender gap between male and female AYA patients receiving fertility information.4 The study looked at the effectiveness of bundled interventions across five Youth Cancer Service Centers in Queensland, Australia. Bundled interventions were introduced in the centers in 2015 and included 4 components: quality indicators, targeted education, patient resources, and referral processes.

Quality indicators were reported by providers in a web-based system and included information on if the patient was provided with both written and verbal fertility preservation options, if the patient was referred to a specialist, and if the patient ultimately underwent fertility preservation, and if so, which method.

Targeted information sessions for more than 80 healthcare professionals were held and included topics on fertility and genetics, communicating with AYAs, sexuality, intimacy, and relationships, and fertility preservation methods for males and females. The sessions included a 30-minute presentation in which healthcare professionals were provided with a fact sheet; resources including journal articles, websites, and a printout of the presentation; and a discussion of referral pathways.

A learning needs survey taken in 2013 by 107 healthcare professionals across all sites indicated that while clinicians were aware of resources provided by a variety of fertility and cancer groups not having a list of these resources readily available to give to the patient prevented some clinicians from having fertility discussions. Therefore, as part of the bundled intervention, resource packs with gender-specific information and brochures for fertility specialist groups were provided to patients by cancer care coordinators.  

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