Gwendolyn P Quinn1, Rebecca G Block2, Marla L Clayman2, Joanne Kelvin2, Sarah R Arvey2, Ji-Hyun Lee2, Joyce Reinecke2, Ivana Sehovic2, Paul B Jacobsen2, Damon Reed2, Luis Gonzalez2, Susan T Vadaparampil2, Christine Laronga2, M Catherine Lee2, Julio Pow-Sang2, Susan Eggly2, Anna Franklin2, Bijal Shah2, William J Fulp2, Brandon Hayes-Lattin2. 1. Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI gwen.quinn@moffitt.org. 2. Moffitt Cancer Center; Morsani College of Medicine, University of South Florida, Tampa, FL; Oregon Health & Science University, Portland, OR; Northwestern University, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York, NY; LIVESTRONG Foundation, Austin; The University of Texas MD Anderson Cancer Center, Houston, TX; and Karmanos Cancer Institute, Wayne State University, Detroit, MI.
Abstract
PURPOSE: The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. METHODS: All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. RESULTS: Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). CONCLUSION: The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation.
PURPOSE: The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. METHODS: All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. RESULTS: Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). CONCLUSION: The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation.
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