Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations

open access: Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations (PanCareLIFE Consortium)

BACKGROUND

Fertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations.
 

CONCLUSIONS

Only approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors.

 INTRODUCTION

Over the last several decades, the survival of patients with childhood cancer has increased significantly due to advances in treatment. In Europe and the United States alone, nearly 80% of children, adolescents, and young adults (CAYAs) survive 5 years from a cancer diagnosis, with the vast majority expected to achieve extended long-term survival into adulthood.[1, 2] As the number of childhood cancer survivors increases, the long-term side effects of treatment gain greater importance. Of particular concern is the substantially elevated risk of fertility impairment after treatment of childhood cancer, especially after treatment with alkylating agents (and similar DNA interstrand cross-linking agents) and/or radiation to fields that expose the ovaries or testes.[3-6] Fertility impairment has serious consequences for quality of life among newly diagnosed patients, their parents, and adults surviving childhood cancer.[7, 8]

Interventions currently can be offered to individuals diagnosed with cancer to preserve their fertility potential.[9, 10] Survey data have indicated that many patients, especially females, are not or are inadequately counseled regarding the potential adverse effects of treatment on fertility and even fewer are referred for fertility preservation.....