title: Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations.
abstract: 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.
  
  
  METHODS
  A systematic search in PubMed (January 2000-October 2014); guideline databases; and Web sites of oncology, pediatric, and fertility organizations was performed. Two reviewers evaluated the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). From high-quality CPGs, the authors evaluated concordant and discordant areas among the recommendations.
  
  
  RESULTS
  A total of 25 CPGs regarding fertility preservation were identified. The average AGREE II domain scores (scale of 0%-100%) varied from 15% on applicability to 100% on clarity of presentation. The authors considered 8 CPGs (32%) to be of high quality, which was defined as scores ≥60% in any 4 domains. Large variations in the recommendations of the high-quality CPGs were observed, with 87.2% and 88.6%, respectively, of discordant guideline areas among the fertility preservation recommendations for female and male patients with cancer.
  
  
  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. Cancer 2016;122:2216-23. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Font-Gonzalez
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Renée L
authors.initials: RL
authors.lastname: Mulder
authors.affiliation: Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Erik A H
authors.initials: EA
authors.lastname: Loeffen
authors.affiliation: Boyne Research Institute, Drogheda, Ireland.
authors.forename: Julianne
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Eline
authors.initials: E
authors.lastname: van Dulmen-den Broeder
authors.affiliation: Department of Pediatric Oncology/Hematology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
authors.forename: Marry M
authors.initials: MM
authors.lastname: van den Heuvel-Eibrink
authors.affiliation: Department of Pediatric Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Department of Pediatric Oncology, Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Kenney
authors.affiliation: Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Levine
authors.affiliation: Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marianne D
authors.initials: MD
authors.lastname: van de Wetering
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Leontien C M
authors.initials: LC
authors.lastname: Kremer
mesh_terms: D000293:Adolescent; D002648:Child; D000066491:Clinical Decision-Making; D019468:Disease Management; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012737:Sex Factors; D055815:Young Adult
keywords: childhood cancer; evidence-based medicine; fertility preservation; guidelines; pediatric oncology