title: Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients.
abstract: OBJECTIVE
  Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation.
  
  
  METHODS
  An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007-2012, after program initiation. The study included women <45, stages 0-III, diagnosed before (n = 278) and after (n = 515) program initiation.
  
  
  RESULTS
  Demographics for the cohorts were similar. Fertility discussions (P < 0.0001), patients interested in maintaining fertility at diagnosis (P = 0.0041), referrals to reproductive endocrinologists (P < 0.0001), appointments (P < 0.0001), and fertility preservation procedures (P < 0.0183) increased significantly after programmatic implementation.
  
  
  CONCLUSIONS
  An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. J. Surg. Oncol. 2017;115:116-121. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Joceline V
authors.initials: JV
authors.lastname: Vu
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Natalia C
authors.initials: NC
authors.lastname: Llarena
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Estevez
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, Michigan.
authors.forename: Molly B
authors.initials: MB
authors.lastname: Moravek
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan.|Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Jeruss
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000628:therapy; D019468:Disease Management; D005260:Female; D059247:Fertility Preservation / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006284:Health Plan Implementation; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis
keywords: breast cancer; fertility preservation; oncofertility; reproductive endocrinology