The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options.
Minimal data exist regarding documentation of therapy-associated infertility risk (IR) and fertility preservation (FP) options during the initial oncology consultation prior to systemic therapy. This study investigated factors affecting IR/FP documentation and assessed the effect of implementation of an Adolescent and Young Adult (AYA) program on documentation rates.



A retrospective review of charts of patients receiving gonadotoxic therapy was undertaken for documentation of IR/FP pre- and post-implementation of an AYA program. Change in documentation rates was assessed using univariate and multiple logistic regression.



A total of 173 charts were reviewed. On univariate analysis, IR/FP documentation was less likely if patients had metastatic disease (P < 0.01, P < 0.01), by tumor type (P < 0.01, P < 0.01), received less intensive chemotherapy (P = 0.03, P = 0.06), were older (P = 0.14, P < 0.01), had more children (P < 0.01, P < 0.01), or lacked AYA program involvement (P < 0.01, P < 0.01). FP discussion was more common in males (P = 0.02). On multivariable analysis, more children (P = 0.01, P = 0.03), older age (P < 0.01, P < 0.01), tumor type (P < 0.01, P = 0.01), stage (P = 0.02, NS), relationship (P = 0.03, NS), and lack of AYA involvement (P < 0.01, P < 0.01) were associated with lower rates of IR/FP documentation. Following AYA program implementation, IR/FP rates increased from 56% (CI 46-65%) to 85% (CI 74-92%, P < 0.01) and 54% (CI 45-64%) to 86% (CI 75-93%, P < 0.01), respectively. The effect of AYA program implementation on IR/FP documentation was most noticeable in leukemia, lymphoma, and breast groups (P < 0.01).



Implementing an AYA consultation service at an adult cancer institution had a positive effect on the rates of IR/FP documentation. Specific programming can improve service delivery to AYA cancer patients, and fertility counseling should be integrated for patients undergoing gonadotoxic therapy.
Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada. Jeremy.Lewin@uhn.ca.|Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada. Jeremy.Lewin@uhn.ca.
Jeremy
J
Lewin
Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada.
Justin Ming Zheng
JMZ
Ma
Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada.
Laura
L
Mitchell
Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada.
Seline
S
Tam
Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada.
Natasha
N
Puri
Centre for Biostatistics, Hospital for Sick Children, Toronto, Canada.
Derek
D
Stephens
Department of Medical Oncology, Vancouver Centre, BC Cancer Agency, Vancouver, Canada.
Amirrtha
A
Srikanthan
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
Philippe
P
Bedard
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
Albiruni
A
Razak
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
Michael
M
Crump
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
David
D
Warr
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
Meredith
M
Giuliani
Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada.|Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
Abha
A
Gupta
D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000379:methods*; D004282:Documentation / Q000379:methods*; D005260:Female; D059247:Fertility Preservation / Q000523:psychology*; D006801:Humans; D007246:Infertility / Q000175:diagnosis*; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult
Adolescent and young adult; Fertility preservation; Gonadotoxic; Infertility; Oncofertility