Notes Related to the Power Point Presentation
Slide 1: Title Slide
Slide 2: Increased cancer treatment success has led to an impressive 5 year survival rate of greater than 70% among pediatric oncology patients. In turn this has allowed for a greater emphasis on quality of life issues including those related to fertility. Improvements in cancer treatment and subsequent success has been parallel to the advances in assisted reproductive technologies (ART) which now allows for several effective fertility preservation options for patients diagnosed with cancer. As a result of the advancements; these two separate disciplines are now crossing paths to provide complimentary treatment. Therefore, today there is a greater need for more information and a better understanding about fertility risk(s) associated with cancer treatment and the available fertility preservation options.
Slide 3: In a recent study that involved a collaboration between the Fertility Clinic and the Pediatric Oncology Group at McMaster University (Neal et al., 2007 published in the Journal of Oncology) we investigated the effectiveness of sperm that was cryopreserved in cancer patients for the purpose of fertility preservation (otherwise known as oncology banked sperm). It was shown that oncology banking was a very effective way to preserve the fertility of men about to undergo gonadotoxic cancer treatment. However, it was disappointing to learn that just under 18% of cancer patients took advantage and actually banked sperm. We postulated that this lack of use of this service was due to the awareness among health care providers and patients.
Slide 4: As part of the follow-up to the initial study we looked at the many interdisciplinary interactions involved in a team approach to fertility preservation. These all revolve around the patient in the center of the web-diagram. There are 4 key groups that surround the cancer patient including: 1) the Medical Team; 2) Risk Management; 3) Patient Support Resources; and 4) Research. Each of these groups have various extensions and networks that all come together to provide complimentary support to maintain this network. In order for this to effectively serve the patient the collaboration between the oncology and fertility specialists needs to be in place in order to act quickly so not to interfere with the cancer treatment schedule. In our situation we make oncology banking appointments a priority. It is not unusual in our program to get a call late in the afternoon and have the patient bank a sample the next morning.
Slide 5: Based on the original study we set out to bridge the gap between oncologists and fertility specialists to improve the quality of life of cancer survivors by providing fertility preservation options.
Slide 6: Through this collaboration we developed a simple algorithm that was designed to aid in the identification of patients that were candidates for fertility preservation. This simple algorithm then became part of the treatment process and planning.
Slide 7: We also improved and created a streamlined approach to the referral form and process. During this process it became apparent that the initiation of the discussion was not easy and was coming from different sources (ie nurse vs social worker vs physician). In addition it was not always consistent and the age of the patient had an influence on how the conversation was initiated. It was clear that it is imperative to provide information to the patient about fertility preservation because of the fact that the treatment could lead to infertility. It was believed that unless this conversation occurs for all patients then it was not proper informed medical consent. This underlying message was very important in making the importance of these issues known to all health care providers.
Slide 8: As a result of the identified needs we then developed educational materials for both patients and health care providers. We found the implementation of this became a teaching tool that opened the door for greater discussion about this sensitive but very important topic.
Slide 9: In conclusion, the year following this study and as a result of our collaboration and information sessions provided to different departments we had a 71% increase in the number of patients who banked sperm. This underlines the fact that awareness is the key to the success of a fertility preservation program. Oncologists combined with a multidisciplinary team of health care professionals provide hope for the future fertility of cancer patients.
Slide 10: Discussion slide with pictures of pre-implantation embryo development and contact information.
ONE Fertility, Burlington, Ontario, Canada (www.onefertility.com)
Michael Neal completed his Masters Degree in Biomedical Sciences at the University of Guelph, focusing on the reproductive consequences of chromosome abnormalities. He is in the final stages of completing a PhD in the Medical Sciences program in the Reproductive Biology Division at McMaster University, Hamilton, Canada.
Mike’s experience in clinical Assisted Reproductive Technologies and his keen research interests have gained him an international reputation for innovation and excellence. He has numerous peer-reviewed publications and is a frequent reviewer for many major scientific journals related to reproduction. As Scientific Director of ONE Fertility he has been an advocate of fertility preservation for patients facing a cancer diagnosis. Mike sits on the advisory board for Fertile Future (fertilefuture.ca), a non-profit organization providing information and resources about fertility preservation for cancer patients.