A cancer and fertility program established at Memorial Sloan Kettering Cancer Center (MSKCC) improves patient satisfaction with information received regarding fertility risks and preservation options, according to a report by Kelvin et al in the Journal of Clinical Oncology. Designed to support clinicians in discussing treatment-related fertility issues with patients and in referring patients to reproductive specialists, the program provides resources, clinician education, and fertility clinical nurse specialist consultation.
The current study assessed the impact of the program by comparing responses to gender-specific questionnaires provided to patients aged 18 to 45 years who started treatment before program initiation (cohort 1: July 2007 to June 2008) and after program initiation at MSKCC (cohort 2: January 2010 to December 2012). The overall questionnaire response rate was 46% for the first cohort and 27% for the second cohort. The response rate was higher in cohort 1 if the questionnaire was distributed in the clinic vs by postal mail (88% vs 38% for women, 97% vs 36% for men) and in cohort 2 if it was sent by e-mail vs postal mail (32% vs 24% for women, 25% vs 15% for men).
Cohort 1 included 271 women and 150 men, and cohort 2 included 320 women and 120 men. The most common cancers were testicular cancer, breast cancer, and lymphoma. The mean time between diagnosis and survey was approximately 2 years in both cohorts.
Outcomes for Women
For women in cohort 1 vs cohort 2, satisfaction with information on topics was 46% vs 75% (χ2 = 62.1, P < .001) for effect of treatment on fertility, 24% vs 62% (χ2 = 71.9, P < .001) for fertility-preservation options, 16% vs 57% (χ2 = 80.2, P < .001) for help with decision-making, 16% vs 55%, χ2 = 60.5, P < .001) for finding a reproductive endocrinologist, and 10% vs 41% (χ2 = 44.7, P < .001) for other family-building options. Among the 320 women in cohort 2, 57 received education and counseling by a fertility clinical nurse specialist. For those without vs with such counseling, satisfaction with information on topics was 74% vs 77% (χ2 = 0.9, P = .62) for effect of treatment on fertility, 55% vs 80% (χ2 = 11.2, P = .004) on fertility-preservation options, 49% vs 74% (χ2 = 10.4, P = .006) on help with decision-making, 42% vs 83% (χ2 = 22.6, P < .001) on finding a reproductive specialist, and 33% vs 60% (χ2 = 8.9, P = .01) on other family-building options.
Outcomes for Men
For men in cohort 1 vs cohort 2, satisfaction with information on topics was 75% vs 84% (χ2 = 3.4, P = .18) for effect of treatment on fertility, 68% vs 85% (χ2 = 9.3, P = .01) for sperm banking, 54% vs 80% (χ2 = 13.3, P = .001) for finding a sperm bank, and 30% vs 65% (χ2 = 18.7, P < .001) for other family-building options.
Among patients in cohort 2 who received and read information materials, 96% of men and 99% of women found them helpful. Among 67 men in cohort 2 who did not participate in sperm banking, 10% reported not knowing about sperm banking as the reason. Among the 255 women in cohort 2 who did not participate in fertility preservation, 10% reported not knowing about fertility preservation as the reason. Women in cohort 2 who received fertility clinical nurse specialist counseling were 6.1 times more likely to undergo fertility preservation than those who did not receive such counseling.
The investigators concluded: “Improvements in patient satisfaction with information received demonstrate the potential for fertility programs in cancer care settings to improve the quality of clinician-patient discussions about fertility.”
The study was supported by the Memorial Sloan Kettering Geri and ME Nursing Fund and a grant from MSKCC.
Joanne F. Kelvin, MSN, RN, CNS, AOCN, of MSKCC, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.