The integration of a "best practice advisory" alert into electronic medical record system regarding referrals for fertility preservation programs for young patients with cancer improved referrals to the Oncofertility program at Fox Chase Cancer Center by 450% over 6 months, according to findings released during the 2025 ASCO Annual Meeting (Abstract e23239).
“This intervention can serve as a model for other institutions to improve provider discussion of the risks of oncologic treatment on fertility, advance patient awareness of preservation options, and ultimately increase rates of fertility preservation in [young adult] and early-onset patients with cancer,” the study authors wrote in their abstract.
Study Methods and Results
Rates for young adult and early-onset cancers have increased significantly over the past several years. For these patients, cancer treatment could impact their future fertility and family planning goals. However, few of these young patients report receiving information on fertility risk and fertility preservation options. The study authors tried to find a method to widely improve fertility discussions for this patient population.
“This is a young population facing life-changing diagnoses,” said lead study author Christopher Cann, MD, Director of the Young Adult Cancer Program and Assistant Professor in the Department of Hematology/Oncology at Fox Chase Cancer Center. “Fertility preservation isn’t just a medical issue, it’s a quality-of-life issue. And yet, too often these conversations never happen. We wanted to look into a way to change that.”
The researchers implemented a best practice advisory through their electronic medical record system (Epic) at Fox Chase Cancer Center in July 2024 that was triggered if chemotherapy or immunotherapy was ordered for any eligible patient under the age of 50 years. Those who had undergone surgical procedures that made them unable to reproduce were excluded from the analysis.
The advisory alert asked the provider if they would like to refer the patient to the Oncofertility team. Rates of oncofertility referrals were compared for the first 6 months of implementation compared with the prior 12 years of referrals.
A median of 13 referrals were made within a 12-year period prior to the advisory alert implementation and only 33% of these patients underwent fertility preservation.
Following implementation of the best practice advisory, the alert was triggered 333 times and 66 referrals were made, which amounted to an increase of 450%. A total of 14 patients received fertility treatment measures.
Of the 66 referrals, 53% were female, and all patients had a median age of 39 years. The most common cancer type among referred women was breast cancer (51.43%) and colorectal cancer, lymphoma, and renal cell carcinoma for referred men (12.90% each).
“In the initial outpatient visit, clinicians are often trying to cover many components of the patient’s care, including diagnosis, treatment plans, and prognosis, which can result in fertility discussions being overlooked,” Dr. Cann said. “The best practice advisory integrates that reminder into the clinical workflow and makes referrals easier.”
Among eligible patients who were not referred to the Oncofertility team, the most common reasons were on active treatment (n = 76), followed by patient refused (n = 37), and medically inappropriate (n = 35).
“It’s a scalable intervention,” Dr. Cann concluded. “Ultimately, we want to ensure every patient of reproductive age understands their options and has a chance to preserve their fertility, if they wish, before starting treatment.”
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
