COSA:AYA cancer fertility preservation/Managing the fertility preservation process/ Management and communication

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Fertility preservation for AYAs diagnosed with cancer: Guidance for health professionals. > COSA:AYA cancer fertility preservation/Managing the fertility preservation process/ Management and communication

Assign responsibility for managing and communicating about each stage of the process

Key responsibilities of the cancer treatment and fertility preservation teams at each stage of the preservation process are detailed below.

RESPONSIBILITIES / TASKS

Before treatment begins:

Cancer treatment team:

  1. Assess the risk of infertility from proposed cancer treatments including the risk of relapse and/or more intense gonadotoxic therapy.
  2. Discuss potential risks of and the implications with the patient and their family.
  3. Provide age-appropriate written information about options to the patient (and family) and referral to a psychologist or counselor if appropriate.
  4. Refer patient promptly for further discussion and/or fertility preservation where appropriate.
  5. Provide detailed referral to fertility specialist including:
    • age of patient
    • cancer diagnosis
    • proposed treatment
    • estimated risks to fertility
    • stage and grade of disease and prognosis
    • time until start of treatment and urgency of treatment
    • whether patient currently has a partner
    • other relevant social details such as drug and alcohol abuse and existing children
    • mental health history if relevant
  6. After the fertility preservation consultation review the patient’s need for further information or support in decision-making.


Fertility preservation team:

  1. Assess capacity for young person to preserve fertility:
    • for young males, capacity to ejaculate or appropriateness for testicular biopsy
    • for young females, assessment may include pubertal staging, menstrual function, menstrual stage and contraceptive medication.
  2. Discuss risks to fertility of proposed cancer treatment with patient and family.
  3. Ascertain patient’s life situation, relationship status and future plans.
  4. Confirm time available before cancer treatment begins.
  5. Discuss all fertility preservation options with patient and family including the process, chance of success, risks and complications, published evidence and costs (if relevant).
  6. Provide age-appropriate written information about options to the patient (and family) and referral to a psychologist or counselor if appropriate.
  7. Conduct follow up discussion with the patient and family after they review information.
  8. Support the young person to understand a recommendation or decision not to preserve or protect fertility if required.


After the fertility preservation process is complete:

Fertility preservation team:

  1. Inform the young person of the outcome of the preservation process.
  2. Inform the patient’s cancer specialist/treatment team of the outcomes including:
    • processes completed and timing
    • outcome including, where possible, quality of gametes or tissue obtained
    • the likely use of any stored gametes
    • any further recommendations for management or collection
    • any peri-operative complications or clinical ramifications of the procedure
    • destruction of stored gamete protocol.
  3. Support the patient to deal with:
    • the physical and psychosocial impact of the fertility preservation/protection process
    • any relevant side effects of the process
    • the consequences of the outcome of the process, both positive and negative.
  4. Evaluate whether further fertility preservation strategies are needed.
  5. Arrange follow up with relevant clinical and psychosocial professionals.


After cancer treatment is complete:

Cancer treatment team:

  1. Record the treatment outcome and update the cumulative total doses of gonadotoxic treatments.
  2. Schedule post-treatment follow up and monitoring for late effects.
  3. Assess endocrine status and evaluate need for hormone replacement or other replacement treatments.
  4. Make a referral for follow up with the fertility preservation team (if appropriate), or to a fertility specialist for discussion about options if fertility preservation was not possible before treatment.
  5. Inform the assisted reproductive service of any changes in circumstance for the young person (particularly if the young person dies).


Fertility preservation team:

  1. Reassess fertility potential on an ongoing basis with appropriate follow up. (See Long-term follow up)
  2. Support the young person to decide whether there is a need to discuss further fertility preservation options.
  3. Support the young person to deal with the long term consequences of cancer and its treatment on their fertility and to consider other family planning options if infertility is confirmed. (See Long-term follow up)

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