Critical appraisal:Bradford NK, Walker R, Henney R, Inglis P, Chan RJ 2018 2
Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28934554.
- What is the effect of oncofertility programs or health professional education on the number of clinician-patient discussions about fertility preservation following a cancer diagnosis?
The study aims were to assess the effects of bundled interventions on clinical practice concerning fertility in young people aged 14–25 years with cancer.
1. Was the patient provided with written and verbal information regarding fertility preservation options? (Yes/No)
�2. Was the patient referred to a fertility specialist? (Yes/No)
3. � Did the patient undergo fertility preservation (Yes/No)
�4. If Yes—what preservation method.
Compared to patients in the pre-intervention cohort, patients in the post-intervention cohort were significantly more likely to have: (a) evidence of risk of infertility discussion (RR 1.47, 95% CI 1.12–1.63 p=<0.001); (b) documented referral to fertility specialist (RR 1.53, 95% CI 1.26–1.87, p=<0.001); and (c) documented fertility preservation outcomes (RR 2.56, 95% CI 1.19–3.44, p=<0.001).
Post intervention, documented rates of referrals to fertility specialists were significantly higher for patients with bone sarcoma (RR 1.84, 95% CI 1.12–3.01, p = 0.015) and carcinoma (RR 2.37, 95% CI 1.15–4.88, p = 0.019).
Also significant improvements for gender disparity. After interventions, there was no significant difference between male and female discussion documentation (RR 1.04, 95% CI 0.95–1.15, p = 0.37). Males were still males were still significantly more likely to be referred to fertility specialists (RR 1.83, 95% CI 1.37– 2.46, p = 0.001), and to have documented fertility preservation outcomes (RR 2.06, 95% CI 1.44–2.96, p = 0.001).
Significant improvements in discussion rates after program implementation. Disparity still present post-intervention in fertility specialist referral and uptake of fertility. This could reflect the ease of access to sperm banking for males, or uncertainty/cost/invasive procedures for females.
|Moderate risk of bias||Comments:|
|1||Reason for decision:|
- Bradford NK, Walker R, Henney R, Inglis P, Chan RJ. Improvements in Clinical Practice for Fertility Preservation Among Young Cancer Patients: Results from Bundled Interventions. J Adolesc Young Adult Oncol 2018 Feb;7(1):37-45 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28934554.
- Assigned to
- Topic area
- Guidelines:COSA:Cancer fertility preservation guidelines/Discussing risk
- Clinical question
Section below only relevant for Cancer Council Project Officer