Critical appraisal:Lewin J, Ma JMZ, Mitchell L, Tam S, Puri N, Stephens D, et al 2017
Critical Appraisal
Lewin J, Ma JMZ, Mitchell L, Tam S, Puri N, Stephens D, et al. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer 2017 Jun;25(6):1915-1922 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28155019.
Key Facts
cross sectional study
To investigate factors affecting the documentation of infertility risk and fertility preservation options during initial oncology consultations prior to systematic therapies for adolescent-young-adults:
(1) determine factors predicting the prevalence of documented infertility risk or fertility preservation discussions
(2) compare the proportion of documented infertility risk and fertility preservation discussions before and after the implementation of the AYA program
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- Fertility discussion
- Associations of discussion with demographic and clinical factors (describing patient factors)
- Pre- and post-intervention cohorts were similar with regard to age, sex, cancer site, treatment, parity and relationship status.
- Documentation of infertility risk was significantly less likely in patients with metastatic disease (P value < 0.001), in patients treated with low-infertility-risk chemotherapy when compared to those treated with intermediate- or high-infertility-risk chemotherapy (P value = 0.03), in certain cancer types (e.g., leukemia compared to testicular cancer) (P value = 0.003), in those who already had children (P value < 0.001), and in those treatment centres without the AYA program involvement (P value < 0.001).
Post intervention: rates of infertility risk increased from 56% - 85% (CI 74–92%, P value < 0.0001), and FP option documentation increased from 54$ to 86% (75–93%, P value< 0.0001).
The effect of AYA program improvement on IR discussion was most noticeable in patients with leukemia (20% to 73%, P value < 0.001), lymphoma (56% to 88%, P value = 0.03), and breast cancer (59% to 94%, P value = 0.01).
The effect of AYA program improvement on IR discussion was most noticeable in patients with leukemia (20% to 73%, P value < 0.001), lymphoma (56% to 88%, P value = 0.03), and breast cancer (59% to 94%, P value = 0.01).
no
Evidence ratings
IV
| High risk of bias | Comments: As per above bias recommendation |
| 1 | Reason for decision: |
| 2 | Additional comments: |
Included
This appraisal has been completed.
- Article
- Lewin J, Ma JMZ, Mitchell L, Tam S, Puri N, Stephens D, et al. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer 2017 Jun;25(6):1915-1922 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28155019.
- Assigned to
- User:Yasmin.jayasinghe
- Topic area
- Guidelines:COSA:Cancer fertility preservation guidelines/Discussing risk
- Clinical question
Section below only relevant for Cancer Council Project Officer
Study shows that addition of specific AYA focused fertility programs increases the rate of risk of infertility discussion and the discussion of fertility preservation options.