Fertility preservation through sperm banking is underutilized among male adolescents who have been newly diagnosed with cancer, according to a new study of these patients.
Only about half of the patients involved in the study (53%) made an attempt to bank sperm, and fewer than half (44%) were successful.
The most significant factor associated with making an attempt at sperm collection was a consultation with a fertility specialist, a fact that suggests that patients could benefit from these specialized referrals as well as from efforts to increase these patients’ understanding and awareness of fertility preservation options.
The study was published online October 4 in the Journal of Clinical Oncology.
Treatment for most cancers in girls and women younger than 39 years can significantly reduce the likelihood of subsequent pregnancy. Experts now agree that the field of fertility preservation has advanced to the point where adults and adolescents who undergo cancer treatments that could potentially affect their fertility can now expect to retain their ability to have their own biological children.
Thus, fertility care needs to be part of the cancer treatment conversation, but not only for female patients.
Male adolescents also risk becoming infertile as a result of cancer treatment, and fertility preservation should be discussed soon after a diagnosis is made. However, these discussions often do not take place, despite the fact that recommendations from the American Society of Clinical Oncology have been in place since 2006.
“Developmentally speaking, when talking to adolescents and young adults, the focus is on avoiding unplanned pregnancy, and fertility is not a desired immediate outcome at this time,” said lead author James L. Klosky, PhD, codirector of the Fertility Preservation Clinic at St. Jude Children’s Research Hospital, Memphis, Tennessee.
But the dynamics change once they marry or become partnered. “As these patients become cancer survivors, we see that fertility is a top priority,” he told Medscape Medical News.
Dr Klosky explained that at St. Jude’s, “we begin with the expectation that treatment will result in a positive outcome. We are focused on survivorship from the start. As a result, we offer fertility preservation to those who are at risk for infertility secondary to treatment. This way, patients can maintain the option of biological parenthood if this is something they desire.”
He emphasized that sperm banking is not for everyone, “but we want to inform adolescents and their parents about the patient’s risk of infertility, engage them in discussions of potential fertility preservation options, support them in their decision-making process, and promote a sense of decisional satisfaction regardless of what choices are made.”
Predictors Identified
In this study, Dr Klosky and colleagues estimated the prevalence of sperm banking among at-risk adolescents who were newly diagnosed with cancer, and they sought to identify factors associated with banking outcomes.
The cohort included 146 male teenagers/young adults (aged 13 through 21 years) who were treated at St. Jude or seven other cancer centers in the United States and Canada. Patients completed a self-report questionnaire, as did 144 parents or guardians and 52 oncologists and other healthcare providers. The questionnaires were completed within 1 week of treatment initiation.
Of the 78 (53.4%) patients who made an attempt to bank sperm, 14 were unsuccessful because they were unable to collect a sample (n = 11) or their sample was azoospermic (n = 3).
“A failed attempt to collect sperm did not result in acute psychological distress for the patients,” said Dr Klosky. “We explain that we don’t have any expectations and that there are other strategies to collect sperm if they are not successful in manually collecting and would like to pursue other options.”
Sixty-eight patients decided not to bank sperm. Their reasons for not doing so included not believing it was necessary, the fact that either the patient or the family was opposed to it, or the fact that the patient was unsure as to what sperm banking was.
The two strongest predictors of making a collection attempt were meeting with a fertility specialist (odds ratio [OR], 29.96; 95% confidence interval [CI], 2.48 – 361.41; P = .007) and parent recommendation (OR, 12.30; 95% CI, 2.01 – 75.94; P = .007).
The final multivariable model also found that a history of masturbation (OR, 5.99; 95% CI, 1.25 – 28.50; P = .025), higher adolescent self-efficacy for banking (OR, 1.23; 95% CI, 1.05 – 1.45; P = .012), and having a medical team member (OR, 4.26; 95% CI, 1.45 – 12.43; P = .008) or parent (OR, 4.62; 95% CI, 1.46 – 14.73; P = .010) recommend sperm banking were also associated with an increased likelihood of successful banking.
“The bottom line is that we want to give patients an opportunity for fertility preservation,” said Dr Klosky. “It’s our obligation to inform them about fertility risks, and then let the patient decide if they want to pursue it.”
The study was funded in part by grants from the National Institutes of Health and by ALSAC, the fundraising and awareness arm of St. Jude Children’s Research Hospital. Dr Klosky has disclosed no relevant financial relationships.
J Clin Oncol. Published online October 4, 2017. Abstract
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar