Skip to main content

Expanding Urgent Oncofertility Services for Reproductive Age Women Remote from a Tertiary Level Fertility Centre by Use of Telemedicine and an On-site Nurse Navigator

Abstract

The objective of this study was to examine a 1-year pilot program aimed at increasing access to fertility preservation (FP) information and services for reproductive-age women newly diagnosed with cancer at a centre geographically remote from a tertiary fertility clinic. An oncofertility nurse navigator (ONN) position was created within the regional cancer centre with the goals of (1) improving local physician knowledge of FP and FP services and (2) improving patient access to FP counselling and services. The ONN identified all women diagnosed with cancer requiring treatment that could impact their fertility and discussed FP options with them and their physicians. As part of a comprehensive program aimed at facilitating access to FP services, the ONN arranged consultations with fertility specialists via telemedicine and coordinated satellite cycle monitoring with a local gynaecologist in order to minimize travel. Patients were surveyed about their reproductive plans, decision-making around FP and experiences with the program. Physicians were surveyed about their engagement with FP services, barriers to FP access and satisfaction with the program. Twenty-two women were eligible for FP during the year-long pilot program. All participated in the study. The most common diagnoses were breast and cervical cancer. At the time of diagnosis, 36.4% of women had no biological children and 68.2% did not desire (more) children. Four women had an FP consultation, and two proceeded with oocyte or embryo cryopreservation. At the end of the pilot program, more physician respondents often or always discussed FP with their patients, stated they frequently refer for FP consultations and stated their patients could obtain FP services in a timely fashion. An ONN within a cancer centre remote from tertiary fertility care can enable access to FP services with minimal need for travel by using local gynaecologic expertise and telemedicine.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2017) Canadian Cancer Statistics 2017. Canadian Cancer Society, Toronto. Available at: cancer.ca/Canadian-Cancer-Statistics-2017-EN.pdf. Accessed 4 Sept 2018

  2. Partridge AH (2008) Fertility preservation: a vital survivorship issue for young women with breast Cancer. JCO 26:2612–2613. https://doi.org/10.1200/JCO.2008.16.1976

    Article  Google Scholar 

  3. Peate M, Meiser B, Hickey M, Friedlander M (2009) The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review. Breast Cancer Res Treat 116:215–223. https://doi.org/10.1007/s10549-009-0401-6

    Article  PubMed  Google Scholar 

  4. Gorman JR, Usita P, Madlensky L, Pierce JP (2011) Young breast cancer survivors: their perspectives on treatment decisions and fertility concerns. Cancer Nurs 34:32–40. https://doi.org/10.1097/NCC.0b013e3181e4528d

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sobota A, Ozakinci G (2014) Fertility and parenthood issues in young female cancer patients—a systematic review. J Cancer Surviv 8:707–721. https://doi.org/10.1007/s11764-014-0388-9

    Article  PubMed  Google Scholar 

  6. Morgan S, Anderson RA, Gourley C et al (2012) How do chemotherapeutic agents damage the ovary? Hum Reprod Update 18:525–535. https://doi.org/10.1093/humupd/dms022

    Article  PubMed  CAS  Google Scholar 

  7. Wallace WHB, Anderson RA, Irvine DS (2005) Fertility preservation for young patients with cancer: who is at risk and what can be offered? Lancet Oncol 6:209–218. https://doi.org/10.1016/S1470-2045(05)70092-9

    Article  PubMed  Google Scholar 

  8. About the Oncofertility Consortium | The Oncofertility Consortium. http://oncofertility.northwestern.edu/about-oncofertility-consortium. Accessed 4 Sep 2018

  9. Lee SJ, Schover LR, Partridge AH et al (2006) American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24:2917–2931. https://doi.org/10.1200/JCO.2006.06.5888

    Article  PubMed  Google Scholar 

  10. Loren AW, Mangu PB, Beck LN et al (2013) Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31:2500–2510. https://doi.org/10.1200/JCO.2013.49.2678

    Article  PubMed  PubMed Central  Google Scholar 

  11. Oktay K, Harvey BE, Partridge AH et al (2018) Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 36:1994–2001. https://doi.org/10.1200/JCO.2018.78.1914

    Article  PubMed  Google Scholar 

  12. Warner E, Yee S, Kennedy E et al (2016) Oncofertility knowledge, attitudes, and practices of Canadian breast surgeons. Ann Surg Oncol 23:3850–3859. https://doi.org/10.1245/s10434-016-5423-9

    Article  PubMed  Google Scholar 

  13. Panagiotopoulou N, Ghuman N, Sandher R et al (2018) Barriers and facilitators towards fertility preservation care for cancer patients: a meta-synthesis. Eur J Cancer Care 27:e12428. https://doi.org/10.1111/ecc.12428

    Article  Google Scholar 

  14. Jones G, Hughes J, Mahmoodi N et al (2017) What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update 23:433–457. https://doi.org/10.1093/humupd/dmx009

    Article  PubMed  Google Scholar 

  15. Goossens J, Delbaere I, Van Lancker A et al (2014) Cancer patients’ and professional caregivers’ needs, preferences and factors associated with receiving and providing fertility-related information: a mixed-methods systematic review. Int J Nurs Stud 51:300–319. https://doi.org/10.1016/j.ijnurstu.2013.06.015

    Article  PubMed  Google Scholar 

  16. Benedict C, Thom B, Kelvin JF (2015) Young adult female cancer survivors’ decision regret about fertility preservation. J Adolesc Young Adult Oncol 4:213–218. https://doi.org/10.1089/jayao.2015.0002

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hill KA, Nadler T, Mandel R et al (2012) Experience of young women diagnosed with breast cancer who undergo fertility preservation consultation. Clinical Breast Cancer 12:127–132. https://doi.org/10.1016/j.clbc.2012.01.002

    Article  PubMed  Google Scholar 

  18. Yee S, Abrol K, McDonald M et al (2012) Addressing oncofertility needs: views of female cancer patients in fertility preservation. J Psychosoc Oncol 30:331–346. https://doi.org/10.1080/07347332.2012.664257

    Article  PubMed  Google Scholar 

  19. Partridge AH, Gelber S, Peppercorn J et al (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22:4174–4183. https://doi.org/10.1200/JCO.2004.01.159

    Article  PubMed  Google Scholar 

  20. Letourneau JM, Smith JF, Ebbel EE et al (2012) Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer. Cancer 118:4579–4588. https://doi.org/10.1002/cncr.26649

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mersereau JE, Goodman LR, Deal AM et al (2013) To preserve or not to preserve: how difficult is the decision about fertility preservation? Cancer 119:4044–4050. https://doi.org/10.1002/cncr.28317

    Article  PubMed  PubMed Central  Google Scholar 

  22. Case MAB (2011) Oncology nurse navigator. Clin J Oncol Nurs 15:33–40. https://doi.org/10.1188/11.CJON.33-40

    Article  PubMed  Google Scholar 

  23. McMullen L (2013) Oncology nurse navigators and the continuum of cancer care. Semin Oncol Nurs 29:105–117. https://doi.org/10.1016/j.soncn.2013.02.005

    Article  PubMed  Google Scholar 

  24. Hazin R, Qaddoumi I (2010) Teleoncology: current and future applications for improving cancer care globally. Lancet Oncol 11:204–210. https://doi.org/10.1016/S1470-2045(09)70288-8

    Article  PubMed  PubMed Central  Google Scholar 

  25. Jhaveri D, Larkins S, Sabesan S (2015) Telestroke, tele-oncology and teledialysis: a systematic review to analyse the outcomes of active therapies delivered with telemedicine support. J Telemed Telecare 21:181–188. https://doi.org/10.1177/1357633X15569959

    Article  PubMed  Google Scholar 

  26. Kelvin JF, Thom B, Benedict C et al (2016) Cancer and fertility program improves patient satisfaction with information received. J Clin Oncol 34:1780–1786. https://doi.org/10.1200/JCO.2015.64.5168

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Letourneau JM, Ebbel EE, Katz PP et al (2012) Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer 118:1710–1717. https://doi.org/10.1002/cncr.26459

    Article  PubMed  Google Scholar 

  28. Srikanthan A, Amir E, Warner E (2016) Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discusgesion and referral? Breast 27:22–26. https://doi.org/10.1016/j.breast.2016.02.012

    Article  PubMed  Google Scholar 

  29. Lewin J, Ma JMZ, Mitchell L et al (2017) 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 25:1915–1922. https://doi.org/10.1007/s00520-017-3597-8

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the staff at the RCCN, at MSF and at Dr. Siren’s office, specifically Dawn Krawczuk, for all of their hard work caring for these patients without which this study would not have been possible.

Funding

This study was funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, Year VII.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rhonda Zwingerman.

Ethics declarations

Informed consent was obtained from all individual participants included in the study. This study was approved by the Research Ethics Boards of Mount Sinai Hospital and the Thunder Bay Regional Health Sciences Centre.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

RZ has received an honorarium from Ferring. KL has received an honorarium from Serono and is on the board of Conceivable Dreams, a non-profit patient advocacy group. EM has received honoraria from Merck. EG is on the board of Fertile Future, a non-profit patient advocacy group. KM, AS and NL have no conflict of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

ESM 1

(DOCX 30.4 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zwingerman, R., Melenchuk, K., McMahon, E. et al. Expanding Urgent Oncofertility Services for Reproductive Age Women Remote from a Tertiary Level Fertility Centre by Use of Telemedicine and an On-site Nurse Navigator. J Canc Educ 35, 515–521 (2020). https://doi.org/10.1007/s13187-019-01490-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-019-01490-w

Keywords

  • Fertility preservation
  • Oncofertility
  • Telemedicine
  • Nurse navigator