Fertility preservation in children and teenagers with cancer
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Over 80% of children, adolescents and young adults (AYA) diagnosed with cancer survive to adulthood. Fertility impairment is a major survivorship consideration. We know from follow-up studies of childhood cancer survivors that infertility may affect long-term wellbeing, relationships and life decisions. We now understand that lack of information about the impact of cancer treatments on fertility can increase distress and anxiety in young people. International bodies now recommend discussion of fertility risks and options prior to cancer treatment.
Fertility Preservation poses unique clinical challenges in children as it is considered experimental. It also poses ethical challenges around consent and beneficence for the young person. Fertility preservation is time sensitive as it is best undertaken prior to the administration of chemotherapy or radiotherapy. Discussions often occur around one or two days after diagnosis of cancer, which is a stressful time. Ovarian tissue collected from children prior to cancer treatment can be stored for many years, and tissue may survive for some years after transplantation back into the body years later. There have been isolated reports in children of return of ovarian function after transplantation. Over 70 pregnancies have been reported worldwide, but only one from tissue from a child. For boys testicular tissue collection may be undertaken, but at present mature sperm from this tissue has not been produced. Lack of governance over paediatric and adolescent Fertility Preservation, creates burdens for families and health providers. Unfortunately detailed national guidelines do not exist to guide clinicians in this complex area of practice. The Royal Children’s Hospital Melbourne developed a multidisciplinary collaborative Paediatric Adolescent and Young Adult Fertility Preservation Taskforce in conjunction with the Royal Women’s Hospital in 2012. The aims of the taskforce are to integrate the collective wisdom of families of children with cancer and experts from a range of disciplines (Paediatric Gynaecology, Oncology, Endocrinology, Reproductive Medicine, Ethics, Legal, Sociology, Paediatric Surgery), in order to develop clinical pathways and policies around paediatric and adolescent fertility preservation; to guide referrals to Clinical Ethics Committees around fertility preservation; to improve patient-provider communication; to design academic programs which collect safety and efficacy data, and information on long-term acceptance by cancer survivors; and to educate health providers and the community.
There are several sub-studies being undertaken under this program
- Safety and efficacy of fertility preservation measures being undertaken at the RCH according to age, diagnosis, risk of infertility from cancer treatment, involving linkage to births and IVF registries
- Evaluation of Decisional acceptance around the fertility preservation decision by parents and survivors
- Evaluation of decisional support tools for clinicians undertaking fertility preservation consultations
- Evaluation of a decision aid for parents and young people involved in fertility preservation decisions.
- Dr Yasmin Jayasinghe, Senior Lecturer
- Prof Lynn Gillam
- Dr Matthew Kemertzis
- Dr Lisa Orme
- Dr Michelle Peate
- Prof Martha Hickey
- Prof Yves Heloury
- Prof Margaret Zacharin
- Dr Cindy Ho
- Prof Kate Stern
- Dr Franca Agresta
- Dr Peter Downie
- AProf Amanda Walker
- Dr Maria McCarthy
- Dr Rosalind McDougall
- Dr Clare Delaney
- Dr Leanne Super
- Dr Michel Sullivan
- Dr Stephanie Robinson
- Prof Sonia Grover
- Dr Genia Rozen
- Dr Shlomi Barak
- Paediatric Integrated Cancer Service
- Australasian Oncofertility Consortium
Victorian Cancer Agency
Victorian Comprehensive Cancer Centre (Grant in Aid for Fertility Preservation summit May 2016).
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