Interdisciplinary Collaboration:Challenges and Successes

Michael S. NealScientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario

www.onefertility.commneal@onefertility.com

Cancer and Fertility Crossroads

Increasing Cancer Survival Rates(≥ 70% for pediatric oncology)

Increased emphasis on Quality of Life

Advances in Assisted Reproductive Technologies (ART)

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Greater need for Information and Understandingabout Fertility Risks and Options

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Oncology banked sperm used for conception is

effective: a) 36.4% clinical PR/IUI

b) 54.5% clinical PR/ET with IVF/ICSI

Only 17.8% (146/821) newly diagnosed AYA cancer patients utilized sperm cryopreservation technology.

Awareness is the key to increased use of sperm banking for oncology purposes.

Awareness of Fertility Preservation Options

Neal et al., Cancer 2007

Interdisciplinary Team Approach to Fertility Preservation

NursingOncologyFertility

ResearchFundamental

Questions

Male•DNA fragmentation study.

•Germ cell regeneration.

Scientific CommunityNew ideas and approaches

Medical TeamCancer Patient

Risk ManagementLegal, ethical.,

government regulations (AHR)

Patient Support

Family of their own in future

ParentsOncologist

REI Physician

ART Lab

Female•Developing reliable ooctye freezing

technology•Ovarian tissue cryopreservation.

•In vitro maturation of oocytes

Patient Centered Research•Improved communication between patients

and Allied Health Professionals•Referrals

Quality of Care Research•Sperm and oocyte banking brochures

•Referral algorithm

SocialWorkFertile Future

www.fertilefuture.ca

NursingHelp a Child Smile

Challenge:

Bridge the gap between oncology and fertility professionals.

Ultimate Goal:

Improve the quality of life of cancer survivors by providingfertility preservation options.

Two pronged Approach:

1. Health Care Professionals2. Patients

Health Care ProfessionalsEmpowering staff to ensure patients are referred

to the Fertility clinic:

Algorithm• designed to aid in the identification of candidates for fertility preservation earlier rather than later to afford the patient the appropriate time to consider options.

Diagnosis

Treatment

Health Care Professionals

Referral Form and Process:• creation of a standard approach.• provides evidence in the health record of informed consent.• educational sessions for all levels of staff (physician, nursing, social work).

Challenges:Who initiates the discussion?

- physician, nurse, social worker

Age of the patient influences:- consent process- who should come to the clinic (Mom/Dad/Partner)- what if no current partner

Patient Information and Awareness

Patients need to make an informed decision at a time when they are inundated with treatment information.

Developed:• plain language educational pamphlet• more effective to provide written material instead of the message being lost amongst verbal information.

Implemention of an educational pamphlet:• became a teaching tool• helped all health care professional to “open the door” to conversations about this sensitive but important topic.

Conclusions

• Awareness and Education is required for not only patients, but, allied health care professionals.

• Oncologists combined with a multi-disciplinary team of health professionals provides hope for the future fertility of oncology patients.

• Increased awareness and a more rigorous clinical approach resulting in a 71% increase in referrals for oncology banking compared with the previous year.

DiscussionDiscussion

Michael S. NealONE Fertility, and Reproductive Biology Division,

Department of Obstetrics and GynecologyMcMaster University, Hamilton, Ontario, Canada

mneal@onefertility.com