Improvements in patient satisfaction with information received demonstrate the potential for fertility programs in cancer care settings to improve the quality of clinician-patient discussions about fertility.— Joanne F. Kelvin, MSN, RN, CNS, AOCN
As reported by Joanne F. Kelvin, MSN, RN, CNS, AOCN, of Memorial Sloan Kettering Cancer Center (MSK), and colleagues in the Journal of Clinical Oncology, a cancer and fertility program established at MSK improved patient satisfaction with information received regarding fertility risks and preservation options.1 The program, designed to support clinicians in discussing treatment-related fertility issues with patients and in referring patients to reproductive specialists, provides resources, clinician education, and fertility clinical nurse specialist consultation.
The current study assessed the impact of the program by comparing responses to gender-specific questionnaires provided to patients aged 18 to 45 years who started treatment before program initiation (cohort 1: July 2007 to June 2008) and after program initiation (cohort 2: January 2010 to December 2012) at MSK. The overall questionnaire response rate was 46% for the first cohort and 27% for the second cohort. The response rate was higher in cohort 1 if the questionnaire was distributed in the clinic vs by postal mail (88% vs 38% for women, 97% vs 36% for men) and in cohort 2 if sent by e-mail vs postal mail (32% vs 24% for women, 25% vs 15% for men).
Cohort 1 included 271 women and 150 men, and cohort 2 included 320 women and 120 men. The most common cancers were testicular cancer, breast cancer, and lymphoma. The mean time between diagnosis and survey was approximately 2 years in both cohorts.
Outcomes for Women
For cohort 1 vs cohort 2 women, satisfaction with information on topics was 46% vs 75% (χ2 = 62.1, P < .001) for the effect of treatment on fertility, 24% vs 62% (χ2 = 71.9, P < .001) for fertility-preservation options, 16% vs 57% (χ2 = 80.2, P < .001) for help with decision-making, 16% vs 55%, χ2 = 60.5, P < .001) for finding a reproductive endocrinologist, and 10% vs 41% (χ2 = 44.7, P < .001) for other family-building options. Among the 320 cohort 2 women, 57 received education and counseling from a fertility clinical nurse specialist. For those without vs with such counseling, satisfaction with information on topics was 74% vs 77% (χ2 = 0.9, P = .62) for the effect of treatment on fertility, 55% vs 80% (χ2 = 11.2, P = .004) on fertility-preservation options, 49% vs 74% (χ2 = 10.4, P = .006) on help with decision-making, 42% vs 83% (χ2 = 22.6, P < .001) on finding a reproductive specialist, and 33% vs 60% (χ2 = 8.9, P = .01) on other family-building options.
Outcomes for Men
For cohort 1 vs cohort 2 men, satisfaction with information on topics was 75% vs 84% (χ2 = 3.4, P = .18) for the effect of treatment on fertility, 68% vs 85% (χ2 = 9.3, P = .01) for sperm banking, 54% vs 80% (χ2 = 13.3, P = .001) for finding a sperm bank, and 30% vs 65% (χ2 = 18.7, P < .001) for other family-building options.
Among cohort 2 patients who received and read information materials, 96% of men and 99% of women found them helpful. Among 67 men in cohort 2 who did not participate in sperm banking, 10% reported not knowing about sperm banking as the reason. Among the 255 cohort 2 women who did not participate in fertility preservation, 10% reported not knowing about fertility preservation as the reason. Cohort 2 women who received fertility clinical nurse specialist counseling were 6.1 times more likely to undergo fertility preservation than those who did not receive such counseling.
The investigators concluded: “Improvements in patient satisfaction with information received demonstrate the potential for fertility programs in cancer care settings to improve the quality of clinician-patient discussions about fertility.” ■
Disclosure: The study was supported by the Memorial Sloan Kettering Geri and ME Nursing Fund and a grant from MSK. For full disclosures of the study authors, visit www.jco.ascopubs.org.
The fact that more than one-third of male respondents and nearly two-thirds of female respondents who were diagnosed with cancer after the initiation of the Cancer and Fertility Program still were not satisfied with certain aspects of the information they received about fertility is a...!-->!-->