Standard Procedures Improve Fertility Preservation in Cancer Care

Julia Olsen, MN, RN, CNL

Fertility preservation for women with cancer tends to be a more involved process than it is for men, highlighting the importance of a multidisciplinary team. However, conversations regarding fertility may fall on a few select nurses or clinicians, giving them a heavy burden and possibly interfering with the best possible outcomes for the patient.

A research team at the Froedtert & Medical College of Wyoming led by Julia Olsen, MN, RN, CNL, recently created a standardized method of fertility preservation education and services for inpatient hematology/oncology patients.

“According to the National Cancer Institute, there are nearly 500,000 cancer survivors of reproductive age in the United States,” Olsen said in her presentation at the 2020 ONS Bridge virtual conference.

“We have multiple ways to effectively treat patients with cancer, whether it’s chemotherapy, radiation therapy, surgical interventions, or clinical trials, but we don’t always know how these therapies affect a patient’s fertility. Because of this, we have a duty to provide patients with options for fertility preservation so they can make the best decision for their care.”

The method that Olsen and her team developed included:

• Handouts/educational resources
• Structured consultants by designated staff members with standardized documentation
• Coordination with the andrology lab and courier services
• Collaboration with the interdisciplinary team

While the plan can be used for both male and female patients, it may be more helpful to women, who tend to have a more complicated — and costly – experience.

Women must be referred to a reproductive medicine center, where they undergo oocyte retrieval procedures and hormone therapy, which could delay cancer treatment by 3 to 4 weeks. This process — plus the egg storage fee – can cost $8,000 to $10,000.

Men, on the other hand, typically use sperm cryopreservation (also known as “sperm freezing” or “sperm banking”). Collection can be completed by any site, inpatient or outpatient, or reproductive medicine center, and it does not delay treatment. Their cost is about $500, according to Olsen.

The goal of the study was to standardize the fertility-related information that patients received, while ensuing that they got the best, most up-to-date materials. Olsen wanted to be sure that patients understood the risks and benefits of fertility preservation procedures, and then make an educated decision for themselves.

“Some key takeaways of this new process [include] pre-treatment discussions with patients regarding fertility preservation is best practice, and should always be completed having a standardized method for providing education and services,” Olson said.

Olson also explained that the project pointed out some flaws in the system that was being used.

“We have identified some opportunities [for improvement] since beginning this new process,” she said. “The first is that there’s a knowledge gap outside of hematology and oncology. Fertility preservation is not specific to oncology. There may be other needs in other areas of the hospital. But there is a lack of knowledge that this service exists and that it could be completed for patients in need.”

Looking ahead, Olson also said that the procedures her team developed could be beneficial in the pediatric setting.

“We’ve also identified that there is an opportunity to collaborate with the Children’s Hospital of Wisconsin’s patients that are pediatric oncology patients and later in life will transition to radiation hospital for care if necessary.”