Practice barriers and physician discussion of fertility preservation. Differences in pediatric versus adult oncology setting.

B29

Rapid advances in cancer treatment options and early detection techniques have resulted in an increased number of cancer survivors, with an improved survival rate of 63% over the 42% rate from the 1950's. The guiding paradigm of quality cancer care has shifted to represent a focus on "quality survival" rather than survival alone. Infertility is an expected consequence of cancer treatment, although the odds vary across males and females and depend on the cancer site and treatment. 50-70% of cancer survivors of childbearing age do not recall a discussion of the impact of the treatment on their future fertility nor recommendation for preserving fertility. As with other clinical services, there are several factors that may contribute to the lack of provider discussion related to fertility preservation such as those that are associated with the patient, provider and health care system. This qualitative study conducted in-depth interviews with 18 oncologists at an adult cancer center, and 24 pediatric oncologists throughout Florida, to examine knowledge, attitude and behaviors related to discussion of fertility preservation with cancer patients. Results show the majority of adult oncologists have limited knowledge about fertility preservation options, local resources, or patient preference for information. Pediatric oncologists more routinely discuss this issue with patients, but are more likely to perceive disinterest in the topic by patients and their families. Respondents varied in attitude towards the priority level of this conversation with newly diagnosed patients. Few adult physicians refer males for sperm banking and even fewer females are referred for consultation with an infertility specialist or reproductive endocrinologist. The majority of pediatric oncologists refer pubertal males for sperm banking, but the only regularly offered preventive measure for females was oophoropexy for patients undergoing radiation therapy. Results show a strong need for physician directed educational tools, patient advocacy efforts to promote to physicians the importance of this discussion, and resource identification methods adaptable for any cancer center.