Improvements in clinical practice for fertility preservation among young cancer patients: Results from bundled interventions

Purpose The consequences of cancer and treatment on fertility can be a continuing source of distress for adolescents and young adults. The study aims were to assess the effects of bundled interventions on clinical practice concerning fertility in young people aged 14-25 years with cancer. Methods Bundled interventions, including development of quality indicators, resources and targeted education, were introduced during 2015 across five cancer centres. Data prior to interventions (2012-2014) was compared with data prospectively collected during 2015-2016. Relative Risks (RR) with 95% Confidence Intervals (CI) were calculated to assess effects of interventions. Results Compared with the pre-intervention cohort (n=260), the post-intervention cohort (n=216) were 1.47 times more likely to have documented discussion of risk of infertility (95% CI 1.12-1.63, p= <0.001). Similarly, documented referral to fertility specialists was more likely in the post-intervention cohort (RR 1.53, 95% CI 1.26-1.87, p=<0.001) as was documented fertility preservation outcomes (RR 2.56, 95% CI 1.91-3.44, p=<0.001). These differences were significant across age, gender and diseases. Females had greater improvement in documented risk of infertility discussion between cohorts (RR 1.70, 95%CI 1.19-2.08, p=<0.001). Amongst diseases, the greatest improvements were seen in those with brain cancers (RR 2.15, 95% CI 1.28-3.62, p=0.004) and soft tissue sarcoma (RR 2.60, 95% CI 1.17-5.78, p=0.02). Conclusions We have demonstrated the effects of bundled interventions to improve clinical practice associated with fertility preservation in young people with cancer. Interventions were successful for reducing disparities identified in the pre-intervention cohort associated with gender and certain diseases. Assessment of the quality of patient care is not possible without accurate, consistent documentation.