An advanced practitioner (AP)-driven fertility preservation initiative introduced at a community oncology practice resulted in a more than two-fold increase in referrals for fertility preservation consultation with a reproductive endocrinologist among adolescents and young adults (AYAs, age 15-39) at risk for infertility. Details of the pilot initiative were presented at the Journal of the Advanced Practitioner in Oncology (JADPRO) Live 2022 meeting.
“Implementing a fertility preservation program as the standard of care within community practice should be a mainstay in care among the AYA population to provide comprehensive, quality care,” noted author Cleo Valdez, CRNP, AOCNP, of Clearview Cancer Institute in Huntsville, Alabama.
Although fertility preservation is a concern of AYAs with cancer and prompt rereferral is recommended if indicated, a gap remains in practice to address the potential impact of gonadotoxic cancer treatment on fertility.
For this pilot program, APs and the quality director at a private community oncology practice along with a software developer designed an initiative to improve fertility preservation corresponding to National Comprehensive Cancer Network (NCCN) guidelines. The research team met with a reproductive endocrinologist to learn more about fertility preservation, patient care timeframes, and expedited referral processes for AYA patients, which together with the NCCN guidelines established the framework for identifying, documenting, and referring patients. An automated report and notification system was developed to identify patients based on age, oncology referral, and new patient appointment status.
“Our main goal of this process and program is to enhance our quality care provided to this AYA population by first focusing on the importance of fertility preservation with the hopes of expanding the program in the future,” Ms. Valdez said.
During the eight-month pilot program, which was initiated in November 2021, 133 AYA patients were identified as eligible for fertility preservation discussions or referrals. Of these, 20 (15%) accepted referrals for fertility preservation consultation with a reproductive endocrinologist. This was an increase of at least 150% compared with 2020 and 2021. When comparing average referrals per month, the pilot period showed an increase of more than 250%. Of the remaining identified patients eligible for fertility preservation discussions or referrals, 18% declined referral and 67% were ineligible for referral for reasons such as a non-cancer diagnosis, sterility, or previously addressed fertility needs.
Ms. Valdez noted that APs are “uniquely positioned to minimize the long-term effects of cancer care in fertility for this underserved population.” Implementing an automated process to quickly identify patients in need and facilitate rapid referrals was an integral feature of the program, she said.
“We strive to make fertility more of a forethought and less of an afterthought,” Ms. Valdez said. “We are also focusing on ways to increase funding [for] these patients who are faced with the financial implications” of fertility preservation.
Any conflicts of interest declared by the authors can be found in the original meeting materials.
Valdez C. Early identification for fertility preservation improves referrals in a community oncology practice. Presented at JADPRO Live 2022, Aurora, Colorado.