Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Abstract

Purpose: Diminished reproductive capacity is a devastating consequence of life-sparing therapies for childhood malignancy. In 2006, the American Society of Clinical Oncology (ASCO) published fertility preservation recommendations (ASCOR) emphasizing the importance of early discussion and intervention for fertility preservation strategies. Using the Survey for Preservation of Adolescent REproduction (SPARE), we sought to determine fertility preservation attitudes and practice patterns post-ASCOR from pediatric oncology specialists nationwide.

Materials and methods: The SPARE survey consists of 22 questions assessing pediatric oncology specialists' attitudes and practice patterns toward fertility preservation. Broad perspectives on fertility preservation, including a willingness to discuss fertility, knowledge of current fertility preservation methods and awareness of ASCOR, were assessed.

Results: The majority of respondents acknowledged that fertility threats are a major concern for them and agreed that all pubertal cancer patients should be offered a fertility consultation, but only 46% reported they refer male pubertal cancer patients to a fertility specialist prior to cancer treatment >50% of the time, and only 12% reported they refer female pubertal cancer patients to a fertility specialist prior to cancer treatment > 50% of the time. While 44% of respondents were familiar with the 2006 ASCOR, only 39% of those utilized them to guide decision-making in greater than half of their patients.

Conclusion: Our study demonstrates pediatric oncologists' motivation to preserve fertility in pediatric cancer patients; however, barriers to both gamete cryopreservation and referral to fertility specialists persist. Female pubertal patients are referred to fertility preservation specialists with much less frequency than are male pubertal patients, highlighting a disparity.

Fig. 1

a−e Attitudes vs. practices: male cancer patients (pubertal and pre-pubertal). a All pubertal males should be/are referred to FP specialist pre-cancer treatment; b All pubertal males should be/are offered sperm banking pre-cancer treatment; c All pubertal males should be/are offered testicular tissue cryopreservation in cases of azoospermia or inability to ejaculate; d All pubertal males should be/are referred to FP specialist post-cancer treatment; e all pre-pubertal males should be/are offered testicular tissue cryopreservation

Fig. 2

a−d Attitudes vs. practices: female cancer patients (pubertal and pre-pubertal). a All pubertal females should be/are referred to FP specialist pre-cancer treatment; b All pubertal females should be/are offered OTC pre-cancer treatment; c All pubertal females should be/are referred to FP specialist post-cancer treatment; d All pre-pubertal females should be/are offered OTC pre-cancer treatment