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.