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Interdisciplinary Collaboration:
Challenges and Successes
Michael S. Neal
Scientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario
www.onefertility.com
mneal@onefertility.com
Cancer and Fertility Crossroads
Increasing Cancer Survival Rates
(≥ 70% for pediatric oncology)
Increased emphasis on Quality of Life
+
Advances in Assisted Reproductive Technologies (ART)
=
Greater need for Information and Understanding
about Fertility Risks and Options
Awareness of
Fertility Preservation Options
Oncology banked sperm used for conception is
effective: a) 36.4% clinical PR/IUI
b) 54.5% clinical PR/ET with IVF/ICSI
Only 17.8% (146/821) newly diagnosed AYA cancer patients
utilized sperm cryopreservation technology.
Awareness is the key to increased use of sperm banking for
oncology purposes.
Neal et al., Cancer 2007
Interdisciplinary Team Approach to
Fertility Preservation
Patient Centered Research
Scientific Community
New ideas and approaches
Female
•Improved communication between patients
and Allied Health Professionals
•Referrals
•Developing reliable ooctye freezing
technology
•Ovarian tissue cryopreservation.
•In vitro maturation of oocytes
Quality of Care Research
•Sperm and oocyte banking brochures
•Referral algorithm
Fertile Future
www.fertilefuture.ca
Social
Work
Male
Research
Fundamental
Questions
Family of their
own in future
•DNA fragmentation study.
•Germ cell regeneration.
REI
Physician
Cancer Patient
Patient Support
Medical Team
Parents
Nursing
Oncologist
Help a Child
Smile
Nursing
Risk Management
Legal, ethical.,
government regulations (AHR)
ART
Lab
Oncology
Fertility
Challenge:
Bridge the gap between oncology and fertility professionals.
Ultimate Goal:
Improve the quality of life of cancer survivors by providing
fertility preservation options.
Two pronged Approach:
1. Health Care Professionals
2. Patients
Health Care Professionals
Empowering staff to ensure patients are referred
to the Fertility clinic:
Algorithm
• designed to aid in the identification of candidates for fertility
preservation earlier rather than later to afford the patient the
appropriate time to consider options.
Diagnosis
Treatment
Health Care Professionals
Referral Form and Process:
• creation of a standard approach.
• provides evidence in the health record of informed
consent.
• educational sessions for all levels of staff (physician,
nursing, social work).
Challenges:
Who initiates the discussion?
- physician, nurse, social worker
Age of the patient influences:
- consent process
- who should come to the clinic (Mom/Dad/Partner)
- what if no current partner
Patient Information and Awareness
Patients need to make an informed decision at a time when they are
inundated with treatment information.
Developed:
• plain language educational pamphlet
• more effective to provide written material instead of the
message being lost amongst verbal information.
Implemention of an educational pamphlet:
• became a teaching tool
• helped all health care professional to “open the door” to
conversations about this sensitive but important topic.
Conclusions
• Increased awareness and a more rigorous clinical approach
resulting in a 71% increase in referrals for oncology banking
compared with the previous year.
• Awareness and Education is required for not only patients, but,
allied health care professionals.
• Oncologists combined with a multi-disciplinary team of health
professionals provides hope for the future fertility of oncology
patients.
Discussion
Michael S. Neal
ONE Fertility, and Reproductive Biology Division,
Department of Obstetrics and Gynecology
McMaster University, Hamilton, Ontario, Canada
mneal@onefertility.com