Raising the Bar of Oncofertility Care in HSCT Patients: Implementation of an Oncofertility Education and Referral Program

Background: Hematopoietic stem cell transplant (HSCT) survivors and their partners frequently struggle with infertility post HSCT, which can decrease quality of life (QOL). With an increasing number of HSCT survivors, a systematic pre-transplant and survivorship care plan that includes oncofertility is eagerly needed. A comprehensive guideline on oncofertility education and referral does not exist for HSCT patients. Therefore, our HSCT program developed an Oncofertility Education and Referral Program (OERP) to empower HSCT physicians, nurses, and patients with knowledge of fertility preservation (FP) and family planning options. The strategy and tools of our OERP implementation can assist transplant groups at other institutions in initiating similar programs. 

Methods: A multidisciplinary team identified barriers that providers experience in delivering oncofertility education, and dealing with programmatic barriers for referrals to reproductive specialists. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines on oncofertility education were used to develop program-specific guidelines and educational material for providers and patients. A referral network was built through collaboration with local reproductive medicine specialists.    

Results: OERP implementation occurred over a 12-month period from July 2013 to July 2014 (Figure 1). We put into service a standard operating procedure (SOP) on FP Education and Referral that incorporated ASCO and NCCN guidelines as well as a referral algorithm with contact information. Biannual in-service oncofertility education sessions were provided to HSCT physicians, nurses, and support staff. Provider education packets that include national guidelines, referral contacts, and support services were made available on the shared drive for anytime access. Patient education packets that contain a one-page fact sheet, local reproductive medicine clinic information, FP financial assistance, and support services were also made available on shared drive. Oncofertility discussions were incorporated into programmatic patient care committee meetings and patient intake education sessions to ensure oncofertility education is delivered from the beginning of patient care. A computer-based learning module was created for continuing education and is undergoing institutional review for implementation.

Conclusions: We created a comprehensive OERP for HSCT providers and patients. Success of the OERP will be measured annually through reproductive specialist referral metrics and surveys given periodically to patients and providers. In an effort to improve HSCT survivors' QOL, programs should implement an OERP to ensure patients make informed decisions concerning the future of their reproductive health before undergoing HSCT.