Aims The paradigm of cancer care is shifting from simply aiming for cure to quality survival. Maintenance of fertility is one such quality of life issue, and though previous studies have resulted in the streamlining of fertility consultations for pre menopausal women across the county, patients in the TYA age group had been omitted. This study therefore aimed to highlight practices surrounding fertility preservation through audit of the TYA oncology unit within the hospital, and re-audit 2 years thereafter to assess any improvements in care.
Methods and Results Notes were initially analysed from a retrospective sample of the last 100 patients to have had potentially gonadotoxic treatment at the hospital prior to July 2013. Standards were modelled on NICE, SIGN and BFS guidelines with results showing that early menopause was discussed in just 37% of cases and infertility in 54%. Re-audit in October 2015 of all of the appropriate female patients who had received potentially gonadotoxic treatment in the interim period since summer 2013 (39) revealed this had substantially improved to 90% and 97% respectively. Referrals for fertility preservation significantly increased from 28% to 61% (chi-squared p < 0.005) and endocrine monitoring of ovarian function after treatment also increased from 52% to 84% (chi-squared p < 0.005). Differences across treatment groups have also been aligned.
Conclusions Where standards were not met across any of the criteria in the initial audit in 2013, with a few simple and easily incorporated changes to practice thereafter, significant advancements have been made over the past 2 years. Through adaptions to the consent form and highlighting of the issue by the medical director to encourage doctors to update their knowledge around fertility preservation, the quality of fertility care TYA females now receive at the hospital has noticeably improved. If these processes can be implemented across the boundaries of different treatment centres, it should be easily achievable to positively impact the quality survival of female TYA cancer patients nationally.
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