Interdisciplinary Collaboration: Challenges and Successes Michael S. Neal Scientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario

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 =

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. Awareness of Fertility Preservation Options Neal et al., Cancer 2007

Interdisciplinary Team Approach to Fertility Preservation Nursing Oncology Fertility Research Fundamental Questions Male DNA fragmentation study. Germ cell regeneration. Scientific Community New ideas and approaches Medical Team Cancer Patient Risk Management Legal, ethical., government regulations (AHR) Patient Support Family of their own in future Parents Oncologist REI Physician ART Lab Female Developing reliable ooctye freezing technology Ovarian tissue cryopreservation. In vitro maturation of oocytes Patient Centered Research Improved communication between patients and Allied Health Professionals Referrals Quality of Care Research Sperm and oocyte banking brochures Referral algorithm Social Work Fertile Future Nursing Help a Child Smile

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 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. Increased awareness and a more rigorous clinical approach resulting in a 71% increase in referrals for oncology banking compared with the previous year.

Discussion Michael S. Neal ONE Fertility, and Reproductive Biology Division, Department of Obstetrics and Gynecology McMaster University, Hamilton, Ontario, Canada