Implementation Of a Systematic Approach To Increase Occurrence and Documentation Of Fertility Discussions In Newly Diagnosed Acute Leukemia Patients Prior To Induction Chemotherapy

The American Society of Clinical Oncology established guidelines on fertility preservation in cancer patients in 2006. However, recent data suggests that the guidelines are not followed in many oncology cases. Several studies have begun to examine the rate in which fertility discussions occurred, appearing as low as 34% in some reviews. A recent study published by Gwede, et al., suggests that less than 50% of adult patients with cancer who are of childbearing receive adequate education about the options before cancer treatment. New acute leukemia patients are in a particularly difficult situation as they typically need to start chemotherapy within days of being diagnosed. The urgency to begin chemotherapy, coupled with a potentially life threatening illness, leaves many medical professionals to focus on the leukemia therapy versus discussions regarding other potential long term side effects of treatment. However, medical professionals agree that it is still essential that patients be educated on the potential impact of chemotherapy on fertility and any possible options for patients protect their fertility. In order to assess programmatic performance in this area, 27 newly diagnosed leukemia patient charts were audited for the documentation of a fertility discussion. This chart review revealed that 12 of 27 (44%) patients had documentation indicating that a fertility discussion took place prior to the start of chemotherapy. In an effort to improve the occurrence and documentation of fertility discussions in newly diagnosed acute leukemia patients, a process improvement plan was put into place. A task force, lead by the program’s Psychologist educated the team on the need for fertility discussions and what documentation needed to occur. Barriers identified as impeding fertility discussions included fear of increasing emotional distress, lack of knowledge of what fertility options existed for patients, and a reminder to bring up fertility and/or document discussions. Due to the underlying emotions related to both a new cancer diagnosis and potential fertility issues, critical team members were identified and educated to discuss fertility issues with patients. The entire treatment team was encouraged to remind those critical team members to have and document the fertility discussion with patients. After implementing a systematic, multi-disciplinary plan and staff education, a new set of 27 newly diagnosed leukemia patient charts were reviewed for documentation of a fertility discussion. After the intervention, 27 of 27 patient charts had documentation that a fertility discussion took place prior to the patient starting induction chemotherapy. As found in a previous review by Reinecke, et al., the inclusion of an internal champion and education of staff worked well to ensure that these discussions occurred. This trend reinforces the use of a multidisciplinary team, process improvement and education as ways to ensure all aspects of patient care are covered.