Guidelines, Counseling Practices, and Fertility Preservation Options for Childhood Cancer Patients in the Nordic-Baltic Region.

Abstract

Purpose: Despite new medicine and treatment options, fertility is impaired for many childhood cancer survivors after gonadotoxic treatment. In the current study, we compiled an overview on the state of fertility preservation (FP) care and limitations for childhood cancer patients throughout the Nordic-Baltic region.

Materials and methods: In partnership with the Nordic Society of Pediatric Hematology and Oncology, an anonymous survey was conducted among 23 major pediatric oncology centers in Nordic and Baltic countries. The survey featured 22 multiple-choice and open-ended questions that provided insights into guidelines, available FP options, clinical indications, and counseling.

Results: The response rate to the questionnaire was 74% (17 of 23 pediatric oncology centers). The survey revealed that only 65% of the centers have national guidelines on FP at the time. Although all centers offer counseling before treatment by oncologists (88%) or gynecologists (65%), 76% of the centers provide it only to those fulfill inclusion criteria. Additionally, counseling is unavailable for some patients because of age (35%), communication issues (29%), or lack of time (24%). Predominantly, sperm cryopreservation is offered across all centers for pubertal boys, while testicular tissue cryopreservation is provided at 41% of pediatric oncology centers for prepubertal boys. Oocyte cryopreservation is offered to pubertal girls at 88% of the centers, and ovarian tissue cryopreservation is offered to prepubertal and pubertal girls at 82% of the questioned centers.

Conclusion: The survey highlights the implementation of FP services status in the Nordic and Baltic countries. However, standardizing FP indications and disseminating guidelines widely is crucial to reduce clinical variability. Addressing issues such as inconsistent counseling, limited collaboration, and unclear risk stratification can drive further improvements.