Current Practice Patterns Surrounding Fertility Concerns in Stage i Seminoma Patients

Survey of United States Radiation Oncologists

Carl M. Post, Aditya Jain, Catherine Degnin, Yiyi Chen, Mike Craycraft, Arthur Hung, Jerry Jaboin, Charles Thomas, Timur Mitin

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Purpose: Patients with testicular seminoma may face fertility issues because of their underlying disease as well as treatments they undergo. The current patterns of practice among U.S. radiation oncologists aimed at assessing and preserving fertility in patients with Stage I seminoma are unknown. Methods: We surveyed practicing U.S. radiation oncologists via an Institutional Review Board-approved online questionnaire. Respondents' characteristics and perceived patient infertility rates were analyzed for association with treatment recommendations. Results: We received 353 responses, of whom one quarter (23%) consider themselves experts. A vast majority (84%) recommend observation as a default strategy. Fifty-two percent routinely advise fertility assessment for patients before observation or chemotherapy, and 74% routinely do so before adjuvant radiation therapy (RT). Forty-one percent and 43% believe that 10% and 30% of patients are infertile following orchiectomy, respectively. Thirty-seven percent and 22% believe infertility rates following para-aortic RT to be 30% and 50%, respectively. Eighty percent routinely use clamshell scrotal shielding. Responders with higher perceived infertility rates are more likely to recommend fertility assessment/sperm banking (Fisher's exact p < 0.0001). Responders who routinely advised fertility assessment were more likely to use clamshell shielding (Cochran-Armitage trend test p = 0.0007). Clamshell use was positively correlated with higher perceived infertility rates following para-aortic RT (Spearman's correlation coefficient = 0.006). Conclusions: Despite a clear knowledge of fertility issues in men diagnosed with seminoma, there is no universal adoption of fertility assessment among U.S. radiation oncologists.

Original languageEnglish (US)
Pages (from-to)292-297
Number of pages6
JournalJournal of Adolescent and Young Adult Oncology
Volume7
Issue number3
DOIs
StatePublished - Jun 1 2018

Fingerprint

Seminoma
Fertility
Infertility
Radiotherapy
Observation
Orchiectomy
Research Ethics Committees
Radiation Oncologists
Surveys and Questionnaires
Spermatozoa
Drug Therapy
Therapeutics

Keywords

  • adjuvant therapy
  • fertility
  • patterns of care
  • radiation therapy
  • survey
  • testicular seminoma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology

Cite this

Current Practice Patterns Surrounding Fertility Concerns in Stage i Seminoma Patients : Survey of United States Radiation Oncologists. / Post, Carl M.; Jain, Aditya; Degnin, Catherine; Chen, Yiyi; Craycraft, Mike; Hung, Arthur; Jaboin, Jerry; Thomas, Charles; Mitin, Timur.

In: Journal of Adolescent and Young Adult Oncology, Vol. 7, No. 3, 01.06.2018, p. 292-297.

Research output: Contribution to journalReview article

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abstract = "Purpose: Patients with testicular seminoma may face fertility issues because of their underlying disease as well as treatments they undergo. The current patterns of practice among U.S. radiation oncologists aimed at assessing and preserving fertility in patients with Stage I seminoma are unknown. Methods: We surveyed practicing U.S. radiation oncologists via an Institutional Review Board-approved online questionnaire. Respondents' characteristics and perceived patient infertility rates were analyzed for association with treatment recommendations. Results: We received 353 responses, of whom one quarter (23{\%}) consider themselves experts. A vast majority (84{\%}) recommend observation as a default strategy. Fifty-two percent routinely advise fertility assessment for patients before observation or chemotherapy, and 74{\%} routinely do so before adjuvant radiation therapy (RT). Forty-one percent and 43{\%} believe that 10{\%} and 30{\%} of patients are infertile following orchiectomy, respectively. Thirty-seven percent and 22{\%} believe infertility rates following para-aortic RT to be 30{\%} and 50{\%}, respectively. Eighty percent routinely use clamshell scrotal shielding. Responders with higher perceived infertility rates are more likely to recommend fertility assessment/sperm banking (Fisher's exact p < 0.0001). Responders who routinely advised fertility assessment were more likely to use clamshell shielding (Cochran-Armitage trend test p = 0.0007). Clamshell use was positively correlated with higher perceived infertility rates following para-aortic RT (Spearman's correlation coefficient = 0.006). Conclusions: Despite a clear knowledge of fertility issues in men diagnosed with seminoma, there is no universal adoption of fertility assessment among U.S. radiation oncologists.",
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