Holly Hoefgen

Fertility preservation options in pediatric and adolescent patients with cancer: Fertility Options in Pediatric Patients

The incidence of childhood cancer has steadily increased since the 1950s, with approximately 16,000 children diagnosed each year. However, with the advent of more effective multimodal therapies, childhood cancer survival rates have continued to improve over the past 40 years, with >80% of patients now surviving into adulthood. Fertility preservation (FP) has become an important quality‐of‐life issue for many survivors of childhood cancer. As a result, the therapeutic options have become less gonadotoxic over time and more patients are being offered FP options. This review examines the indications for consultation, male and female FP options both in the prepubertal patient and adolescent patient, and the unique ethical issues surrounding FP in this vulnerable population. Cancer 2018;124:1867‐76.

A Pediatric Emergency Department Intervention to Increase Contraception Initiation among Adolescents.

BACKGROUND The pediatric emergency department (PED) provides care for adolescents at high risk of unintended pregnancy, but little is known regarding the efficacy of PED-based pregnancy prevention interventions. The objectives of this PED-based pilot intervention study were to 1) assess the rate of contraception initiation after contraceptive counseling and appointment facilitation in the PED during the study period, 2) identify barriers to successful contraception initiation, and 3) determine adolescent acceptability of the intervention. METHODS This pilot intervention study included females 14 to 19 years of age at risk for unintended pregnancy. Participants received standardized contraceptive counseling and were offered an appointment with gynecology. Participants were followed via electronic medical record and phone to assess contraception initiation and barriers. Chi-square tests were used to examine the association between contraception initiation and participant characteristics. RESULTS A total of 144 patients were eligible, and 100 were enrolled. In the PED, 68% (68/100) expressed interest in initiating hormonal contraception, with 70% (48/68) of interested participants indicating that long-acting reversible contraception (LARC) was their preferred method. Twenty-five percent (25/100) of participants initiated contraception during the study period, with 19 participants starting LARC. Thirty-nine percent (22/57) of participants who accepted a gynecology appointment attended that appointment. Barriers to follow-up include transportation and inconvenient follow-up times. Participants were accepting of the intervention with 93% agreeing that the PED is an appropriate place for contraceptive counseling. CONCLUSIONS PED contraceptive counseling is acceptable among adolescents and led to successful contraception initiation in 25% of participants. The main barrier to contraception initiation was participant follow-up with the gynecology appointment.

Contraception and Menstrual Suppression for Adolescent and Young Adult Oncology Patients

According to the 2013 National Youth Risk Behavior Survey [1], 47 % of high school students in the United States (USA) admitted to previous sexual intercourse, and of those, 14 % did not use any method of pregnancy prevention [1]. An unintended pregnancy during cancer treatments may result in delay in therapy, teratogenic exposure, and/or pregnancy termination [2]. For many of these patients, unintended pregnancy is associated with an unacceptable health risk. Therefore, an open and early discussion about contraceptive needs and options is essential to the overall care of the adolescent and young adult oncology patient. Choosing a contraceptive method is an important decision with many involved factors for both patients and physicians. We must consider the efficacy and safety profile of each method, as well as how the method fits into each patient’s lifestyle, including technical, social, and religious factors, among others. In the adolescent oncology patient, these issues can compound quickly. Medically, these patients’ present increased challenges due to their underlying diagnoses and the increased risk of thrombotic disease associated with all malignancy. A thorough discussion of indicated contraceptive methods should be undertaken with each patient, with focus placed on efficacy and safety. An added benefit (or alternative use) of contraceptive medications during cancer treatment has been to elicit menstrual lightening and suppression, especially in patients with low blood count, menorrhagia, and/or risk of bone marrow suppression. Additionally, every social situation is unique and we must remember to ensure confidentiality in our adolescent patients seeking sexual health counseling and contraception.