Fertility Preservation

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Fertility Preservation Patient Navigation
Jill Trainer, MSW, LCSW Patient Navigator for
Fertility Preservation Robert H Lurie
Comprehensive Cancer Center of Northwestern
University
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Fertility PreservationPatient Navigation
Learning Objectives Today we will discuss
1. Fertility preservation for cancer patients
at Northwestern.2. Referral process3.
Clinical cases ___________________________
_________________________________
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Patient Navigation
Education BA from University of Iowa in
Psychology MSW from Loyola University
Chicago Work Experience DCFS Child Welfare
Worker Grief/Loss Therapist ACS Patient
Navigator Fertility Preservation Patient
Navigator

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What is Patient Navigation?
Helping patients navigate their options for
fertility preservation by working with their
surgeon, oncologist and reproductive
endocrinologist. Goals To ensure that the
patient is informed of their risk of
infertility To educate patients about their
options to preserve fertility To act as a
liaison between the oncology world and the
reproductive world
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Existing Practice Guidelines

• ASCO (American Society of Clinical Oncology)
  Decision Tree

• ASRM (American Society for Reproductive Medicine)
• Parents may act to preserve fertility of cancer
  patients who are minors if the child assents and
  the intervention is likely to provide net
  benefits to the child

Lee et al., 2006 ASRM, 2006
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• Referral Process
• for Fertility Preservation
• Patient is diagnosed with a cancer
• Patient and/or Physician will make referral for
• fertility preservation consult
• Pt Navigator
• has initial contact with pt regarding options
• supportive counseling
• covers costs
• gives additional web info
• will make appropriate consult (REI, surgery or
• urology)
• will coordinate care between oncology and
• specialist
• on-going communication

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What Technique is Appropriate ?
Jeruss and Woodruff (2009) New England Journal of
Medicine (In Press).
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Clinical Cases

• 17 year old female with Beta Thalassemia
• Beta-thalassemia (ß-thalassemia) is a form of
  thalassemia due to mutations in the HBB gene on
  chromosome 11 1, inherited in an autosomal
  recessive fashion.
• If both alleles have thalassemia mutations. This
  is a severe microcytic, hypochromic anemia.
  Untreated, this progresses to death before age
  twenty. Treatment consists of periodic blood
  transfusion splenectomy if splenomegaly is
  present, and treatment of transfusion-caused iron
  overload. Cure is possible by bone marrow
  transplantation.
• chronically transfused monthly since dx at 4 mos
• Plan to have allogeneic stem cell transplant
  (sibling)
• Muslim, mother concerned about virginity
• Would like to have oocyte cryopreservation,
  concerns about TVUS
• had evaluation with ob regarding TVUS
• Banked 8 oocytes

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Clinical Cases

• 19 year old female with CLL, dx in Mexico
• B-cell chronic lymphocytic leukemia (also known
  as "chronic lymphoid leukemia" or "CLL"), is a
  type of leukemia, or cancer of the white blood
  cells (lymphocytes). CLL affects a particular
  lymphocyte, the B cell, which originates in the
  bone marrow, develops in the lymph nodes, and
  normally fights infection. In CLL, the DNA of a B
  cell is damaged, so that it can't fight
  infection, but it grows out of control and crowds
  out the healthy blood cells that can fight
  infection.
• because of illness, chemo needed to be started
  immediately
• Had several cycles of chemo, was cleared to do
  egg harvest prior to stem cell treatment
• Difficult time making decision embryo v. egg cyro
• Banked 5 embryos with boyfriend

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Clinical Cases

• 16 year old female diagnosed with non-Hodgkin's
  Lymphoma
• sudden onset of chest pains
• the non-Hodgkin lymphomas (NHLs) are a diverse
  group of hematologic cancers which encompass any
  lymphoma other than Hodgkin lymphoma. Lymphoma is
  a type of cancer derived from lymphocytes, a type
  of white blood cell. Many subtypes of non-Hodgkin
  lymphoma have been described. Non-Hodgkin
  lymphomas are treated by combinations of
  chemotherapy, monoclonal antibodies,
  immunotherapy, radiation, and hematopoietic stem
  cell transplantation.
• because of illness, chemo and xrt needed to be
  started immediately
• no time to do an egg harvest
• participated in ovarian tissue freezing protocol
• banked 3 oocytes as well as tissue

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Clinical Cases

• 15 year old diagnosed with ALL
• is a form of leukemia, or cancer of the white
  blood cells characterized by excess lymphoblasts.
  Malignant, immature white blood cells
  continuously multiply and are overproduced in the
  bone marrow. ALL causes damage and death by
  crowding out normal cells in the bone marrow, and
  by spreading (metastasizing) to other organs. ALL
  is most common in childhood with a peak incidence
  at 4-5 years of age, and another peak in old age.
  The overall cure rate in children is 85, and
  about 50 of adults have long-term disease-free
  survival.1 'Acute' refers to the
  undifferentiated, immature state of the
  circulating lymphocytes ("blasts"), and to the
  rapid progression of disease, which can be fatal
  in weeks to months if left untreated.
• 3 month hx of coughing and wheezing
• Had some chemo and xrt which put him in remission
• Recurred almost 3 years later with mediastinal
  mass (now 18 years old)
• New plan to have total body radiation in
  preparation for stem cell transplant
• Banked sperm

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Clinical Cases

• 14 year old male with osteogenic sarcoma
• Osteosarcoma is the most common type of malignant
  bone cancer, accounting for 35 of primary bone
  malignancies. Osteogenic Sarcoma is the 6th
  leading cancer in children under age 15.
  Osteogenic Sarcoma affects 400 children under age
  20 and 500 adults (most between the ages of
  15-30) every year in the USA.
• Broke hip playing basketball
• Treatment involves chemo, xrt (hip), surgery to
  salvage native hip function, followed by repeat
  chemo
• Pt has not had a nocturnal emission, not able to
  give sample
• Used 2 am urine samples to search for sperm, able
  to bank some sperm with this method

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• Questions?
• Thank you!