Fertility preservation in oncologic patients has been gaining increasing attention, yet despite all the fast-moving scientific advancements in fertility preservation procedures, there are relatively few patients who choose to undertake such a path. International guidelines recommend counselling be carried out in a timely fashion, as early as possible, and a close cooperation between oncologists and fertility specialists over the decision-making process, but there are still several hurdles that doctors and patients face. Currently, ovarian tissue cryopreservation (OTC) is an extremely promising technique still considered experimental; in fact, there is still no clearly defined set of criteria for patient selection, concentration rates of Anti-Muellerian hormone (AMH) and Antral Follicle Count (AFC) may constitute a valid proposal, in light of their correlation with post-chemotherapy ovarian function.
The aims of this project are: identify all critical factors which hinder access to fertility preservation procedures; lay out a set of data related to the management and administration of counselling within healthcare institutions; analyze current orientation of health specialists; gain awareness of the motivations determining a given patient's acceptance or refusal of the treatment; record and analyze AMH rates and AFC in patients undergoing OTC.
The project is set to unfold over 4 distinct phases: preliminary; data collection (analysis of medical records, online delivery of questionnaires to doctors and patients, determination of AMH and AFC); analysis; divulgation.
The study focus on three different stakeholders at the same time and integrates all available information in order to gain a thorough insight of the phenomenon, aimed at improving and streamlining counselling processes within healthcare facilities, enhancing quality of information and identify a workable set of selection criteria for patients eligible for OTC.
The study take into account three different stakeholders at the same time, and integrates all available information thus worked out in order to gain a thorough insight of the phenomenon, and has been conceived to unfold on three different levels: healthcare institutions, doctors and patients, drawing a comparison among three different Italian hospitals at different geographic locations and with varying degrees of patient flows, thus ensuring that specialists and hospital authorities will be provided with the requisite tools needed to gain greater awareness, improve communication and manage in the best way possible such an essential aspect in oncologic patients' therapeutic paths.
One more relevant element is the evaluation of the doctors' attitude towards oncofertility preservation techniques from the standpoint of clinical risk management and possible medical-legal implications. It is in fact important to thoroughly evaluate, for instance, the suitability of informed consent and, through the gathering and simulation of controversial cases, to analyze from a judicial and legal perspective every noteworthy situation, in order to be able to effectively provide interpretation tools into those contentious cases on which the judiciary has not ruled yet, and to support specialists in difficult choices and decision making. It has been well established that women who could rely on effective counselling and have undergone fertility preservation procedures enjoy a better quality of life; this represents an essential aspect nowadays, and deserves to be thoroughly and deeply covered on account of its repercussions on public health.
The information thus gathered may well be valuable on a global scale, in terms of setting up and organizing in the best possible way a network of oncologists and fertility units and ensuring a better allocation of resources.
Lastly, the pursuance of biochemical and ultrasound criteria which may be predictive of a treatment's success could represent an important step towards a better selection of patients eligible for OCT procedures, both in terms of risk-benefit ratios and cost-effectiveness as well.