Fertility in male medulloblastoma survivors: closing the gaps in counseling

Leena Nahata,1 Richard N Yu,2 Ian P Dumont,3,4 Peter E Manley,3,4 Laurie E Cohen1,3,4 1Division of Endocrinology, 2Department of Urology, Department of Medicine, Boston Children's Hospital, 3Division of Hematology/Oncology, Department of Medicine, Boston Children's Hospital, 4Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Background: Pediatric medulloblastoma patients have high survival rates and are at risk for treatment-related sequelae, including infertility, emphasizing the need for fertility counseling. This cohort is less likely to pursue higher education, marry, and live independently, which may impact fertility counseling. Our goal was to explore fertility-related concerns in medulloblastoma survivors and counseling practices among providers. Methods: This study was performed at the Dana-Farber/Children's Hospital Cancer Center in Boston, Massachusetts. Surveys were administered to male pediatric medulloblastoma survivors aged 18 years and older and pediatric neuro-oncology practitioners. Medical records were reviewed to determine treatment protocols and documentation of fertility counseling. Data analysis was descriptive. Results: Fourteen male medulloblastoma survivors and six neuro-oncology practitioners completed the study. All patients had received central nervous system irradiation and adjuvant chemotherapy with at least one alkylating agent. Five (83%) practitioners stated that they discussed fertility with all survivors at most visits. Eight (57%) medulloblastoma survivors stated that they had received fertility counseling at initial diagnosis. Six (43%) stated that fertility had been discussed since treatment had ended. The majority (>70%) of survivors reported a desire to have children and were open to learning more about their fertility status. Fertility counseling was documented in survivorship visits in only 46% of subjects. Conclusion: Most of our subjects had no documented fertility-related discussions after completing treatment and could not recall any ...