Time to chemotherapy and oncofertility counseling in pediatric hematology/oncology patients: a single-center retrospective review.

Background: The American Society of Reproductive Medicine and American Society of Clinical Oncology emphasize the importance of oncofertility counseling in pediatric cancer patients. Survivors often report inadequate attention to this crucial aspect of care. Balancing timely treatment initiation with oncofertility counseling presents challenges, including cost, age at diagnosis, information overload, and time constraints. Procedures: We performed chart abstraction of 265 pediatric patients diagnosed at the University of Rochester Medical Center (January 1, 2015-May 31, 2022). Hematologic malignancies made up 37.65% of the population. Median age was 7, with male predominance (56.2%). The majority of patients were Caucasian (80.7%). Results: Only 12.5% of the population had an oncofertility visit with reproductive endocrinology or urology and 42.4% had documented counseling with their oncology team. Sexual health was discussed in 2.6% of patients, and 12.1% of patients had documented Tanner staging. Hematologic malignancy patients had a lower time to systemic therapy (4.2 days) compared to extracranial solid tumors (14.8 days) and CNS tumors (97.8 days) when outliers were removed. Longer time to systemic therapy trended toward significance for oncofertility visits, and there was no statistical difference in oncofertility visits or primary team counseling rates based on disease severity. Conclusions: The time before chemotherapy initiation is a unique barrier to oncofertility counseling for pediatric patients with malignancy. While some patients will have retained fertility on current front-line protocols, patients with a high risk of relapse will receive therapy more likely to threaten fertility. The results of this study indicate that targeted intervention prior to relapse for this population may be a feasible approach.