OncOlOgy nursing FOrum – vOl 35, nO 2, 2008
survival rate for pediatric patients has improved dramatically
in recent decades, with more than 79% of patients surviving
(nci). Pediatric cancer researchers have begun to focus on
issues such as long-term morbidity and quality of life in sur-
vivors (Oeffinger et al, 2006; Wallace, Anderson, & irvine,
2005). infertility is one of the possible side effects of cancer
treatments, such as chemotherapy and radiation, that has the
potential to affect quality of life (meirow, 2000; Wallace et
ccording to the national cancer institute ([nci],
2008), 10,400 children were diagnosed with cancer
in 2007. childhood cancer is relatively rare and the
Trends in Clinical Practice and Nurses’
Attitudes About Fertility Preservation
for Pediatric Patients With Cancer
Heather Clayton, MPH, Gwendolyn P. Quinn, PhD, Ji-Hyun Lee, DrPH, Lindsey M. King, MPH,
Cheryl A. Miree, MS, Michael Nieder, MD, and Susan T. Vadaparampil, PhD
Purpose/Objectives: To examine trends in fertility preservation at-
titudes and behaviors of pediatric oncology nurses and evaluate their
awareness of fertility preservation guidelines published in June 2006 by
the American Society of Clinical Oncology (ASCO).
Design: Cross-sectional surveys conducted in 2005 and 2006.
Setting: Annual meetings of the Florida Association of Pediatric
Sample: 115 pediatric oncology nurses in 2005 and 95 nurses in
Methods: A 45-item survey was distributed to conference attendees.
Main Research Variables: Knowledge, current fertility preservation
practices, and awareness of fertility preservation guidelines.
Findings: Nurses’ attitudes about fertility preservation discussions with
patients did not change during the survey period; however, the number of
nurses believing that one of their duties was to discuss fertility preservation
with patients decreased from 91% in 2005 to 81% in 2006. Nurses’ likeli-
hood to discuss fertility preservation with patients with specific characteris-
tics significantly changed over time. Fertility preservation discussions were
just as likely for single patients as they were for those married or recently
engaged, although nurses were more likely to discuss fertility preservation
with patients who had at least one child or who had a poor prognosis.
Nurses’ awareness of ASCO guidelines was less than 5%.
Conclusions: A majority of nurses perceive that fertility preservation
options should be offered to patients. However, practice and patient fam-
ily barriers exist that may impede discussion. Attitudes and behaviors
will be monitored with the 2006 ASCO guidelines.
Implications for Nursing: Nurses play a key role in survivorship dis-
cussions for pediatric patients with cancer and their families. Increased
knowledge of fertility preservation guidelines may help promote the
fertility preservation concept and lead to improved dissemination and
implementation of training programs that focus on current ASCO fertility
preservation guidelines and address the psychosocial needs of children
aged 12–16 years.
Key Points . . .
➤ The survival rate for pediatric patients with cancer has im-
proved in recent decades and the focus of patient care has
shifted to quality of life for survivors.
➤ A potential side effect of cancer treatment is infertility, a factor
that affects quality of life in survivors.
➤ A few fertility preservation options exist for pediatric patients,
but available methods must be initiated prior to cancer treatment
(chemotherapy or radiation).
➤ Fertility preservation guidelines do not fully address the psycho-
social needs of patients younger than age 18.
Heather Clayton, MPH, is a research intern at Moffitt Cancer Cen-
ter and Research Institute and a doctoral student in the Department
of Community and Family Health in the College of Public Health
at the University of South Florida, both in Tampa; Gwendolyn P.
Quinn, PhD, is an associate professor and Ji-Hyun Lee, DrPH, is
an assistant professor, both at Moffitt Cancer Center and Research
Institute and in the Department of Interdisciplinary Oncology in
the College of Medicine at the University of South Florida; Lindsey
M. King, MPH, and Cheryl A. Miree, MS, are research associates
at Moffitt Cancer Center and Research Institute; Michael Nieder,
MD, is the director of the Bone and Marrow Transplant Program
at All Children’s Hospital in St. Petersburg, FL; and Susan T.
Vadaparampil, PhD, is an assistant professor at Moffitt Cancer
Center and Research Institute and in the Department of Interdis-
ciplinary Oncology in the College of Medicine at the University
of South Florida. (Submitted July 2007. Accepted for publication
September 6, 2007.)
Digital Object Identifier: 10.1188/08.ONF.249-255
Precise data about which patients may experience infertility
or sterility are not available because factors, such as the type of
cancer treatment and age of the patient, have differing effects
on fertility (Brougham & Wallace, 2005; rueffer et al., 2001;
simon, lee, Partridge, & runowicz, 2005). For example, young
girls undergoing cancer treatment may experience damage to
the ovaries or uterus (Brougham & Wallace; Thomson, critch-
ley, Kelnar, & Wallace, 2002), whereas irradiation can impair
spermatogenesis in young boys (Brougham & Wallace). several
chemotherapy agents are known to cause gonadal damage,