The use of an electronic medical record (EMR) best practice advisory (BPA) to facilitate oncofertility referrals and fertility preservation.

Abstract

e23239 Background: The incidence of young adult (YA) and early onset cancer has increased significantly over the past two decades, necessitating an increase in access to fertility preservation for this patient population. Up to 75% of young cancer survivors are concerned about their future fertility, yet as low as 28% of YA patients report receiving information on fertility risk associated with chemotherapy. We sought to find a widely applicable method to improve fertility discussions and preservation. Methods: At Fox Chase Cancer Center (FCCC), we implemented a BPA through our EMR (Epic) in July 2024. The alert was triggered for any patient under the age of 50, when a provider placed an order for a new chemotherapy or immunotherapy agent. Patients were excluded if they underwent surgical procedures that would lend themselves to be unable to reproduce. The alert would prompt the provider to send a referral to the FCCC Oncofertility team or provide a reason that precluded referral such as medically inappropriate, currently undergoing systemic treatment, no significant risk for infertility or patient refusal. Data was collected through an Epic inquiry collecting data. We compared the number of oncofertility referrals and successful fertility preservation within the first 6 months of BPA implementation to the past 12 years at our center. Results were stratified by gender, race and cancer type. Results: From 2011 to 2023, a median of 13 referrals were made per year with 33% of these patients undergoing fertility preservation. After implementation of the BPA, from 7/1/24 to 1/1/25, the BPA was triggered 333 times, with 66 referrals made (19.8%), representing a 450% increase in the number of referrals over 6 months. 53% of referrals were female, 47% were male. Referrals ranged from 24 to 49 years old, with a median age of 39. The most common referred cancer type for women was breast cancer at 51.43% (n = 18), and for men, it was colorectal, lymphoma, and renal cell carcinoma at 12.90% (n = 4) each. Of the patients not referred, the most common reasons were: on active treatment (n = 76), followed by patient refused (n = 37), and medically inappropriate (n = 35). 14 patients underwent fertility preservation. Conclusions: The implementation of an EMR BPA resulted in a significant increase in referrals to the FCCC Oncofertility program and fertility preservation. This intervention can serve as a model for other institutions to improve provider discussion of the risks of oncologic treatment on fertility, advance patient awareness of preservation options and ultimately increase rates of fertility preservation in YA and early onset patients with cancer. Future directions include promoting fertility discussions as early as possible after initial diagnosis, increasing awareness of the implications of cancer directed therapy on fertility, and increasing access and funding to fertility preservation.