Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists
Abstract Background Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Medical Ethics |
| Online Access: | http://link.springer.com/article/10.1186/s12910-020-00466-6 |
| _version_ | 1818505566315610112 |
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| author | Aliya Oulaya Affdal Michael Grynberg Laila Hessissen Vardit Ravitsky |
| author_facet | Aliya Oulaya Affdal Michael Grynberg Laila Hessissen Vardit Ravitsky |
| author_sort | Aliya Oulaya Affdal |
| collection | DOAJ |
| description | Abstract Background Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a few options are open to post-pubertal patients, the only immediate option currently open to pre-pubertal girls is cryopreservation of ovarian tissue and subsequent transplantation. The aim of the study was to address a current gap in knowledge regarding the offer of fertility preservation by Ovarian Tissue Cryopreservation (OTC) for prepubescent girls with cancer, and to explore current practices and attitudes of Canadian, French and Moroccan pediatric heme oncologists. The comparative perspective is relevant since legal frameworks surrounding fertility preservation and funding offered by the healthcare system vary greatly. Methods An online survey was sent to the 45 pediatric oncology centers in Canada, France and Morocco. Results A total of 39 centers responded (86.6%). OTC is offered by almost all pediatric heme oncologists in France (98%), very few in Canada (5%), and none in Morocco (0%). For pediatric hematologists/oncologists who do not propose fertility preservation in Canada, the reasons are: the technique is still experimental (54%), it is not available locally (26%) and cost of the technique for the family (14%). 97% of Canadian and 100% of Moroccan pediatric hematologists/oncologists think OTC should be funded by the healthcare system as it is in France and in the province of Quebec in Canada. Conclusions The results of this study show tremendous diversity in the provision of OTC across countries, whereby its offer is correlated with legislation and funding. We argue that the current reality, in which this technology is often not offered to families, raises ethical issues related to justice and equity of access, as well as informed consent and future reproductive autonomy. |
| first_indexed | 2024-12-10T21:52:31Z |
| format | Article |
| id | doaj.art-35b3199c180e47a9b2b8fec0949a7a1f |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-12-10T21:52:31Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-35b3199c180e47a9b2b8fec0949a7a1f2022-12-22T01:32:08ZengBMCBMC Medical Ethics1472-69392020-04-0121111110.1186/s12910-020-00466-6Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologistsAliya Oulaya Affdal0Michael Grynberg1Laila Hessissen2Vardit Ravitsky3Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, University of MontrealDepartment of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Beclere, Clamart, France; Université Paris SaclayPediatric Hematology and Oncology Center, Mohamed V UniversityBioethics Program, Department of Social and Preventive Medicine, School of Public Health, University of MontrealAbstract Background Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a few options are open to post-pubertal patients, the only immediate option currently open to pre-pubertal girls is cryopreservation of ovarian tissue and subsequent transplantation. The aim of the study was to address a current gap in knowledge regarding the offer of fertility preservation by Ovarian Tissue Cryopreservation (OTC) for prepubescent girls with cancer, and to explore current practices and attitudes of Canadian, French and Moroccan pediatric heme oncologists. The comparative perspective is relevant since legal frameworks surrounding fertility preservation and funding offered by the healthcare system vary greatly. Methods An online survey was sent to the 45 pediatric oncology centers in Canada, France and Morocco. Results A total of 39 centers responded (86.6%). OTC is offered by almost all pediatric heme oncologists in France (98%), very few in Canada (5%), and none in Morocco (0%). For pediatric hematologists/oncologists who do not propose fertility preservation in Canada, the reasons are: the technique is still experimental (54%), it is not available locally (26%) and cost of the technique for the family (14%). 97% of Canadian and 100% of Moroccan pediatric hematologists/oncologists think OTC should be funded by the healthcare system as it is in France and in the province of Quebec in Canada. Conclusions The results of this study show tremendous diversity in the provision of OTC across countries, whereby its offer is correlated with legislation and funding. We argue that the current reality, in which this technology is often not offered to families, raises ethical issues related to justice and equity of access, as well as informed consent and future reproductive autonomy.http://link.springer.com/article/10.1186/s12910-020-00466-6 |
| spellingShingle | Aliya Oulaya Affdal Michael Grynberg Laila Hessissen Vardit Ravitsky Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists BMC Medical Ethics |
| title | Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists |
| title_full | Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists |
| title_fullStr | Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists |
| title_full_unstemmed | Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists |
| title_short | Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists |
| title_sort | impact of legislation and public funding on oncofertility a survey of canadian french and moroccan pediatric hematologists oncologists |
| url | http://link.springer.com/article/10.1186/s12910-020-00466-6 |
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