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Improving Fertility Discussions and Decision-Making for Adolescent Males With Cancer

Improving Fertility Discussions and Decision-Making for Adolescent Males With Cancer 1024 683 Pam Georgiana

 A pilot study shows promise in enhancing shared decision-making and patient satisfaction through family-centered support.

Fertility preservation is a critical yet underutilized aspect of cancer care for adolescent males. Despite being a medically low-risk and effective option, only a minority of young patients attempt sperm banking. Barriers exist at both the system and individual/family levels, and many institutions lack structured clinical approaches to support timely decision-making.

To address these barriers, Leena Nahata, MD, pediatric endocrinologist, medical director of the Fertility and Reproductive Health Program and principal investigator in the Center for Biobehavioral Health at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, led a pilot study of a novel intervention called Fertility Preservation Discussions And Decisions (FP-DAD). This family-centered model incorporates the Family-centered Adolescent Sperm banking values clarification Tool (FAST © 2020, Nationwide Children’s Hospital) and interventionist-led discussions. Results were recently published in Pediatric Blood Cancer.

“Despite published guidelines recommending fertility counseling, the consult is typically focused on risks and fertility preservation logistics. Families often navigate discussions and decisions on their own,” says Dr. Nahata, who is also a professor of Clinical Pediatrics at The Ohio State University College of Medicine. “We need structured tools that help families bridge that gap and facilitate these important conversations.”

The study enrolled 21 adolescents and 32 caregivers at Nationwide Children’s between January 2021 and January 2024. Participants were randomly assigned to either standard of care fertility counseling or standard of care fertility counseling and the FP-DAD intervention. The FP-DAD intervention involved completing the FAST and using the results to have a structured discussion with a trained facilitator. Grounded in the Health Belief Model, the FAST helps families identify and discuss perceived benefits and barriers to sperm banking.

Although COVID-19 and the burden of a new cancer diagnosis posed challenges to recruitment for this study, the FP-DAD intervention demonstrated high acceptability (88% to 100%). Sperm banking rates were high across both groups (67% standard of care vs. 82% FP-DAD). Those who attempted banking reported higher decision quality in specific domains. Comparing the FP-DAD intervention to those in the control group, researchers observed medium to large effect sizes in four of six decision quality domains for adolescents and two of six for caregivers.

“These effect sizes are meaningful and suggest emerging efficacy, particularly given the small sample size and the high overall rate of banking,” says Dr. Nahata.

Male adolescents often have just 24 to 48 hours between diagnosis and the start of treatment to make sperm banking decisions.

“This narrow window, combined with the shock of a cancer diagnosis and the challenging subject matter for some families, makes effective communication and decision-making support crucial,” Dr. Nahata explains.

While the interventionist-guided format can be helpful for some families, it also poses feasibility and scalability challenges. As a result, Dr. Nahata’s research team is developing a web-based version of the FAST that families can access via a QR code. The tool generates a tailored summary report based on participant responses to support family-centered discussions during and after oncofertility counseling. The next phase of research will test the feasibility and effectiveness of this version across multiple clinical sites with a variety of resource levels.

“Our goal is to make fertility-related conversations easier and more effective for families without adding burden to care teams,” says Dr. Nahata. “This approach could ensure every adolescent has the opportunity to make an informed, family-supported fertility preservation decision before starting cancer treatment.”

References:

  1. El Alaoui-Lasmaili K, Nguyen-Thi PL, Demogeot N, Lighezzolo-Alnot J, Gross MJ, Mansuy L, Chastagner P, Koscinski I. Fertility discussions and concerns in childhood cancer survivors, a systematic review for updated practice. Cancer Medicine. 2023 Mar;12(5):6023-6039.
  2. Nahata L, Roche CI, Griffith MM, Karkare T, Quinn GP, O’Brien SH, Boone K, Audino A, Yeager N, Whiteside S, English J, Klosky JL, Rausch JR, Gerhardt CA. Fertility preservation discussions and decisions: results from a pilot randomized controlled trial among adolescent males with cancer. Pediatric Blood and Cancer. 2025 Aug;72(8):e31795.

 

Image credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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