Future Fertility Among Pediatric Cancer Patients: Experiences and Perspectives of Health Workers in a Low Resource Setting

Abstract

PURPOSE While fertility preservation for childhood and adolescent cancer patients is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology healthcare professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. METHODS As part of the Understanding Reproductive Health among Survivors of Pediatric and Young adult (URHSPY) cancers project, we conducted in-depth interviews of healthcare professionals involved in the cancer care of pediatric patients at the Uganda Cancer Institute. Participants were asked about their understanding of fertility preservation for pediatric cancer patients and their perspectives on implementing this care in the institution. This qualitative approach applied ground theory methodology. Interview transcripts were openly coded and analyzed into refined categories and concepts. RESULTS Twelve healthcare professionals were interviewed. Most participants identified as female (n=9). Their role in the medical team varied from nurses (n=6), medical officers (n=3), pediatric oncologists (n=2), and pediatric oncology fellow (n=1). Six themes were noted: (1) Importance of information, (2) Importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. CONCLUSION Although healthcare providers at the Uganda Cancer Institute face contextual barriers to addressing future fertility among pediatric cancer patients, they value the importance of preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.