Oncofertility counselling station — communication and decision-making

Communication and decision-making station in oncofertility: tests shared decision-making under time pressure, evidence-based counselling on oocyte cryopreservation with the letrozole protocol, honest prognostication using age-stratified outcomes, and consent for storage and disposition. Includes assessor key and marking domains.

Prompt

A 34-year-old single woman is referred urgently with a new diagnosis of oestrogen-receptor-positive breast cancer. Cyclophosphamide-containing chemotherapy is to start in two weeks. She is an only child, has no partner, and tells you her mother underwent an early menopause at 38. She is frightened of the cancer and frightened of losing her fertility. You are the reproductive medicine registrar running the oncofertility consult.

Station brief

Format. Communication and decision-making station, approximately 12 minutes. You are the reproductive medicine registrar. The assessor plays the patient; a second examiner scores. You have the referral, the AMH and antral follicle count, and the oncology timeline.^[1]

Candidate instruction. Conduct the oncofertility consultation: establish rapport under time pressure, share the decision on strategy, explain the stimulation protocol and its oncological safety, give an honest prognosis, and obtain consent for storage and disposition. Verbalise your reasoning and your checks.^[1]^[2]

References6Show

[1]Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines Ann Oncol, 2020.PMID 32976936
[2]Oktay K, Harvey BE, Partridge AH, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update J Clin Oncol, 2018.PMID 29620997
[3]Cobo A, García-Velasco JA, Coello A, et al. Oocyte vitrification as an efficient option for elective fertility preservation Fertil Steril, 2016.PMID 26688429
[4]Kim J, Turan V, Oktay K Long-Term Safety of Letrozole and Gonadotropin Stimulation for Fertility Preservation in Women With Breast Cancer J Clin Endocrinol Metab, 2016.PMID 26751194
[5]Oktay K, Buyuk E, Libertella N, et al. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation J Clin Oncol, 2005.PMID 15824416
[6]Lambertini M, Moore HCF, Leonard RCF, et al. Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer: A Systematic Review and Meta-Analysis of Individual Patient-Level Data J Clin Oncol, 2018.PMID 29718793

Oncofertility counselling station — communication and decision-making

Station brief

References6Show

[1]Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines Ann Oncol, 2020.PMID 32976936
[2]Oktay K, Harvey BE, Partridge AH, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update J Clin Oncol, 2018.PMID 29620997
[3]Cobo A, García-Velasco JA, Coello A, et al. Oocyte vitrification as an efficient option for elective fertility preservation Fertil Steril, 2016.PMID 26688429
[4]Kim J, Turan V, Oktay K Long-Term Safety of Letrozole and Gonadotropin Stimulation for Fertility Preservation in Women With Breast Cancer J Clin Endocrinol Metab, 2016.PMID 26751194
[5]Oktay K, Buyuk E, Libertella N, et al. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation J Clin Oncol, 2005.PMID 15824416
[6]Lambertini M, Moore HCF, Leonard RCF, et al. Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer: A Systematic Review and Meta-Analysis of Individual Patient-Level Data J Clin Oncol, 2018.PMID 29718793