Purpose: The VHA does not have a national directive or set process to address the risks of infertility from cancer treatments and preservation options available to veterans. The goal was to establish guidelines and improve the process in addressing the reproductive health needs for veterans newly diagnosed with cancer.
Methods: A multidisciplinary project charter was established in June 2013 to develop a policy to outline the steps and information needed for a veteran to make informed decisions regarding his or her reproductive health prior to initiation of oncologic therapies. An integrated approach with members from the Cancer Care Program, Women’s Health Clinic, Medical Oncology and Non-VA Care Department was taken. This project included a local and national VHA review of what types of fertility preservation options were covered and/or performed at the VA. A comprehensive review was done to compare what was being provided at other VHA facilities, along with the standard of care in the community. This included a review of existing psychosocial resources available, along with the 2006 American Society of Clinical Oncology Fertility Preservation Guidelines (updated in May 2013). Scope of project also included the development of educational tools for the Veterans and staff regarding reproductive health options.
Results: A Standard Operating Procedure (SOP) was developed to describe the options available to veterans in the event that they desire to minimize fertility risks while receiving cancer-related treatments. The SOP outlines the process for providers to assist veterans in accessing and receiving treatment available for fertility preservation. This policy follows VHA Handbook 1330.01, which includes the reproductive options that are covered under the VA policy. All other options or procedures for the preservation of reproduction not covered by the VA will be the responsibility of the veteran. To support the SOP, additional resources were created to allow for the most seamless referral process limiting any delays to initiation of treatment. This includes an algorithm to guide VHA providers through the decision-making process and applicable referrals; Non-VA Care Reproductive Health consult with designated delegate of authority (Chief of Oncology); and a patient education brochure titled: Cancer and Reproductive Health.
Conclusions: This project highlighted the importance of VHA providers discussing fertility with their reproductive age veterans diagnosed with cancer. The development and implementation of a new SOP, along with new clinical tools and resources has been well received by VHA providers within the Cancer Care Program at the Richard L. Roudebush VAMC in Indianapolis, Indiana. A follow-up project charter has been initiated to now address the reproductive health needs of cancer survivors. The follow-up project should be completed by August 2014 and will be included in the presentation at the AVAHO annual meeting.