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Fertility HAI

About

What is covered

This pathway covers assessment and treatment for people with fertility problems.
It is estimated that infertility affects 1 in 7 heterosexual couples in the UK. Since the original NICE guideline on fertility published in 2004, there has been a small increase in the prevalence of fertility problems, and a greater proportion of people now seeking help for such problems.
The main causes of infertility in the UK are 'unexplained infertility' (no identified male or female cause), ovulatory disorders, tubal damage, factors in the man, and uterine or peritoneal disorders. In about 40% of cases, disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role.
Given the range of causes of fertility problems, the provision of appropriate investigations is critical. These investigations include semen analysis; assessment of ovulation, tubal damage and uterine abnormalities; and screening for infections such as Chlamydia trachomatis and susceptibility to rubella.
Once a diagnosis has been established, treatment falls into 3 main types: medical or surgical treatment to restore fertility and assisted reproduction techniques.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on fertility

Information about the children and young people with cancer quality standard

NICE has also written a document for patients and the public explaining its quality standard for children and young people with cancer.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

26 February 2014 Quality standard on children and young people with cancer added to the pathway.
17 December 2013 Minor maintenance updates.
5 July 2013 Minor maintenance update.

Short Text

Assessment and treatment for people with fertility problems

What is covered

This pathway covers assessment and treatment for people with fertility problems.
It is estimated that infertility affects 1 in 7 heterosexual couples in the UK. Since the original NICE guideline on fertility published in 2004, there has been a small increase in the prevalence of fertility problems, and a greater proportion of people now seeking help for such problems.
The main causes of infertility in the UK are 'unexplained infertility' (no identified male or female cause), ovulatory disorders, tubal damage, factors in the man, and uterine or peritoneal disorders. In about 40% of cases, disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role.
Given the range of causes of fertility problems, the provision of appropriate investigations is critical. These investigations include semen analysis; assessment of ovulation, tubal damage and uterine abnormalities; and screening for infections such as Chlamydia trachomatis and susceptibility to rubella.
Once a diagnosis has been established, treatment falls into 3 main types: medical or surgical treatment to restore fertility and assisted reproduction techniques.

Sources

The NICE guidance that was used to create the pathway.
Fertility. NICE clinical guideline 156 (2013)
Laparoscopic helium plasma coagulation for the treatment of endometriosis. NICE interventional procedure guidance 171 (2006)
Fallopian tube recanalisation by guidewire. NICE interventional procedure guidance 71 (2004)
Falloposcopy with coaxial catheter. NICE interventional procedure guidance 62 (2004)

Quality standards

Children and young people with cancer

These quality statements are taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statements

Multidisciplinary teams for young people

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Young people (aged 16–24 years) with cancer have their diagnosis, treatment and support agreed and delivered by a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team.

Rationale

Children’s services have well-established models of care to ensure that children with cancer are seen by a children’s cancer multidisciplinary team. However, there is variation in access to age-appropriate care for young people. In addition to cancers more commonly found in their own age group, young people can also experience cancers more common to children or adults. It is therefore important for them to be seen by both a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team, to ensure that they have a correct diagnosis and receive the most effective treatment.

Quality measures

Structure
Evidence of local arrangements for all young people (aged 16–24 years) with cancer to have their diagnosis, treatment and support agreed and delivered by a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team.
Data source: Local data collection.
Process
a) The proportion of young people (aged 16–24 years) diagnosed with cancer who have their diagnosis, treatment and support agreed by a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team.
Numerator – the number of people in the denominator who have their diagnosis, treatment and support agreed by a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team.
Denominator – the number of young people (aged 16–24 years) diagnosed with cancer.
Data source: Local data collection.
b) The proportion of young people (aged 16–24 years) with cancer who have their treatment and support delivered by a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team.
Numerator – the number of people in the denominator who have their treatment and support delivered by a cancer-site-specific multidisciplinary team and a teenage and young adult multidisciplinary team.
Denominator – the number of young people (aged 16–24 years) with cancer.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that cancer-site-specific multidisciplinary teams and a teenage and young adult multidisciplinary team are in place to agree and deliver the diagnosis, treatment and support for young people (aged 16–24 years) with cancer.
Health and social care practitioners work collaboratively across cancer-site-specific and teenage and young adult multidisciplinary teams to agree and deliver the diagnosis, treatment and support for young people (aged 16–24 years) with cancer.
Commissioners ensure that they commission cancer services for young people (aged 16–24 years) that include provision of cancer-site-specific multidisciplinary teams and a teenage and young adult multidisciplinary team for young people with cancer.

What the quality statement means for patients, service users and carers

Young people with cancer (aged 16–24 years) have their diagnosis, treatment and support agreed and delivered by a team of experts in the specific type of cancer that they have and a team of experts in treating and supporting young people with cancer.

Source guidance

Definitions of terms used in this quality statement

Teenage and young adult multidisciplinary team
A dedicated multidisciplinary team with expertise in cancer-related issues for teenagers and young adults, and their families and carers. The composition of the multidisciplinary team varies depending on the stage in the care pathway, but may include a:
  • lead oncologist/haematologist with experience in teenage and young adult cancer
  • principal treatment centre lead nurse
  • specialist nurse
  • psychologist or level 3 psychology support
  • young people’s social worker
  • youth worker or activity coordinator
  • teenage and young adult key worker.
[Adapted from Children and young people with cancer: improving outcomes in children and young people with cancer, Multidisciplinary teams: page 92, table 4; and National Cancer Peer Review Programme Manual for cancer services: teenage and young adults cancer measures 11-7D-201 Lead clinician and core team membership]
Cancer-site-specific multidisciplinary team
A dedicated multidisciplinary team with specialist expertise in treating cancer in specific sites. [Adapted from Children and young people with cancer: improving outcomes in children and young people with cancer, Multidisciplinary teams, page 94, paragraph 1]

Access to clinical trials

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Children and young people (aged 0–24 years) with cancer should be offered the opportunity to take part in clinical trials if they are eligible.

Rationale

Involvement of children and young people with cancer in clinical trials has made an important contribution to improved childhood cancer survival rates. Multidisciplinary teams should identify suitable trials for children and young people, and key workers should provide support to the patient and their family in deciding whether to participate. The decision to participate should be an informed choice.

Quality measures

Structure
Evidence of local arrangements to ensure that children and young people (aged 0–24 years) are assessed for eligibility for relevant clinical trials and offered the opportunity to take part.
Data source: Local data collection.
Process
a) The proportion of children and young people (aged 0–24 years) with cancer and eligible for a clinical trial who are offered the opportunity to take part.
Numerator – the number of people in the denominator offered the opportunity to take part.
Denominator – children and young people (aged 0–24 years) with cancer and eligible for a clinical trial.
Data source: Local data collection.
b) The proportion of children and young people (aged 0–24 years) with cancer who are recruited into a clinical trial for which they are eligible.
Numerator – the number of people in the denominator recruited into the clinical trial.
Denominator – the number of children and young people (aged 0–24 years) with cancer and eligible for a clinical trial.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that multidisciplinary teams discuss the eligibility of children and young people (aged 0–24 years) with cancer for relevant clinical trials and promote participation in research and development.
Healthcare professionals from the multidisciplinary teams identify relevant clinical trials for children and young people (aged 0–24 years) with cancer, assess eligibility and offer opportunities to take part.
Commissioners ensure that the cancer services they commission for children and young people (aged 0–24 years) identify relevant clinical trials and support participation.

What the quality statement means for patients, service users and carers

Children and young people with cancer are offered the opportunity to take part in clinical trials (which carry out research into new treatments) that have been identified as suitable for them and are supported to participate in these trials if they want to.

Source guidance

Equality and diversity considerations

When providing support for children and young people to access clinical trials any potential difficulties in participation, which may include distance, disability and financial barriers, should be taken into account.

Electronic prescribing of chemotherapy

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Children and young people (aged 0–24 years) receiving chemotherapy have it prescribed using an electronic prescribing system.

Rationale

There are a number of risks associated with prescribing and administering chemotherapy. Electronic prescribing of chemotherapy should be used in all settings to help reduce the risks. However, at present it is widely used in adult cancer care but not available in all children’s chemotherapy services. Chemotherapy regimens for children and young people are varied and often very complex, and there is a high risk of error in calculating the correct doses, fluid volumes and scheduling. Drug dose and fluid volume calculations are based on weight and body surface area. Electronic prescribing systems perform the calculations and support safer prescribing.

Quality measures

Structure
Evidence of local arrangements to ensure that all children and young people (aged 0–24 years) receiving chemotherapy have it prescribed using an electronic prescribing system.
Data source: Local data collection. National Cancer Peer Review Programme Manual for cancer services: children’s cancer measures: 11-7B-161 Computer generated prescriptions.
Outcome
The number of patient safety incidents in children and young people (aged 0–24 years) related to chemotherapy prescriptions.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that an electronic prescribing system is in place for children and young people (aged 0–24 years) receiving chemotherapy.
Healthcare professionals use electronic prescribing systems for prescribing chemotherapy regimens for children and young people (aged 0–24 years).
Commissioners work with service providers to ensure that children and young people (aged 0–24 years) receiving chemotherapy have it prescribed using an electronic prescribing system.

What the quality statement means for patients, service users and carers

Children and young people with cancer receiving chemotherapy have the correct amount of drugs and fluids, and when to have them, calculated by a computer-based prescribing system.

Source guidance

Definitions of terms used in this quality statement

Electronic prescribing system
A computer package that calculates the correct chemotherapy doses, fluids and scheduling for each child and young person based on previously entered and verified data. The system should be suitable for use with paediatric chemotherapy regimens. [Expert opinion]

Psychological and social support

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Children and young people (aged 0–24 years) with cancer, and their families and carers, have their psychological and social needs assessed at key points in their care pathway and receive support based on their identified needs.

Rationale

The impact of a diagnosis of cancer, its prognosis and its treatment can be devastating and wide-ranging for children and young people, and their families and carers. As the child or young person progresses through their care pathway, their psychological and social needs, and those of their family, are likely to change. To help address this, their psychological and social support needs should be reassessed at key points to inform their care plan and to assess the need for specialist services such as psychologists.

Quality measures

Structure
a) Evidence of local arrangements to ensure that children and young people (aged 0–24 years) with cancer, and their families and carers, have their psychological and social needs assessed at key points on their care pathway.
Data source: National Cancer Peer Review Programme Manual for cancer services: children’s cancer measures: 11-7B-322 PTC psychosocial assessment guidelines.
b) Evidence of local arrangements to ensure that children and young people (aged 0–24 years) with cancer, and their families and carers, can access services delivering psychological and social support.
Data source: National Cancer Peer Review Programme Manual for cancer services: children’s cancer measures: 11-7B-322 PTC psychosocial assessment guidelines.
Process
a) The proportion of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway who have their psychological and social needs assessed.
Numerator – the number of people in the denominator who have their psychological and social needs assessed.
Denominator – the number of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway.
Data source: Local data collection.
b) The proportion of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway whose family and carers have their psychological and social needs assessed.
Numerator – the number of people in the denominator whose family and carers have their psychological and social needs assessed.
Denominator – the number of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway.
Data source: Local data collection.
c) The proportion of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway who receive support with identified psychological or social needs.
Numerator – the number of people in the denominator receiving psychological or social support.
Denominator – the number of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway with identified psychological or social needs.
Data source: Local data collection.
d) The proportion of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway whose family and carers receive support with identified psychological and social needs.
Numerator – the number of people in the denominator receiving psychological or social support.
Denominator – the number of children and young people (aged 0–24 years) with cancer reaching a key point in their care pathway whose family and carers have identified psychological or social needs.
Data source: Local data collection.
Outcome
Children and young people with cancer, and their families and carers, feel supported during their care.
Data source: Local data collection. National Cancer Peer Review Programme Manual for cancer services: teenage and young adults measures: 11-7D-210 TYA cancer measures patient experience exercise.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that the psychological and social needs of children and young people (aged 0–24 years) with cancer, and their families and carers, are assessed at key points in their care pathway, and that protocols are in place for referral to the appropriate specialists, such as psychologists.
Health and social care practitioners carry out psychological and social needs assessments for children and young people (aged 0–24 years) with cancer, and their families and carers, at key points in their care pathway, and use the results to inform the care plan and offer appropriate specialist support.
Commissioners ensure that they commission services that assess the psychological and social needs of children and young people (aged 0–24 years), and their families and carers, at key points in their care pathway. They should commission services to provide specialist psychological and social support to children and young people with cancer, and their families and carers.

What the quality statement means for patients, service users and carers

Children and young people with cancer, and their families and carers, have their psychological and social needs assessed at different stages during and after their treatment. These assessments should result in a care plan that can be used to get extra help and support if they need it.

Source guidance

Definitions of terms used in this quality statement

Psychological and social needs assessment
An assessment of psychological and social support needs that includes:
  • patient information needs and coping skills that are age-appropriate
  • family information needs and coping skills
  • financial support
  • practical support
  • social and cultural circumstances
  • educational and employment needs
  • the needs of siblings
  • relationships with peers
  • spiritual needs.
The assessment should result in a care plan to meet the identified needs, agreed with the child or young person, and their family or carers. [Expert opinion and adapted from Children and young people with cancer: improving outcomes in children and young people with cancer. Psychosocial care: page 74, paragraph 4]
Key points in their care pathway
The key points in a care pathway when psychological and social needs should be assessed are:
  • at diagnosis
  • during treatment
  • at the end of treatment
  • during long-term follow-up
  • at relapse
  • during palliative care
  • following bereavement (for families and carers).
Psychological and social support
Psychological and social support is the supportive care received by a child or young person and their family or carers during active cancer therapy and long-term follow-up, and it may include respite care, palliative care and bereavement counselling for families and carers. Psychological or social support may help with:
  • how the child or young person perceives the challenge of the disease, its symptoms and the side effects of treatment
  • problems experienced by the child or young person with body image, relationships with peers and potential partners, difficulties with schooling and other education, or difficulties with employment
  • the disruption of the normal transition for young people from dependence on their family to independence
  • the shock and grief a family experiences when a member of the family has a life-threatening illness.

Equality and diversity considerations

When providing psychological and social support for children and young people with cancer, any potential difficulties in accessing services, which may include distance, disability and financial barriers, should be taken into account.

Neuro-rehabilitation

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Children and young people (aged 0–24 years) who have had a central nervous system malignancy receive a specialist neuro-rehabilitation care package.

Rationale

All children and young people who have had cancer are likely to need some form of rehabilitation. Many children and young people who have had cancer affecting their central nervous system (such as brain tumours) are likely to need complex rehabilitation over a long period of time (for the rest of their lives for some people). Access to skilled neuro-rehabilitation can make a significant difference, enabling children and young people to become independent adults and reducing the need for ongoing complex care packages.

Quality measures

Structure
Evidence of local arrangements to ensure that all children and young people (aged 0–24 years) who have had a central nervous system malignancy receive a specialist neuro-rehabilitation care package.
Data source: Local data collection.
Process
The proportion of children and young people (aged 0–24 years) who have had treatment for a central nervous system malignancy who receive a specialist neuro-rehabilitation care package.
Numerator – the number of people in the denominator receiving a specialist neuro-rehabilitation care package.
Denominator – the number of children and young people (aged 0–24 years) who have had treatment for a central nervous system malignancy.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that specialist neuro-rehabilitation care packages are available for children and young people (aged 0–24 years) who have had a central nervous system malignancy.
Healthcare professionals ensure that children and young people (aged 0–24 years) who have had a central nervous system malignancy receive a specialist neuro-rehabilitation care package.
Commissioners ensure that they commission services that provide specialist neuro-rehabilitation care packages for children and young people (aged 0–24 years) who have had central nervous system malignancy.

What the quality statement means for patients, service users and carers

Children and young people who have had cancer of the central nervous system (such as a brain tumour) are supported by a team of specialists to help them recover as fully as possible (called neuro-rehabilitation).

Source guidance

Definitions of terms used in this quality statement

Specialist neuro-rehabilitation care package
A package of support that takes into account the effects of the cancer and treatment on neurological, physical, psychological and academic function, recognising that these effects can become more evident over time. The specialist team should cover but not be limited to: speech and language therapy, physiotherapy, occupational therapy, neurology and psychology (including neuropsychology). The rehabilitation programme should continue for as long as it is needed and can make a difference. [Adapted from Children and young people with cancer: improving outcomes in children and young people with cancer. Rehabilitation: page 68, paragraph 6]

Equality and diversity considerations

When providing neuro-rehabilitation services for children and young people with cancer, any potential difficulties in accessing services, which may include distance, disability and financial barriers, should be taken into account.

Follow-up and monitoring of late effects

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Children and young people (aged 0–24 years) who have been treated for cancer have an end-of-treatment summary and care plan that includes agreed follow-up and monitoring arrangements.

Rationale

Children and young people who have had cancer are at risk of long-term adverse effects from the cancer and its treatment. At the end of their treatment they should be provided with verbal and written information about the long-term risks of their cancer and treatment, and the arrangements for monitoring and identifying potential problems and treating them as quickly as possible.

Quality measures

Structure
Evidence of local arrangements to ensure that children and young people (aged 0–24 years) who have been treated for cancer have an end-of-treatment summary and care plan that includes agreed follow-up and monitoring arrangements.
Data source: Local data collection.
Process
a) The proportion of children and young people (aged 0–24 years) completing treatment for cancer who have an end-of-treatment summary and care plan.
Numerator – the number of people in the denominator who have an end-of-treatment summary and care plan.
Denominator – the number of children and young people (aged 0–24 years) completing treatment for cancer.
b) The proportion of children and young people (aged 0–24 years) treated for cancer who have their end-of-treatment summary and care plan reviewed 5 years after the end of their initial treatment.
Numerator – the number of people in the denominator who have their end-of-treatment summary and care plan reviewed 5 years after the end of their initial treatment.
Denominator – the number of children and young people (aged 0–24 years) treated for cancer with an end-of-treatment summary and care plan.
Data source: a), b) Local data collection and National Cancer Peer Review Programme Manual for cancer services: children’s cancer measures: 11-7B-211 Follow up and care planning decision, and 1-7B-212 Late effects MDT follow up and long term sequelae protocol.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that services and systems are in place for children and young people (aged 0–24 years) who have been treated for cancer to have an end-of-treatment summary and care plan that includes agreed follow-up and monitoring arrangements.
Healthcare professionals ensure that children and young people (aged 0–24 years) who have been treated for cancer have an end-of-treatment summary and care plan that includes agreed follow-up and monitoring arrangements, and ensure that the plan is reviewed 5 years after the end of initial treatment.
Commissioners ensure that they commission services that provide children and young people (aged 0–24 years) who have been treated for cancer with an end-of-treatment summary and care plan that includes agreed follow-up and monitoring arrangements. This should include commissioning services with long-term follow-up clinics to deliver the agreed care plan.

What the quality statement means for patients, service users and carers

Children and young people who have had treatment for cancer should have a care plan developed at the end of their treatment. This plan should include the treatment they have received, possible problems that they may experience, details of future appointments that have been agreed, how checks for possible problems should be carried out and who to contact if they have any concerns after their treatment.

Source guidance

Definitions of terms used in this quality statement

End-of-treatment summary and care plan
A plan that should include details of:
  • treatment, including chemotherapeutic agents and their cumulative doses, radiotherapy and surgery
  • existing or potential late effects associated with the cancer or treatment
  • agreed follow-up, including where and with whom
  • monitoring for:
    • relapse or recurrence
    • immediate and late effects of treatment
    • risk of second malignancy.
As a minimum, the care plan should be available and revised at:
  • the end of treatment
  • entry into long-term follow-up (usually 5 years after completing therapy) and
  • discharge from formal follow-up by the oncologist or the long-term follow-up clinic.
The care plan should also be used by key workers to support transition from children’s services to young people’s services and from young people’s services to adult services. [Expert opinion]

Fertility support

This quality statement is taken from the children and young people with cancer quality standard. The quality standard defines clinical best practice in cancer services for children and young people and should be read in full.

Quality statement

Children and young people (aged 0–24 years) with cancer are assessed for potential future fertility problems and advised about their options for fertility preservation before treatment is started.

Rationale

The late effects of cancer treatment are well-recognised and involve most organ systems. Approximately 15% of patients have a high risk of future fertility problems because of their cancer treatment. Children and young people with cancer and their parents or carers should have the risks discussed with them and be advised about their options for fertility preservation before cancer treatment starts.

Quality measures

Structure
Evidence of local arrangements to ensure that children and young people (0–24 years) with cancer are assessed for potential future fertility problems and advised about their options for fertility preservation before treatment is started.
Data source: Local data collection.
Process
The proportion of children and young people (aged 0–24 years) with cancer who are assessed for potential future fertility problems and advised about their options for fertility preservation before treatment is started.
Numerator – the number of people in the denominator who are assessed for potential future fertility problems before treatment and are advised about their options for fertility preservation.
Denominator – the number of children and young people (aged 0–24 years) diagnosed with cancer.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that processes are in place for children and young people (aged 0–24 years) with cancer to be assessed for potential future fertility problems and advised about their options for fertility preservation before treatment for cancer is started.
Healthcare professionals ensure that children and young people (aged 0–24 years) with cancer are assessed for potential future fertility problems before treatment for cancer is started and are advised about their options for fertility preservation.
Commissioners ensure they commission services that assess children and young people (aged 0–24 years) with cancer for potential future fertility problems before they start cancer treatment and advise them about their options for fertility preservation.

What the quality statement means for patients, service users and carers

Children and young people with cancer have the risk of future fertility problems caused by their cancer or its treatment assessed before their treatment is started, and are given advice about their options for freezing some sperm, eggs or embryos for use at a later date (called cryopreservation).

Source guidance

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on fertility

Information about the children and young people with cancer quality standard

NICE has also written a document for patients and the public explaining its quality standard for children and young people with cancer.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

26 February 2014 Quality standard on children and young people with cancer added to the pathway.
17 December 2013 Minor maintenance updates.
5 July 2013 Minor maintenance update.

Supporting information

Glossary

Treatments designed to lead to conception by means other than sexual intercourse.
Body mass index
A formal approach that encourages conception through unprotected vaginal intercourse. It involves supportively offering an individual or couple information and advice about the regularity and timing of intercourse and any lifestyle changes which might improve their chances of conceiving. It does not involve active clinical or therapeutic interventions.
A full cycle of IVF treatment, with or without ICSI comprises 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s).
Intracytoplasmic sperm injection
In vitro fertilisation
Defined for the purposes of this pathway as meaning when 2 or more semen analyses have 1 or more variables below the 5th centile (as defined by the WHO, 2010). The effect on the chance of pregnancy occurring naturally through vaginal intercourse within 2 years would then be similar to people with unexplained infertility or mild endometriosis.
An IVF procedure in which one or more oocytes are collected from the ovaries during a spontaneous menstrual cycle without the use of drugs.
World Health Organization Group I ovulation disorders are classified as hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
World Health Organization Group II ovulation disorders are classified as hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome).

Paths in this pathway

Pathway created: February 2013 Last updated: February 2014

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