Developing clinical practice guidelines in paediatric and adolescent oncofertility

Recent international guidelines in child, adolescent, and young adult (CAYA) oncofertility uniformly recommend fertility discussion before cancer treatment, and individualised decision-making for fertility preservation procedures. Yet significant disparities remain across the globe. Various aspects of oncofertility care are in different stages of translation and the boundaries between experimental, innovative and established techniques are not always clear to patients, clinicians and policymakers. This poses barriers for implementation of high-quality care and for the allocation of resources required. International and national guidelines play a key role in promoting equitable care. In 2019, members of the Australian New Zealand Consortium in CAYA Oncofertility (ANZCO) called for national guidelines to standardise care and improve connectedness amongst Australian New Zealand Haematology Oncology Group (ANZCHOG) centres. A clearer understanding of the similarities and differences amongst key guidelines was deemed useful for closing knowledge gaps in the local context and identifying the priorities of key stakeholders with respect to guideline development. This paper provides an overview of CAYA oncofertility guidance from six peak bodies from four continents (Australia, Europe, North America, Asia). A review of recommendations and levels of evidence followed by a Delphi consensus of ANZCO members to develop priority questions is described. ANZCHOG guidelines tailored to the local CAYA context were deemed a high priority, in order to provide a common purpose, direction and governance for providers of paediatric care.