Real world experience of fertility preservation in adolescents with Hodgkin lymphoma in India
Bibliographic record
Abstract
Background: Cure rates for Hodgkin lymphoma are high and the focus is now on minimizing long-term morbidities like infertility.The InPOG-HL-15-01 enrolled 396 patients (of which 99 were G€ e Ñ 13 years of age) from 27 centers.Of these adolescent patients, 7.4% were offered fertility preservation (FP) and 2.1% successfully achieved FP.We wanted to understand better the barriers that impact healthcare provider decision-making for FP in this context.Methods: The investigators of each of the participating hospitals were contacted and were provided with two hypothetical scenarios.The scenarios consisted of a 16-year-old adolescent (one scenario with male gender and one with female gender) with Stage IIIB Hodgkin lymphoma who would receive 6 cycles of ABVD (+/-) radiotherapy depending upon the response) as per the InPOG-HL-15-01 protocol.The investigators were asked to rank eight barriers in their setting to achieving FP prior to commencing treatment.Results: 24 of the 27 centers responded (14 public/trust hospitals, 10 private).Affordability followed by accessibility ranked as the two most important barriers for FP in public/trust hospitals for either of the scenarios (see table ).In private hospitals, cultural acceptance of FP (in the male scenario) and the time involved for FP (in the female scenario) were the most important barriers.While affordability remained an important barrier, accessibility was not ranked highly in private hospitals.Apprehension of family abandoning treatment as well as the inadequacy of knowledge/experience in FP did not rank high as barriers in any of the settings.Conclusions: Barriers to FP in adolescent patients with Hodgkin lymphoma vary by healthcare setting and gender.Innovative solutions involving public-private partnerships and leveraging other stakeholders can be developed for addressing the affordability and accessibility of FP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".