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Yoshida K, Hashimoto T, Koizumi T, Suzuki N. Psychosocial experiences regarding potential fertility loss and pregnancy failure after treatment in cancer survivors of reproductive age to identify psychosocial care needs: a systematic review. Support Care Cancer 2024; 32:337. [PMID: 38727728 DOI: 10.1007/s00520-024-08544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/03/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The challenges of fertility loss owing to cancer treatment persist long after treatment. However, psychosocial care for fertility among cancer survivors who have completed cancer treatment is insufficient. This systematic review examined psychosocial experiences related to the potential loss of fertility and unsuccessful pregnancy after treatment in cancer survivors of reproductive age to identify psychosocial care needs. METHODS A systematic review was conducted using the online databases PubMed, Cochrane Library, PsycINFO, CINAHL, and Ichushi-Web between August and December 2022 to identify studies that addressed psychosocial experiences after fertility loss or failure to conceive among young cancer survivors. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS Forty studies were included, revealing psychosocial experiences across five categories: subjective fear of (potential) fertility loss, impact on romantic relationships, alternative methods for family building, reliance on social support, and specialized care. Only one study addressed the psychosocial aspects after complete loss of fertility in young cancer survivors. CONCLUSIONS The possibility and uncertainty of fertility loss led to stress and depression, loss of identity, decreased opportunities to meet a new partner, and damaged relationships established before diagnosis. The needs encompass fertility preservation, sexuality, approaches to building a family, partner communication, and other diverse needs.
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Affiliation(s)
- Kanako Yoshida
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo, Tokyo, Japan.
| | - Tomoko Hashimoto
- Division of Integrated Medicine, IVF Namba Clinic, 1-17-28 Minamihorie Nishi-Ku, Osaka, Japan
| | - Tomoe Koizumi
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, Japan
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Yoshida K, Matsui Y. An Examination of the Association Between Psychosocial Aspects of Fertility Issues and Demographic Characteristics of Unmarried Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2024; 13:293-299. [PMID: 37902972 DOI: 10.1089/jayao.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Purpose: The purpose of this study was to examine the association between fertility issues and demographic characteristics of unmarried adolescent and young adult cancer survivors. Methods: We conducted a survey among cancer survivors who were 15-39 years old and unmarried at the time of cancer diagnosis and 20-45 years old at the time of the survey. Views on fertility issues, originally developed based on the results of a qualitative study conducted with the same inclusion criteria, were used to assess thoughts and feelings regarding fertility issues. Results: Through exploratory factor analysis of the 128 respondents who either had children or desired children, two factors related to fertility issues were identified: "anxiety related to the possibility of not being able to have children" and "pressure from others to have children." Multiple regression analysis was performed to examine the association between these factors and demographic characteristics. The analysis revealed that being male and having a partner were significant predictors for both factors for views on fertility issues. Additionally, younger age at the time of diagnosis was a significant predictor for the first factor. Conclusions: Greater fertility issues among unmarried cancer survivors were associated with younger age at diagnosis, having a partner, and being male. Surprisingly, contrary to previous findings, male cancer survivors experienced more significant fertility problems than women. This result may be attributed to the well-established gender roles in Japan, where men are predominantly considered the heirs and inheritors of the family.
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Affiliation(s)
- Kanako Yoshida
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yutaka Matsui
- Institute of Human Sciences, University of Tsukuba, Tokyo, Japan
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Boedeker D, Hunkler K, Pekny C, Watson N, Yamasaki M, Drayer S, Spitzer T. Assessing Knowledge, Counseling, and Referral Patterns Regarding Fertility Preservation Before Gonadotoxic Treatments Among Physicians in the Military Health System. J Adolesc Young Adult Oncol 2024. [PMID: 38451721 DOI: 10.1089/jayao.2023.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Purpose: We sought to evaluate physicians' baseline knowledge of fertility preservation services available to patients with a cancer diagnosis within the military health system (MHS). Methods: Data on current cancer prevalence of over 31,000 unique cancer diagnoses were obtained from a comprehensive nationwide MHS dataset. Additionally, a 22-item survey was distributed to physicians practicing within the MHS assessing knowledge of reproductive health benefits, oncofertility counseling practices, and subspecialist referral patterns. Results: From 2020 to 2022, there were 31,103 individuals of reproductive age with cancer receiving care at a military treatment facility. One hundred fourteen physicians completed our survey, 76 obstetrician gynecologists (OB/GYNs), 18 oncologists, and 20 primary care physicians (PCPs). Ninety-three percent of respondents felt conversations about fertility preservation for reproductive-aged patients with cancer were very important. A total of 66.7% of oncologists, 35.5% of OB/GYNs, and 0% of PCPs felt comfortable counseling patients on coverage. A total of 33.3% of oncologists, 29.3% of OB/GYNs, and 0% of PCPs were familiar with oncofertility Defense Health Agency guidelines. Conclusion: Primary care, OB/GYN, and oncology practitioners are well situated to provide fertility preservation counseling to all individuals with a cancer diagnosis, but differences in counseling and referral patterns and a lack of knowledge of current agency policies may impair a patient's timely access to these resources. We propose implementation of an electronic patient navigator to address gaps in oncofertility care and standardize patient counseling in the MHS. This patient-focused guide would serve as a valuable model in all types of health care settings.
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Affiliation(s)
- David Boedeker
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Kiley Hunkler
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Carissa Pekny
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Nora Watson
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Meghan Yamasaki
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Sara Drayer
- Department of Gynecologic Surgery and Obstetrics, Gynecologic Cancer Center of Excellence, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda Maryland, USA
| | - Trimble Spitzer
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Taniskidou AM, Voultsos P, Tarlatzis V, Timotheadou E. Perceptions and experiences of fertility preservation in female patients with cancer in Greece. BMC Womens Health 2024; 24:108. [PMID: 38336757 PMCID: PMC10858603 DOI: 10.1186/s12905-024-02955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND As advances in oncology have led to remarkable and steady improvements in the survival rates of patients with cancer and anticancer treatment can cause premature ovarian failure in women, fertility preservation (FP) has become a global public health concern and an integral part of the care for women diagnosed with cancer during reproductive age. However, for various reasons, FP remains underutilized for patients with cancer. There are substantial gaps in our knowledge about women's experiences and perceptions of the issue. This study aims to contribute to bridging that gap. METHODS This prospective qualitative study was conducted from March 2018 to February 2023. A combination of purposive and snowball sampling was used. Data were collected by semistructured interviews with nineteen reproductive-age women who had been recently diagnosed with cancer. Data were classified and analysed with a thematic analysis approach. RESULTS A variety of distinct themes and subthemes emerged from the analysis of the interview data. The cancer diagnosis emerged as a factor that considerably affects the women's attitudes towards biological parenthood: It can further increase their (strong) previous desire or decrease their previous (weak) desire. Women with a recent cancer diagnosis had not received adequate and multidisciplinary counselling, including clear and sufficient information. However, participants felt satisfied with the information they received because they either received the information they requested or remained in denial about the need to be informed (i.e., because they felt overwhelmed after the cancer diagnosis). Embryo cryopreservation emerged as a less desirable FP option for women with cancer. Participants showed respect for human embryos, not always for religious reasons. Surrogacy emerged as the last resort for most participants. Religious, social or financial factors did play a secondary (if any) role in women's decision-making about FP. Finally, male partners' opinions played a secondary role in most participants' decision-making about FP. If embryo cryopreservation was the selected option, partners would have a say because they were contributing their genetic material. CONCLUSIONS The findings that emerged from the data analysis were partly consistent with prior studies. However, we identified some interesting nuances that are of clinical importance. The results of this study may serve as a starting point for future research.
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Affiliation(s)
- Anna-Maria Taniskidou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR, 54124, Greece
| | - Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR, 54124, Greece.
| | - Vasileios Tarlatzis
- 1st Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR, 54124, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Glackin A, Marino JL, Peate M, McNeil R, Orme LM, McCarthy MC, Sawyer SM. Experiences of Oncofertility Decision-Making and Care in a National Sample of Adolescent and Young Adult Cancer Patients and Parents. J Adolesc Young Adult Oncol 2024; 13:170-179. [PMID: 37535814 DOI: 10.1089/jayao.2023.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Purpose: Cancer and its treatments are known to compromise fertility in adolescents and young adults (AYAs). The emotional burden of possible infertility is reduced in those who receive supportive oncofertility care. In legal minors, provision of health care must consider the legal context and desire that AYAs have for autonomous decision-making, together with their competence to make health decisions. This has important implications for how oncofertility discussions may, or may not, involve parents. The aim of this study was to explore oncofertility decision-making and care experiences in a national Australian sample of AYA cancer patients and their parents. Methods: AYAs aged 15-25 years and parents were recruited from 17 cancer care sites and CanTeen Australia as part of a national AYA cancer care study. The cross-sectional survey included open-ended questions regarding oncofertility care experiences. We used reflexive thematic analysis to identify themes. Results: Data were available for 99 AYAs and 111 parents. Four themes were identified: emotional care needs; parent-AYA dynamics including AYA autonomy and agency; decision-making considerations including values and practicalities; and reflections on oncofertility care and follow-up. Both AYAs and parents placed importance on AYA autonomy in fertility decision-making, but many AYAs appreciated the role of parents in providing support and guidance throughout the process. Conclusion: Health care professionals are encouraged to autonomously engage AYAs around fertility decision-making, while concurrently offering opportunities that promote parental support. Better psychological support and follow-up oncofertility care are also needed.
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Affiliation(s)
- Aoife Glackin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa M Orme
- ONTrac at Peter Mac, Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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6
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Rodriguez-Wallberg KA, Ahlgren J, Smedby KE, Gorman JR, Hellman K, Henriksson R, Ståhl O, Wettergren L, Lampic C. Prevalence and predictors for fertility-related distress among 1010 young adults 1.5 years following cancer diagnosis - results from the population-based Fex-Can Cohort study. Acta Oncol 2023; 62:1599-1606. [PMID: 37909865 DOI: 10.1080/0284186x.2023.2272291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Cancer treatment during reproductive ages may negatively impact fertility and there is a need of firm knowledge about the prevalence and predictors of fertility-related distress. The aim was to examine fertility-related distress in a population-based sample of young women and men recently treated for cancer and to identify predictors for this outcome. MATERIAL AND METHODS This nationwide cohort study included 1010 individuals (694 women and 316 men), mean age 34.5 ± 4.9 and 32.1 ± 5.5, respectively, diagnosed with breast, cervical, ovarian, testicular cancers, brain tumors or lymphoma at ages 18-39 in Sweden. Participants completed a survey 1.5-year post-diagnosis to assess fertility-related distress (RCAC), emotional distress (HADS) and self-efficacy, as well as sociodemographic and clinical factors and fertility preservation. Logistic regression was used to examine associations between explanatory factors and high fertility-related distress (RCAC subscale mean >4). RESULTS Many participants (69% of women and 47% of men) had previous children and about half reported a wish for future children. High fertility-related distress was more prevalent among women (54%) than men (27%), and women were more likely than men to report distress concerning all but one RCAC dimension after adjustment for sociodemographic factors. Use of fertility preservation was unevenly distributed (15% of women and 71% of men) and was not associated with decreased fertility-related distress. In multivariable logistic regression models, a wish for future children, being single, not having previous children, symptoms of anxiety and low self-efficacy regarding one's ability to handle threats of infertility were associated with high fertility-related distress. CONCLUSION This nationwide study found a high prevalence of fertility-related distress in young women and men recently treated for cancer and identified sociodemographic and psychological predictors. Fertility preservation was not found to act as a buffer against fertility-related distress, indicating the continuous need to identify strategies to alleviate fertility distress following cancer.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Regional Cancer Centre, Mid-Sweden, Uppsala, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Roger Henriksson
- Department of Radiation Science and Oncology, Umeå University, Umeå, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Lena Wettergren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Lampic
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
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Meernik C, Engel SM, Wardell A, Baggett CD, Gupta P, Rodriguez-Ormaza N, Luke B, Baker VL, Wantman E, Rauh-Hain JA, Mersereau JE, Olshan AF, Smitherman AB, Cai J, Nichols HB. Disparities in fertility preservation use among adolescent and young adult women with cancer. J Cancer Surviv 2023; 17:1435-1444. [PMID: 35169982 PMCID: PMC9378772 DOI: 10.1007/s11764-022-01187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Women face multiple barriers to fertility preservation after cancer diagnosis, but few studies have examined disparities in use of these services. METHODS Women aged 15-39 years diagnosed with cancer during 2004-2015 were identified from the North Carolina Central Cancer Registry and linked to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Women who cryopreserved oocytes or embryos for fertility preservation (n = 96) were compared to women who received gonadotoxic treatment but did not use fertility preservation (n = 7964). Conditional logistic and log-binomial regression were used to estimate odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Few adolescent and young adult women with cancer in our study (1.2%) used fertility preservation. In multivariable regression, women less likely to use fertility preservation were older at diagnosis (ages 25-29 vs. 35-39: OR = 6.27, 95% CI: 3.35, 11.73); non-Hispanic Black (vs. non-Hispanic White: PR = 0.44, 95% CI: 0.24, 0.79); and parous at diagnosis (vs. nulliparous: PR = 0.24, 95% CI: 0.13, 0.45); or lived in census tracts that were non-urban (vs. urban: PR = 0.12, 95% CI: 0.04, 0.37) or of lower socioeconomic status (quintiles 1-3 vs. quintiles 4 and 5: PR = 0.39, 95% CI: 0.25, 0.61). CONCLUSIONS Women with cancer who were older, non-Hispanic Black, parous, or living in areas that were non-urban or of lower socioeconomic position were less likely to use fertility preservation. IMPLICATIONS FOR CANCER SURVIVORS Clinical and policy interventions are needed to ensure equitable access to fertility services among women facing cancer treatment-related infertility.
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Affiliation(s)
- Clare Meernik
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Ally Wardell
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Christopher D Baggett
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Parul Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nidia Rodriguez-Ormaza
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer E Mersereau
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Andrew B Smitherman
- Department of Pediatrics and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
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Benedict C, Stal J, Davis A, Zeidman A, Pons D, Schapira L, Diefenbach M, Ford JS. Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors. Psychooncology 2023; 32:1606-1615. [PMID: 37695291 PMCID: PMC10591918 DOI: 10.1002/pon.6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/28/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Many adolescent and young adult female (AYA-F) cancer survivors face decisions about family building using reproductive medicine or adoption to achieve parenthood. This study evaluated associations among reproductive distress, avoidance, and family-building decision making and identified sociodemographic and clinical characteristics related to high distress and avoidance. METHODS A cross-sectional survey assessed AYA-F survivors' oncofertility experiences. Measures included an investigator-designed Unmet Information Needs scale, Reproductive Concerns After Cancer Scale, Impact of Events Scale-Avoidance subscale, Decision Self-Efficacy scale, and Decision Conflict Scale. Two linear regression models evaluated correlates of decision self-efficacy and decisional conflict about family building after cancer. Bivariate analyses evaluated correlates of avoidance using Pearson's correlation, t-test, and ANOVA. RESULTS AYA-Fs (N = 111) averaged 31-years-old (SD = 5.49) and 3 years post-treatment (range: 1-23 years); 90% were nulliparous. Most common diagnoses were leukemia (24%) and breast cancer (22%). Average decisional conflict was 52.12 (SD = 23.87, range: 0-100); 74% of the sample reported DCS scores within the clinically significant range. Higher levels of reproductive distress (B = -0.23, p = 0.04) and avoidance (B = -0.24, p = 0.02) related to lower decision self-efficacy. Younger age (B = -0.18, p = 0.03), greater unmet information needs (B = 0.33, p < 0.001), and higher levels of reproductive distress (B = 0.34, p = 0.001) related to worse decisional conflict. Predictors of distress and avoidance were identified. CONCLUSIONS After cancer treatment, high fertility distress and avoidant coping were associated with poorer quality decision making about family building after cancer. Fertility counseling post-treatment should support self-efficacy and constructive coping skills to counteract high distress, maladaptive coping, and facilitate values-based decision making.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
- Stanford Cancer Institute, Stanford, CA
| | - Julia Stal
- Department off Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Ali Davis
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
- Department of Clinical Psychology, Palo Alto University, Palo Alto, CA
| | - Anna Zeidman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Devon Pons
- University of San Francisco, San Francisco, CA
| | | | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, NY
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9
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Shen J, Jiang H, Lin H, Fan S, Yu D, Yang L, Chen L. Fertility concerns in cancer patients: a bibliometric analysis via CiteSpace: A review. Medicine (Baltimore) 2023; 102:e35211. [PMID: 37746999 PMCID: PMC10519520 DOI: 10.1097/md.0000000000035211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Fertility concerns are a pervasive issue but very subtle in patients with cancer. Though various studies have focused on fertility concerns, limited research endeavor has been dedicated to bibliometric analysis. Given this, to visually analyze the hot frontier trends of research related to fertility concerns of patients with cancer using CiteSpace and provide new insights for future research in this field using the bibliometric method. We used CiteSpace software to retrieve the literature related to fertility concerns of patients with cancer in the Web of Science core collection database from the year of establishment to 2022 and conducted visual analysis in terms of authors, countries and regions, research institutions, and keywords. The search resulted in 201 valid articles, and the annual publication volume of literature related to fertility concerns in patients with cancer was generally on the rise; the country with the most publications was the United States, which also had the highest influence; the main research institution was Sloan Kettleson Cancer Research Center; the core research scholar was Jessica R. Gorman; the research hotspots mainly centered on quality of survival, women, survivorship, preservation, breast cancer, adolescence, and infertility. The results of this bibliometric study provide the current status and trends in the fertility concerns of patients with cancer and may help researchers identify the hotspots and frontier trends in this field.
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Affiliation(s)
- Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Siyue Fan
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Doudou Yu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liping Yang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
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10
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Whiteside SL, Frias OJ, Clifford L, Schultz K, Erickson L, Caldwell M, Prebus O, Pruett M, Smith K. Oncofertility patient navigation: The frontlines of fertility and reproductive health care in cancer. Pediatr Blood Cancer 2023; 70 Suppl 5:e28810. [PMID: 37606939 DOI: 10.1002/pbc.28810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 08/23/2023]
Abstract
Oncofertility is an emerging field that incorporates diverse disciplines working together to care for oncology patients from birth to adulthood who are facing surgery, radiation therapy, or chemotherapy that may impact their fertility potential and reproductive function. Providing this care to newly diagnosed oncology patients in an expedited manner can be challenging. There is currently a paucity of published data about how this care is provided, training and education of individuals providing this care, and patient-reported outcomes related specifically to oncofertility care. The role of the oncofertility patient navigator is to bridge the institutional and disciplinary boundaries so oncology patients of all ages can receive timely information regarding fertility risk and preservation options at diagnosis and throughout survivorship care. The purpose of this paper is to define the role of the oncofertility patient navigator within diverse models of care and health care systems, and provide a framework for ongoing efforts to improve reproductive care for those affected by cancer in their years of child-bearing potential.
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Affiliation(s)
- Stacy L Whiteside
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio
| | - Olivia Jaworek Frias
- Division of Pediatric and Adolescent Gynecology, Comprehensive Fertility Care and Preservation Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lindsey Clifford
- Stead Family Children's Hospital and Holden Comprehensive Cancer Center Clinic, University of Iowa Health Care, Iowa City, Iowa
| | - Katie Schultz
- Department of Gynecology, Pediatric Fertility Preservation, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Erickson
- Fertility and Hormone Preservation and Restoration Program, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mary Caldwell
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Olivia Prebus
- Adolescent and Young Adult Oncology Program, Cook Children's Medical Center, Fort Worth, Texas
| | - Megan Pruett
- Division of Endocrinology and Diabetes, Aflac Cancer Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kristin Smith
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Northwestern Medicine, Chicago, Illinois
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11
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Nichols HB, Wernli KJ, Chawla N, O’Meara ES, Gray MF, Green LE, Baggett CD, Casperson M, Chao C, Jones SMW, Kirchhoff AC, Kuo TM, Lee C, Malogolowkin M, Quesenberry CP, Ruddy KJ, Wun T, Zebrack B, Chubak J, Hahn EE, Keegan TH, Kushi LH. Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults. CURR EPIDEMIOL REP 2023; 10:115-124. [PMID: 37700859 PMCID: PMC10495081 DOI: 10.1007/s40471-022-00286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.
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Affiliation(s)
- Hazel B. Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Neetu Chawla
- Veterans Health Administration, Greater Los Angeles, CA
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Laura E. Green
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Christopher D. Baggett
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Chun Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, University of California Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Erin E. Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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12
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Koizumi T, Sugishita Y, Suzuki-Takahashi Y, Nara K, Miyagawa T, Nakajima M, Sugimoto K, Futamura M, Furui T, Takai Y, Matsumoto H, Yamauchi H, Ohno S, Kataoka A, Kawai K, Fukuma E, Nogi H, Tsugawa K, Suzuki N. Oncofertility-related psycho-educational therapy for young adult patients with breast cancer and their partners: Randomized controlled trial. Cancer 2023; 129:2568-2580. [PMID: 37082910 DOI: 10.1002/cncr.34796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND A couples' psycho-educational program called Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy was created and its effect when provided before cancer treatment was examined. METHODS This multicenter randomized controlled trial with nonmasking, parallel two-group comparison enrolled women aged 20 to 39 years with early-stage breast cancer and their partners. They were randomly assigned to receive O!PEACE (37 couples) or usual care (37 couples). Primary end points were cancer-related posttraumatic stress symptoms, symptoms of depression, and anxiety. Secondary end points were stress-coping strategies, resilience, and marital relationship. RESULTS Women receiving psycho-educational therapy had significantly reduced Impact of Event Scale-revised version for Japanese scores (p = .011, ηp 2 = = .089). For patients with Impact of Event Scale-revised version for Japanese scores at baseline ≥18.27, O!PEACE therapy improved these scores when compared with usual care (U = 172.80, p = .027, r = 0.258). A >5-point reduction was present in 59.3% and 30% of women in the O!PEACE therapy and usual-care groups, respectively. For partners, O!PEACE therapy significantly improved stress-coping strategies (95% CI, -0.60 to -0.05; p = .018, ηp 2 = = .074) and escape-avoidance marital communication (95% CI, -0.33 to -0.08; p = .001, ηp 2 = .136). O!PEACE therapy significantly improved the partners' support (95% CI, 0.10-0.50; p = .001, ηp 2 = .127), the rate of receiving fertility preservation consultations, and knowledge levels. CONCLUSIONS O!PEACE therapy before cancer treatment can improve posttraumatic stress symptoms, stress-coping behavior, and marital relationships. Larger sample sizes and longer term follow-up are required. PLAIN LANGUAGE SUMMARY A psycho-educational program, the Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy program was developed and evaluated for women diagnosed with breast cancer and their partners. A multicenter randomized controlled trial showed that the O!PEACE psycho-educational therapy, with only two precancer treatment sessions, can reduce cancer-related posttraumatic stress symptoms and improve oncofertility knowledge and marital relationships in young adult patients with breast cancer. The therapy could also improve stress-coping strategies in marital communications with their partners. Couples may use O!PEACE psycho-educational therapy to consider fertility preservation and improve their psychosocial aspects.
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Affiliation(s)
- Tomoe Koizumi
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yodo Sugishita
- Department of Frontier Medicine, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yuki Suzuki-Takahashi
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Frontier Medicine, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kazuko Nara
- Department of Clinical Psychology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Tomoko Miyagawa
- Department of Clinical Psychology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | | | - Kouhei Sugimoto
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Manabu Futamura
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Hiroshi Matsumoto
- Lacteal Gland Surgery Department, Saitama Cancer Center, Kitaadachi, Saitama, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Chuo, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
| | - Akemi Kataoka
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Tokyo, Japan
| | - Kiyotaka Kawai
- Kameda IVF Clinic, Chiba, Chiba, Japan
- Assisted Reproductive Technology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hiroko Nogi
- Department of Surgery, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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13
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Murphy KM, Siembida E, Lau N, Berkman A, Roth M, Salsman JM. A systematic review of health-related quality of life outcomes in psychosocial intervention trials for adolescent and young adult cancer survivors. Crit Rev Oncol Hematol 2023; 188:104045. [PMID: 37269881 PMCID: PMC10527433 DOI: 10.1016/j.critrevonc.2023.104045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The National Cancer Institute has catalyzed research in adolescent and young adult (AYA) oncology by identifying the need for supportive care intervention studies and psychometrically robust health-related quality of life (HRQOL) measures. We evaluated progress toward these goals (1) examining changes in the number of registered psychosocial intervention trials being conducted with AYAs over time; (2) determining what domains of HRQOL were assessed across these intervention trials; and (3) identifying the most frequently used measures of HRQOL. METHODS We conducted a systematic review of psychosocial intervention trials for AYAs registered on ClinicalTrials.gov from 2007 to 2021. Following identification of relevant trials, we extracted the outcome measures and determined whether they were measures of HRQOL and which HRQOL domains were evaluated. Descriptive statistics were used to summarize trial and outcome characteristics. RESULTS We identified 93 studies that met our inclusion criteria and 326 HRQOL outcomes across studies. The average number of clinical trials conducted annually has increased from 2 (SD = 1) during the years of 2007-2014 to 11 (SD = 4) during the years of 2015-2021. 19 trials (20.4%) did not include a measure of HRQOL. HRQOL measures varied widely, and most evaluated psychological and physical domains. Of the 9 measures used 5 + times, none were developed to cover the full AYA age spectrum. CONCLUSIONS This review demonstrated that the number of AYA psychosocial intervention trials conducted annually has increased. However, it also revealed several important areas for additional work including: (1) ensuring psychosocial trials include HRQOL measures; (2) increasing the frequency of evaluation of underrepresented domains of HRQOL (e.g., body image, fertility/sexuality and spiritual); and (3) improving the validity and standardization of measures used to evaluate domains of HRQOL across AYA-focused trials to improve the field's ability to compare the impact of different psychosocial interventions on HRQOL outcomes.
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Affiliation(s)
- Karly M Murphy
- Wake Forest University School of Medicine, Department of Social Sciences and Health Policy, USA; Wake Forest Baptist Comprehensive Cancer Center, USA.
| | | | - Nancy Lau
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Amy Berkman
- Duke University School of Medicine, Department of Pediatrics, USA
| | - Michael Roth
- MD Anderson Cancer Center, Department of Pediatrics, USA
| | - John M Salsman
- Wake Forest University School of Medicine, Department of Social Sciences and Health Policy, USA; Wake Forest Baptist Comprehensive Cancer Center, USA
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14
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Bentsen L, Pappot H, Hjerming M, Hanghøj S. Thoughts about fertility among female adolescents and young adults with cancer: a qualitative study. Support Care Cancer 2023; 31:421. [PMID: 37357225 DOI: 10.1007/s00520-023-07887-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Nine hundred female adolescents and young adults (AYAs) aged 15-39 are diagnosed with cancer in Denmark annually. Advances in cancer therapy have led to increased long-term survival; however, a serious side effect of cancer therapy is reduced fertility. The aim of our study was to explore the thoughts about fertility among female AYAs with cancer. METHODS Our study was conducted from September 2020 to March 2021 at the Copenhagen University Hospital, Rigshospitalet. Inclusion criteria were female AYAs with cancer aged 18-39. Twelve individual, semi-structured, qualitative interviews were performed with female AYAs with cancer (20-35 years). Data were analysed using thematic analysis. RESULTS Four main themes were found: (1) the female AYAs held on to a hope of having children in the future; (2) the female AYAs experienced time pressure and waiting time as a sprint as well as a marathon; (3) the female AYAs faced existential and ethical choices about survival and family formation; and (4) the female AYAs felt a loss of control of their bodies. CONCLUSION Our study contributes with knowledge on how important holding on to the hope of children in the future is among female AYAs with cancer. Meanwhile, they are frustrated by the rushed decision on fertility preservation at diagnosis. The female AYAs also have existential and ethical concerns related to the choice of cancer therapy and fertility preservation. Finally, they suffer from altered body image, loss of femininity, and body control due to hormone therapy.
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Affiliation(s)
- Line Bentsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Signe Hanghøj
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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15
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Benedict C, Thom B, Diefenbach M, Schapira L, Simon P, Ford JS. The Impact of Cancer-Related Financial Toxicity on Reproductive Concerns and Family-Building Decision-Making in Post-Treatment Survivorship. J Adolesc Young Adult Oncol 2023; 12:408-415. [PMID: 36169520 PMCID: PMC10282808 DOI: 10.1089/jayao.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors are at-risk for cancer-related financial difficulties (i.e., financial toxicity [FT]). Family building after cancer often requires reproductive medicine or adoption with high costs; AYAs experience financial barriers to family building. This study evaluated the relationships among cancer FT, reproductive concerns, and decision-making processes about family building after cancer. Methods: AYA female (AYA-F) cancer survivors completed a cross-sectional survey including measures of FT, reproductive concerns, decisional conflict about family building, and decision-making self-efficacy. Differences across FT subgroups (i.e., no/mild, moderate, and severe FT) were tested. Linear regression evaluated the relationships between FT and reproductive concerns and decision-making processes. Results: Participants (N = 111) averaged 31.0 years (standard deviation [SD] = 5.49), 90% were nulliparous, and 84% were employed full/part-time. The overall FT levels were in the "moderate" range (M = 20.44, SD = 9.83); 48% worried quite a bit or very much about financial problems because of cancer. AYA-Fs reporting severe FT (24% of sample) experienced higher levels of reproductive concerns compared with those reporting no/mild and moderate FT. Those reporting moderate FT (46% of sample) reported greater decisional conflict about family-building options, compared with the no/mild FT subgroup. Both moderate and severe FT subgroups reported lower decision-making self-efficacy compared with the no/mild FT subgroup. In separate models controlling for covariates, greater FT related to higher levels of reproductive concerns (B = -0.39, p < 0.001), greater decisional conflict about family building (B = -0.56, p = 0.02), and lower decision-making self-efficacy (B = 0.60, p = 0.01). Conclusions: Given the high costs of reproductive medicine and adoption, fertility counseling pre- and post-treatment must address survivors' financial concerns and barriers.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Stanford Cancer Institute, Stanford, California, USA
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | | | - Pam Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, New York, USA
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16
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Gerstl B, Signorelli C, Wakefield CE, Deans R, Vaishnav T, Johnston K, Neville K, Cohn RJ, Anazodo A. Sexual and reproductive complications and concerns of survivors of childhood, adolescent and adult cancer. J Cancer Surviv 2023:10.1007/s11764-023-01349-6. [PMID: 36991269 DOI: 10.1007/s11764-023-01349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/10/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Cancer survivors may experience infertility and sexual dysfunction following cancer treatment. Survivors report significant gaps in oncofertility care and consider these issues important, yet they are rarely discussed. The aims of this study were to evaluate survivors' sexual and reproductive complications across age groups and to identify specific groups of survivors at risk for sexual and reproductive complications. METHOD We report data collected from survivors of cancers diagnosed in childhood, adolescence and adulthood following the development and piloting of a reproductive survivorship patient reported outcome measure (RS-PROM). RESULTS One hundred and fifty survivors participated in the study (mean age at cancer diagnosis was 23.2 years [SD, 10.3 years]). About 68% of participants expressed concerns about their sexual health and function. Survivors (50%) expressed at least one body image concern, with the female gender the most common risk factor for all subgroups. A total of 36% of participants reported at least one concern regarding their fertility, with more male than female survivors reporting fertility preservation prior to treatment. Females compared with male participants were more likely to feel less physically attractive after treatment (OR = 3.83, 95% CI = 1.84-7.95, p < 0.001). More females than males were also more likely to feel dissatisfied with the appearance of a scar(s) after treatment (OR = 2.36, 95% CI = 1.13-4.91, p = 0.02). CONCLUSION The RS-PROM identified multiple reproductive complications and concerns for cancer survivors in the survivorship period. IMPLICATIONS FOR CANCER SURVIVORS Utilising the RS-PROM in conjunction with a clinic appointment could help identify and address cancer patients' concerns and symptoms.
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Affiliation(s)
- Brigitte Gerstl
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Childrens Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Childrens Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
- Department of Gynaecology, The Royal Hospital for Women, Sydney, NSW, Australia
- Fertility Research Centre, The Royal Hospital for Women, Sydney, NSW, Australia
| | - Tejnei Vaishnav
- Fertility Research Centre, The Royal Hospital for Women, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Kristen Neville
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
- Department of Endocrinology, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Childrens Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Childrens Hospital, Randwick, Sydney, NSW, 2031, Australia.
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW , Sydney, Australia.
- Fertility Research Centre, The Royal Hospital for Women, Sydney, NSW, Australia.
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia.
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17
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Allison KR, Patterson P, Ussher JM, McDonald FEJ, Perz J. Evaluating Maybe Later Baby, a Fertility Information Resource for Adolescents and Young Adults Diagnosed with Cancer: A Randomized, Controlled Pilot Study. J Adolesc Young Adult Oncol 2023; 12:101-109. [PMID: 35333618 DOI: 10.1089/jayao.2021.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Fertility is a major concern for adolescents and young adults (AYAs, 15-30 years) diagnosed with cancer, yet they often report a lack of information and understanding about fertility impacts and preservation options. This study aimed to evaluate the acceptability and preliminary efficacy of Maybe Later Baby (MLB), an oncofertility information resource for AYAs diagnosed with cancer. Methods: In a randomized controlled trial, 13 participants received MLB alone and 10 received an augmented intervention involving an additional consultation with a health care professional (HCP). Pre- and postintervention surveys and interviews explored participants' well-being, fertility knowledge, health literacy, and experiences using the resource. Results: Participants indicated that the resource was accessible and understandable and provided valuable information without increasing distress. When averaged across conditions, functional health literacy (p = 0.006) and oncofertility knowledge (p = 0.002) increased, although there were no significant changes in fertility-related emotions (p > 0.05), and quality of life decreased (p = 0.014). While qualitative accounts suggested that HCP consultations were useful and validated participants' experiences and concerns, participants receiving the augmented intervention became more nervous/fearful about fertility treatment (p = 0.005). There were no other differences in outcomes between conditions. Conclusions: Young people diagnosed with cancer want and value information about oncofertility and resources such as MLB are acceptable and useful means of providing this information. This could be supplemented by clinical discussion to ensure that tailored situation-specific information is provided and understood and patient distress is appropriately managed. Clinical Trial Registration number: 12615000624583.
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Affiliation(s)
- Kimberley R Allison
- Research and Youth Cancer Services, Canteen Australia, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Pandora Patterson
- Research and Youth Cancer Services, Canteen Australia, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Fiona E J McDonald
- Research and Youth Cancer Services, Canteen Australia, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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18
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Abusanad A, Mokhtar AMA, Aljehani SAA, Aljuhani KFA, Saleh KAA, Alsubhi BH, Hamdi RM, Alzoriri AD. Oncofertility care and influencing factors among cancer patients of reproductive age from Saudi Arabia. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1014868. [PMID: 36466012 PMCID: PMC9714457 DOI: 10.3389/frph.2022.1014868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/18/2022] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND More cancer survivors and a greater burden of long-term side effects have resulted from rising cancer incidence, improved treatment modalities, and younger age at cancer diagnosis. Treatment- related Infertility (TRI) is a well-known sequelae. This study looked at current oncofertility support and fertility preservation (FP) in men and women of reproductive age with cancer in Saudi Arabia, where there is little knowledge on the subject. METHODS A cross-sectional study included oncology patients of reproductive age from an academic hospital was conducted. Patients' characteristics, cancer type, treatment modalities and assessment of oncofertility support data were collected and examined to assess oncofertility support and potentially influencing factors. RESULTS Our study included 135 patients (39.3% males and 60.7% females). Although 66.7% believed they were fertile at the time of diagnosis, and more than half planned to have children in the future, Unfortunately, only 37.8% have received fertility counseling, and only 17% have seen a fertility specialist. In male patients, the most common FP method was sperm cryopreservation (6.7%), while the majority of both genders (87.4%) did not use any FP method. Two-thirds of the patients are knowledgeable about TRI and FP methods. About half of the female patients (57.3%) were advised about the possibility of post-treatment amenorrhea while only 8.1% of the whole cohort received psychological support. CONCLUSIONS Despite patients' satisfactory knowledge of TRI and FP, oncologists infrequently referred their patients to a specialized fertility service. More than half of our patients expressed a desire to have children in the future, but this desire was impeded by limited oncofertility care and FP procedures. Several factors influenced the knowledge of TRI, fertility counseling and FP. It is critical to incorporate oncofertility into management planning as it has a significant impact on patients' quality of life.
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Affiliation(s)
- Atlal Abusanad
- Medical Oncology, King Abdul Aziz University Hospital, Jeddah, Makkah, Saudi Arabia
- Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | | | | | | | | | | | - Raad Mohammed Hamdi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
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19
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Han J, Park S, Kim SH. Supporting decision‐making regarding fertility preservation in patients with cancer: An integrative review. Eur J Cancer Care (Engl) 2022; 31:e13748. [DOI: 10.1111/ecc.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jeehee Han
- Red Cross College of Nursing Chung‐Ang University Seoul Korea
| | - Sangwoo Park
- Severance Hospital Yonsei University Health System Seoul Korea
| | - Sung Hae Kim
- Department of Nursing, College of Health, Welfare and Education Tongmyong University Busan Korea
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20
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van den Berg M, Kaal SEJ, Schuurman TN, Braat DDM, Mandigers CMPW, Tol J, Tromp JM, van der Vorst MJDL, Beerendonk CCM, Hermens RPMG. Quality of integrated female oncofertility care is suboptimal: A patient-reported measurement. Cancer Med 2022; 12:2691-2701. [PMID: 36031940 PMCID: PMC9939180 DOI: 10.1002/cam4.5149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend to inform female cancer patients about their infertility risks due to cancer treatment. Unfortunately, it seems that guideline adherence is suboptimal. In order to improve quality of integrated female oncofertility care, a systematic assessment of current practice is necessary. METHODS A multicenter cross-sectional survey study in which a set of systematically developed quality indicators was processed, was conducted among female cancer patients (diagnosed in 2016/2017). These indicators represented all domains in oncofertility care; risk communication, referral, counseling, and decision-making. Indicator scores were calculated, and determinants were assessed by multilevel multivariate analyses. RESULTS One hundred twenty-one out of 344 female cancer patients participated. Eight out of 11 indicators scored below 90% adherence. Of all patients, 72.7% was informed about their infertility, 51.2% was offered a referral, with 18.8% all aspects were discussed in counseling, and 35.5% received written and/or digital information. Patient's age, strength of wish to conceive, time before cancer treatment, and type of healthcare provider significantly influenced the scores of three indicators. CONCLUSIONS Current quality of female oncofertility care is far from optimal. Therefore, improvement is needed. To achieve this, improvement strategies that are tailored to the identified determinants and to guideline-specific barriers should be developed.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Suzanne E. J. Kaal
- Department of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands,Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands
| | - Teska N. Schuurman
- Center for Gynecologic Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch HospitalDen BoschThe Netherlands
| | - Jacqueline M. Tromp
- Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands,Department of Medical OncologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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21
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Rae C, Costa A, Seow H, Barr RD. Factors Associated with Adolescent and Young Adult Males with Cancer Attending Fertility Consultation: A Population-Based Cohort Study in Ontario, Canada. J Adolesc Young Adult Oncol 2022; 12:232-240. [PMID: 35704052 DOI: 10.1089/jayao.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Cancer and its treatment can impair fertility in men. It is recommended that they be referred for fertility consultation before the start of treatment. This study examined factors associated with men attending a fertility consultation within 30 days of diagnosis. Methods: Males 15 to 39 years of age, diagnosed with cancer in Ontario, Canada, between 2006 and 2019, were identified from the Ontario Cancer Registry. Linked administrative data were used to obtain other clinical and sociodemographic variables. The main outcome was a fertility consultation within 30 days of diagnosis, defined using Ontario Health Insurance Plan billing codes (606 or 628). A backward selection multivariate logistic regression was performed. Results: Of 13,720 cases identified, 8.5% attended a fertility consultation within 30 days of diagnosis. A more recent year of diagnosis (odds ratio [OR] = 5.5; 95% confidence interval [CI] 4.6-6.6), living in an urban area (OR = 1.3; 95% CI 1.0-1.8), receiving radiation therapy (OR = 1.4; 95% CI 1.2-1.6), chemotherapy (OR = 1.9; 95% CI 1.6-2.2), and reproductive organ-related cancer surgery (OR = 1.5; 95% CI 1.2-1.7) were associated with a greater likelihood of attending a consultation. Older age (OR = 0.2; 95% CI 0.1-0.2), living in a northern region (OR = 0.3; 95% CI 0.2-0.5), having a cancer with low (OR = 0.3; 95% CI 0.2-0.4) or moderate risk to fertility (OR = 0.6; 95% CI 0.5-0.7), and residing in a neighborhood with lower income (OR = 0.4; 95% CI 0.3-0.5) or residential instability quintile (OR = 0.8; 95% CI 0.6-1.0) were associated with being less likely to attend a consultation. Conclusion: Although rates of fertility consultation have increased over time, these remain low in various clinical and demographic groups. Funding for fertility preservation appears to have had an important impact on fertility consultation in young men with cancer.
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Affiliation(s)
- Charlene Rae
- Department of Pediatrics, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hsien Seow
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronald D Barr
- Department of Pediatrics, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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22
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Benedict C, Dauber-Decker KL, Ford JS, King D, Spiegel D, Schapira L, Simon P, Diefenbach M. Development of a Web-Based Decision Aid and Planning Tool for Family Building After Cancer (Roadmap to Parenthood): Usability Testing. JMIR Cancer 2022; 8:e33304. [PMID: 35639461 PMCID: PMC9198824 DOI: 10.2196/33304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/26/2022] [Accepted: 04/18/2022] [Indexed: 01/22/2023] Open
Abstract
Background Owing to gonadotoxic cancer treatments, young adult female survivors often report uncertainty about their fertility, reproductive potential, and family-building options after treatment. Roadmap to Parenthood is a web-based decision aid and planning tool for family building after cancer. Objective As part of a patient-centered development process, this study evaluated the usability of the decision aid website to inform design modifications and improve user experience. Methods In total, 2 rounds of usability testing were conducted with the target population of young adult female cancer survivors. During the testing sessions, participants viewed the website twice; first, as a think-aloud exercise, and second, while a researcher interrupted at key points to obtain user feedback. Quantitative and qualitative data were collected to assess website usability. Quantitative measures included the System Usability Scale, WebQual, and eHealth Impact Questionnaire. An exit interview with open-ended questions gathered feedback on likes and dislikes and suggestions for improvement. Results Participants (N=10) were young adult women, with average age of 30.9 (SD 4.51) years, and average time since treatment was 4.44 (SD 3.56) years. Website usability scores improved on the System Usability Scale from “acceptable” in round 1 to “excellent” in round 2 after making design changes based on user feedback (scores of 68 and 89.4, respectively). WebQual scores showed similar improvement from round 1 to round 2 of testing (mean 5.6 to 6.25; range 1-7). On the eHealth Impact Questionnaire, the information and presentation of the website was perceived as comprehensive, easy to understand, and trustworthy. Participants also reported improved confidence to discuss and manage fertility and family-building issues and felt encouraged to play a more active role in managing their fertility. In all, 3 usability themes were identified from the qualitative feedback: ease of use, visibility and navigation, and informational content and usefulness. Overall feedback was positive, and participants reported intentions to use the decision aid website in the future. In total, 10% (1/10) of the participants reported negative emotions when learning about infertility risks and potential family-building challenges. Conclusions Website usability improved after design changes were made in response to user feedback. Young adult female survivors reported positive views about the website and indicated that the decision aid would be useful in decision-making about family building after cancer. Future studies will include further design modifications to consider the emotional experiences of users and any additional navigational features or content to optimize the ease of use and support provided by the tool.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | | | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, NY, United States
| | - D'Arcy King
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - David Spiegel
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | - Lidia Schapira
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | - Pamela Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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23
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Karzai S, Port E, Siderides C, Valente C, Ahn S, Moshier E, Ru M, Pisapati K, Couri R, Margolies L, Schmidt H, Cate S. Impact of Screening Mammography on Treatment in Young Women Diagnosed with Breast Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11581-6. [PMID: 35364765 DOI: 10.1245/s10434-022-11581-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is little data exploring the impact of screening mammography on subsequent treatment in the 40-49-year age group with breast cancer. We sought to assess the association between frequency of mammography in young women and extent of surgery and chemotherapy required. METHODS An IRB-approved retrospective review was performed of patients diagnosed with breast cancer between ages 40 and 49 years from 1 January 2010 to 19 November 2018 within a single health system. Patients were grouped based on last screening 1-24 months prior to diagnosis (1-24 group), > 25 months prior to diagnosis (> 25 group), never screened, and > 25+ never screened (combination group). Multivariate logistic regression models were used to assess for associations between screening intervals and tumor and nodal stage, chemotherapy use, and extent of surgery. RESULTS Of 869 patients included for analysis, 20% were never screened, 60% screened 1-24 months, and 19% screened > 25 months prior to diagnosis. Compared with the 1-24 months group, the never-screened group, > 25 months group, and combined group were more likely to receive chemotherapy. The never-screened and combined groups were more likely to undergo mastectomy and/or axillary lymph node dissection. Of patients undergoing upfront surgery, the > 25 months and combined groups were more likely to receive adjuvant chemotherapy, while the never-screened and combined groups were more likely to have nodal disease. CONCLUSION Our findings support the initiation of screening mammography at age 40 years to reduce the risk of aggressive treatments for newly diagnosed breast cancers in this group.
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Affiliation(s)
- Shkala Karzai
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Port
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cleo Siderides
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Valente
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Soojin Ahn
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Ru
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kereeti Pisapati
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald Couri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie Margolies
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hank Schmidt
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Cate
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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24
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Barriers to Oncofertility Care among Female Adolescent Cancer Patients in Canada. Curr Oncol 2022; 29:1583-1593. [PMID: 35323333 PMCID: PMC8947634 DOI: 10.3390/curroncol29030133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
High survival rates in adolescent cancer patients have shifted the medical focus to the long-term outcomes of cancer treatments. Surgery, chemotherapy, and radiation increase the risk of infertility and infertility-related distress in adolescent cancer patients and survivors. The aims of this narrative review were to (1) describe the psychosocial impacts of cancer-related infertility in adolescents, (2) identify multilevel barriers to fertility preservation (FP) conversations and referrals, and (3) conclude with evidence-based clinical solutions for improving the oncofertility support available to Canadian adolescents. The results of this review revealed that FP decisions occur within the patient, parent, and health care provider (HCP) triad, and are influenced by factors such as parent attitudes, patient maturity, and HCP knowledge. Decision tools and HCP education can promote the occurrence of developmentally appropriate fertility discussions. At the systems level, cost and resource barriers prevent patients from receiving sufficient fertility information and referrals. Clinical models of care (MOCs) can define interdisciplinary roles and referral pathways to improve the integration of oncofertility services into adolescent cancer care. The continued integration of oncofertility care will ensure that all Canadian adolescents receive the exemplary medical and psychological support necessary to make empowered decisions about their own fertility.
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25
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Gorman JR, Lyons KS, Reese JB, Acquati C, Smith E, Drizin JH, Salsman JM, Flexner LM, Hayes-Lattin B, Harvey SM. Adapting a Theory-Informed Intervention to Help Young Adult Couples Cope With Reproductive and Sexual Concerns After Cancer. Front Psychol 2022; 13:813548. [PMID: 35185733 PMCID: PMC8854289 DOI: 10.3389/fpsyg.2022.813548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health (RSH) outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded couple-based intervention to address the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples (22 individuals) with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors (one heterosexual couple and one LGBTQ+ couple, both with cancer history) participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: (1) A highly flexible intervention that can be tailored to couples’ specific RSH concerns; (2) Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; (3) A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and (4) Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship.
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Affiliation(s)
- Jessica R. Gorman
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
- *Correspondence: Jessica R. Gorman,
| | - Karen S. Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX, United States
- Department of Clinical Sciences, College of Medicine, University of Houston, Houston, TX, United States
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, Houston, TX, United States
| | - Ellie Smith
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Julia H. Drizin
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Lisa M. Flexner
- Doctor of Physical Therapy Program, Oregon State University, Bend, OR, United States
| | - Brandon Hayes-Lattin
- School of Medicine, OHSU Knight Cancer Institute, Oregon Health and Sciences University, Portland, OR, United States
| | - S. Marie Harvey
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
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Zhang A, Weaver A, Walling E, Zebrack B, Levin NJ, Stuchell B, Himle J. Evaluating an engaging and coach-assisted online cognitive behavioral therapy for depression among adolescent and young adult cancer survivors: A pilot feasibility trial. J Psychosoc Oncol 2022; 41:20-42. [PMID: 35040368 PMCID: PMC10599691 DOI: 10.1080/07347332.2021.2011530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Technology-assisted Cognitive Behavioral Therapy (tCBT) has significant potentials to provide engaging and accessible depression treatment for adolescents and young adults (AYAs) coping with cancer. This study evaluated the feasibility and preliminary efficacy of an engaging and tailorable tCBT - Mind Your Total Health (MYTH) - for AYA cancer survivors' depression. METHODS Seventeen AYAs diagnosed with cancer were randomly assigned to either the intervention (MYTH) or control group. The intervention group (n = 10) received eight weekly 30-35 minutes coach-assisted tCBT (MYTH), while the control group (n = 7) received active control, BeatingtheBlues (BtB). RESULTS Eight out of ten participants in the MYTH group completed at least six out of eight sessions, suggesting strong feasibility (80% completion rate) among AYAs with cancer. Efficacy outcomes indicated that participants in the MYTH group reported significant pre- and post-treatment reduction in depression, t(9) = 5.25, p < 0.001, and anxiety, t(9)=5.07, p < 0.001. Notably, participants in the MYTH group reported significantly lower post-treatment depression than participants in the BtB group, t(15) = 2.40, p < 0.05. The between-group difference reflected a significant between-group treatment effect size, d = 1.12, p < 0.05. DISCUSSION This engaging, tailorable, and coach-assisted tCBT intervention is promising in alleviating depression and anxiety among AYA cancer survivors. Future research needs to include larger sample size and a more diverse patient population.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatrics, University of Michigan, Medical School, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Nina Jackson Levin
- School of Social Work & Department of Anthropology, University of Michigan, Ann Arbor, Michigan, USA
| | - Beth Stuchell
- Department of Pediatrics, University of Michigan, Medical School, Ann Arbor, Michigan, USA
| | - Joseph Himle
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Di Mattei VE, Perego G, Taranto P, Rancoita PMV, Maglione M, Notarianni L, Mangili G, Bergamini A, Cioffi R, Papaleo E, Candiani M. Factors Associated With a High Motivation to Undergo Fertility Preservation in Female Cancer Patients. Front Psychol 2022; 12:782073. [PMID: 34975672 PMCID: PMC8716366 DOI: 10.3389/fpsyg.2021.782073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/30/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: Fertility loss due to cancer treatment can be a devastating experience for women and the couple. Undergoing fertility preservation can be a complex decision from both a medical and emotional point of view. The aim of the present study was to evaluate which socio-demographic and psychological factors predict a high motivation to undergo fertility preservation. Methods: Fifty-eight female cancer patients who accessed an Oncofertility Unit completed: a questionnaire to collect socio-demographic characteristics and the level of motivation, the Beck-Depression Inventory-II, the State-Trait Anxiety Inventory-Y, and the Fertility Problem Inventory. Results: Almost half of the sample (44.8%) declared a high motivation. At multiple logistic regression analysis only the “Need for parenthood” subscale of the FPI predicted a high motivation. We alternatively evaluated as possible predictor the construct “Representations about the importance of parenthood” (i.e., the sum of the “Need for Parenthood” and “Rejection of childfree lifestyle” subscales) in place of the two separate subscales. At multiple logistic regression analysis, only this variable predicted a high motivation to undergo fertility preservation. Conclusion: The most important predictor of a high motivation to undergo fertility preservation is the individual desire for parenthood. This implies that, regardless of socio-demographic characteristics, any woman of childbearing age should receive an appropriate counseling about fertility preservation.
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Affiliation(s)
- Valentina Elisabetta Di Mattei
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Perego
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Paola Taranto
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola M V Rancoita
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mariangela Maglione
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lisa Notarianni
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Papaleo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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28
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Ulrich ND, Raja NS, Moravek MB. A Review of Fertility Preservation in Patients with Breast Cancer. Best Pract Res Clin Obstet Gynaecol 2022; 82:60-68. [DOI: 10.1016/j.bpobgyn.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 12/20/2022]
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Gorman JR, Drizin JH, Smith E, Flores-Sanchez Y, Harvey SM. Patient-Centered Communication to Address Young Adult Breast Cancer Survivors' Reproductive and Sexual Health Concerns. HEALTH COMMUNICATION 2021; 36:1743-1758. [PMID: 32703034 DOI: 10.1080/10410236.2020.1794550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Women faced with a diagnosis of breast cancer as young adults commonly experience negative effects of cancer and cancer treatment on their reproductive and sexual health (RSH) that are inadequately addressed by their healthcare providers (HCPs). The objectives of this study were to 1) identify approaches to improving RSH communication from YA breast cancer survivors' perspectives, 2) identify facilitators and barriers to the approaches identified, and 3) identify specific strategies to improve patient-centered RSH communication. We conducted individual telephone interviews with 29 women who were diagnosed with breast cancer under age 40 years. We used a grounded theory approach to identify themes, and explored how the themes related to the PCC framework to elucidate specific strategies for improving communication. Three main themes emerged: 1) Normalizing and integrating assessment of RSH concerns; 2) HCP conveying genuine caring and investment; and 3) Improving accessibility of comprehensive RSH services after cancer. Results revealed concrete strategies for improving patient-centered RSH communication at the patient-provider and health system levels. These included reminding patients that RSH concerns are common, routinely asking about RSH, using active listening, and connecting patients to HCP who can address their RSH concerns.
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Affiliation(s)
- Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | - Julia H Drizin
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | - Ellie Smith
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | | | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
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30
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Coker Appiah L, Fei YF, Olsen M, Lindheim SR, Puccetti DM. Disparities in Female Pediatric, Adolescent and Young Adult Oncofertility: A Needs Assessment. Cancers (Basel) 2021; 13:5419. [PMID: 34771582 PMCID: PMC8582476 DOI: 10.3390/cancers13215419] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Advancements in cancer screening and implementation of targeted treatments have significantly improved survival rates to 85% for pediatric and AYA survivors. Greater than 75% of survivors will live to experience the long-term adverse outcomes of cancer therapies, termed late effects (LE), that disrupt quality of life (QoL). Infertility and poor reproductive outcomes are significant disruptors of QoL in survivorship, affecting 12-88% of survivors who receive at-risk therapies. To mitigate risk, fertility preservation (FP) counseling is recommended as standard of care prior to gonadotoxic therapy. However, disparities in FP counseling, implementation of FP interventions, and screening for gynecologic late effects in survivorship persist. Barriers to care include a lack of provider and patient knowledge of the safety and breadth of current FP options, misconceptions about the duration of time required to implement FP therapies, cost, and health care team bias. Developing strategies to address barriers and implement established guidelines are necessary to ensure equity and improve quality of care across populations.
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Affiliation(s)
- Leslie Coker Appiah
- Division of Academic Specialists in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Denver, CO 80045, USA
- Pediatric and Adolescent Gynecology, Children’s Hospital Colorado, Denver, CO 80045, USA
| | - Yueyang Frances Fei
- Pediatric and Adolescent Gynecology, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Mallery Olsen
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
| | - Steven R. Lindheim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wright State University, Dayton, OH 45409, USA;
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Diane M. Puccetti
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
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31
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Diesch-Furlanetto T, Rovó A, Galimard JE, Szinnai G, Dalissier A, Sedlacek P, Bodova I, Roussou VK, Gibson BE, Poiré X, Fagioli F, Pichler H, Faraci M, Gumy-Pause FG, Dalle JH, Balduzzi A, Bader P, Corbacioglu S. Pregnancy and pregnancy outcomes after hematopoietic stem cell transplantation in childhood: a cross-sectional survey of the EBMT Pediatric Diseases Working Party. Hum Reprod 2021; 36:2871-2882. [PMID: 34529796 DOI: 10.1093/humrep/deab199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the characteristics of patients with conceptions transplanted in childhood and adolescence? SUMMARY ANSWER Insemination and conception after hematopoietic stem cell transplantation (HCT) in childhood or adolescence was possible, even after myeloablative conditioning regimes, although some patients required reproductive medicine support. WHAT IS KNOWN ALREADY Preparative regimens of HCT are highly gonadotoxic, which leads to gonadal failure and pubertal development disorders. There are few population-based studies assessing the risk of future infertility in children after HCT. STUDY DESIGN, SIZE, DURATION We conducted a retrospective study to investigate natural or assisted conceptions and their outcomes in patients <18 years old before their first transplantation who received HCT between 1995 and 2016 and were in the European Society for Blood and Marrow Transplantation (EBMT) registry. Adoptions were excluded from the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Detailed information concerning pregnancy occurrences and outcomes were obtained by a separate questionnaire. Quantitative variables were presented as medians with their interquartile range (IQR) or range, and categorical variables were presented as frequencies and percentages. MAIN RESULTS AND THE ROLE OF CHANCE In total, 62 988 pediatric patients received a first HCT in EBMT centers between 1995 and 2016. Pregnancy was reported in 406 patients in the database. The median age at transplantation was 15.7 (range: 0.7-18) years, and the median age at declared conception was 25.0 (range: 16.3-38.8) years. Details concerning the first pregnancy and pregnancy outcome were obtained from 99 patients (24%) from the returned questionnaires. The median age at delivery or pregnancy interruption of the females was 23.0 (IQR: 20.8-27) years, with a median time after transplant of 10.7 (IQR: 6.6-15.4) years. Compared with the mean age of healthy women at their first child's birth (29 years old), the transplanted women delivered 5 years earlier (mean: 24.3 years). In terms of conception modality, 13/25 (52%) females conditioned with total body irradiation (TBI) and 50/52 (96%) of those conditioned without TBI conceived naturally. All seven male patients who had been conditioned with TBI achieved fatherhood but required assisted fertilization or used their cryopreserved sperm. In the females, 63/70 (90%) of all conceptions resulted in a live birth, 49/63 (84.5%) were at term and 43/46 (93%) had normal birthweight. Cesarean delivery was performed in 9/61 (15%) especially in women who had received a myeloablative regimen. LIMITATIONS, REASONS FOR CAUTION In the EBMT pediatric dataset, the age at last follow-up or death was <17 years for 75% of the patients, therefore a longer follow-up for all patients would be necessary to calculate the cumulative incidence of conception for patients transplanted during childhood and allow all patients to realize their reproductive willingness/potential. WIDER IMPLICATIONS OF THE FINDINGS Reproductive health surveillance and fertility preservation counseling are important in younger transplanted patients. Our results showed that there is a window of opportunity to conceive naturally or with reproductive medicine support. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by the 'Stiftung für krebskranke Kinder Regio Basiliensis', Basel, Switzerland. All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- T Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, UKBB, University of Basel, Basel, Switzerland
| | - A Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - G Szinnai
- Division of Pediatric Endocrinology/Diabetology, University Children's Hospital Basel, UKBB, University of Basel, Basel, Switzerland
| | | | - P Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - I Bodova
- Pediatric University Teaching Hospital, BMT Unit, II Children's Clinic, Bratislava, Slovakia
| | - V K Roussou
- St. Sophia Children's Hospital, Oncology Center, "MARIANNA V. VARDINOGIANNIS-ELPIDA", BMT Unit, Athens, Greece
| | - B E Gibson
- Department of Hematology, Royal Hospital for Children, Schiehallion Ward (Ward 2A), Glasgow, UK
| | - X Poiré
- Department of Hematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - F Fagioli
- Onco-Ematologia Pediatrica, Centro Trapianti Cellule Staminali, Ospedale Infantile Regina Margherita, Turin, Italy
| | - H Pichler
- Department of Pediatrics, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - M Faraci
- Dipartimento di Emato-Oncologia Pediatrica, Centro Trapianti Cellule Staminali, Institute G. Gaslini, Genova, Italy
| | - F G Gumy-Pause
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - J H Dalle
- Department of Pediatric Hematology, Hôpital Robert Debré, GH APHP-Nord Université de Paris,Paris, France
| | - A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - P Bader
- Division of Stem-Cell Transplantation and Immunology, Hospital for Children and Adolescents of Frankfurt, Frankfurt, Germany
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem-Cell Transplantation, University of Regensburg, Regensburg, Germany
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Biskup E, Xin Z, Li R, Zucal JP, Lu Y, Sun Y, Appiah LC, Lindheim SR, Zhang H. Oncofertility Knowledge and Communication: Comparison Between Medical and Surgical Oncologists and Breast Cancer Patients in Academic Chinese Centers. Front Surg 2021; 8:681614. [PMID: 34557514 PMCID: PMC8453209 DOI: 10.3389/fsurg.2021.681614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: As cancer has become a major public health issue in China, fertility preservation remains limited despite the wide application of Assisted Reproductive Technology (ART) throughout the country. Objective: This study aimed to identify gaps in knowledge and communication as well as referrals in the previous year regarding oncofertility among medical and surgical oncologists and breast cancer patients (BCPs) in Chinese academic settings to target areas of needed improvement. Materials and Methods: A WeChat online questionnaire was designed, distributed, and compared between medical and surgical oncology specialists and reproductive age BCPs in academic teaching settings in Shanghai. Results: Sixty-one medical and surgical oncologists and 125 BCPs responded to the survey. 63.3% of oncologists were familiar with the term “oncofertility” compared to 25.6% of BCPs (p < 0.001). Oncologists were more likely to correctly know the costs associated with treatment (59.0 vs. 32.0%, p < 0.001); patient did not have to be married to undergo oncofertility treatment (50.8 vs. 24.8%, p < 0.001). Both oncologists and BCPs were similarly unlikely to know when patients could utilize cryopreserved tissue in the future (37.7 vs. 22.2%, p = 0.056). While oncologists reported they discussed all oncofertility options (41.0%) and offered psychological counseling (98.4%), significantly fewer BCPs reported receiving information on all options and offered counseling (3.2%, p < 0.001 and 85.6%, p < 0.01). Knowledge of oncofertility was the most important predictor for providing and receiving counseling from oncologists [OR = 6.44 (95% CI = 1.59–26.1, p = 0.009] and BCPs (OR = 3.73 95% CI: = 1.36–10.2, p = 0.011). Overall, 57.4% of oncologists referred <10 patients and none referred more than 25 patients in the past year. Conclusion: Data suggests a significant knowledge gap and ineffective communication/comprehension exists between academic Chinese oncologists and BCPs. Continued education and raised awareness are needed to optimize utilization of oncofertility services in China.
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Affiliation(s)
- Ewelina Biskup
- Department of Medical Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Basic and Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China.,International Center for Multimorbidity and Complexity in Medicine (ICMC), Universität Zürich, Zürich, Switzerland
| | - Zhaochen Xin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rui Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - John P Zucal
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States
| | - Yao Lu
- Center for Reproductive Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Leslie Coker Appiah
- Department of Obstetrics and Gynecology, The University of Colorado, Denver, CO, United States
| | - Steven R Lindheim
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States.,Center for Reproductive Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hongwei Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Micaux C, Wiklander M, Eriksson LE, Wettergren L, Lampic C. Efficacy of Fex-Can Fertility, a web-based psychoeducational intervention for young adults with fertility-related distress following cancer: a randomized controlled trial. (Preprint). JMIR Cancer 2021; 8:e33239. [PMID: 35348459 PMCID: PMC9006131 DOI: 10.2196/33239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/18/2021] [Accepted: 02/07/2022] [Indexed: 01/02/2023] Open
Affiliation(s)
- Claire Micaux
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Lena Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
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34
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Gerstl B, Signorelli C, Wakefield CE, D'Souza C, Deans R, Vaishnav T, Johnston K, Neville KA, Cohn RJ, Anazodo A. Feasibility, acceptability and appropriateness of a reproductive patient reported outcome measure for cancer survivors. PLoS One 2021; 16:e0256497. [PMID: 34449779 PMCID: PMC8396734 DOI: 10.1371/journal.pone.0256497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cancer patients can experience a number of reproductive complications as a result of cancer treatment and may benefit from reproductive preventative health strategies. A Reproductive Survivorship Patient Reported Outcome Measure (RS-PROM) is not currently available but could assist patients address reproductive concerns. Purpose To develop and test the acceptability, feasibility and appropriateness of a RS-PROM tool to be used to assess reproductive needs of cancer survivors aged 18–45 years. Methods We reviewed the outcomes of a recently published audit of reproductive care provided in our cancer survivorship clinic to identify gaps in current service provided and used this along with available validated reproductive measures, to develop this pilot RS-PROM. Survivors aged 18–45 years either attending the SCH survivorship clinic over a 1-year period or participants on the Australasian Oncofertility Registry (AOFR) who had agreed to be contacted for future research studies were asked to complete the RS-PROM and a questionnaire on the acceptability, feasibility and appropriateness of content included. Results One-hundred and fifty patients participated (61.3% females). Median age at cancer diagnosis was 24.5 years (range: 2–45 years). Eighty percent of participants reported the length of the RS-PROM was “just right”, 92% agreed they would not mind completing the RS-PROM and 92.7% were willing to answer all questions, with 97% agreeing that the RS-PROM would be an important tool in addressing difficult sexual/reproductive topics concerning with healthcare professionals. Conclusion The large majority of survivors participating in our pilot study found the RS-PROM to be an acceptable, feasible and useful tool to assist discussions of their sexual and reproductive health concerns and experiences with their clinical team.
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Affiliation(s)
- Brigitte Gerstl
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Chantelle D'Souza
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Department of Gynaecology, the Royal Hospital for Women, Sydney, NSW, Australia.,Fertility Research Centre, the Royal Hospital for Women, Sydney, NSW, Australia
| | - Tejnei Vaishnav
- Fertility Research Centre, the Royal Hospital for Women, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Kristen A Neville
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Department of Endocrinology, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
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35
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Trosman JR, Weldon CB, Rapkin BD, Benson AB, Makower DF, Liang SY, Kulkarni SA, Perez CB, Lo SS, Krueger EA, Throckmorton AD, Gallagher C, Hoskins K, Schaeffer CM, Van Horn J, Schapira L, Ravelo A, Yu E, Gradishar WJ. Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non-Safety-Net Centers. JCO Oncol Pract 2021; 17:e1202-e1214. [PMID: 34375560 DOI: 10.1200/op.21.00161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non-safety-net institutions. METHODS Ten institutions (five safety-net and five non-safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort. RESULTS Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non-safety-net centers (87.6%, 74.2%, P = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P < .001) and ability to manage care (78.9%, 72.1%, P = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P = .045) and flu vaccination (38.6%, 27.9%, P = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non-safety-net patients, even after controlling for all other variables. CONCLUSION 4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non-safety-net patients, indicating that 4R may reduce care disparities.
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Affiliation(s)
- Julia R Trosman
- Center for Business Models in Healthcare, Glencoe, IL.,Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christine B Weldon
- Center for Business Models in Healthcare, Glencoe, IL.,Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bruce D Rapkin
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Al B Benson
- Northwestern Medicine, Chicago, IL.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Su-Ying Liang
- Sutter Health-Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Swati A Kulkarni
- Northwestern Medicine, Chicago, IL.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Shelly S Lo
- Loyola University Medical Center, Maywood, IL
| | | | | | | | - Kent Hoskins
- Division of Medical Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Cathleen M Schaeffer
- Division of Medical Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Jennifer Van Horn
- Banner MD Anderson Cancer Center, Loveland, CO, Formerly Cheyenne Regional Medical Center, Cheyenne, WY
| | - Lidia Schapira
- Stanford University and Stanford Cancer Institute, Stanford, CA
| | | | - Elaine Yu
- Genentech Inc, South San Francisco, CA
| | - William J Gradishar
- Northwestern Medicine, Chicago, IL.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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Hoffman A, Crocker L, Mathur A, Holman D, Weston J, Campbell S, Housten A, Bradford A, Agrawala S, Woodard TL. Patients' and Providers' Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment. JMIR Form Res 2021; 5:e25083. [PMID: 34096871 PMCID: PMC8218210 DOI: 10.2196/25083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. OBJECTIVE This study aims to assess providers' and survivors' fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. METHODS Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. RESULTS A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. CONCLUSIONS Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors' optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women's clinical characteristics and their information-seeking and deliberative styles.
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Affiliation(s)
- Aubri Hoffman
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Laura Crocker
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aakrati Mathur
- Department of Biostatistics, The University of Texas at Arlington, Arlington, TX, United States
| | - Deborah Holman
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - June Weston
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sukhkamal Campbell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Ashley Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Shilpi Agrawala
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Terri L Woodard
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
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Ussher JM, Perz J, Hawkey AJ. A randomized controlled evaluation of an educational resource to address fertility concerns after cancer. Psychooncology 2021; 30:1442-1448. [PMID: 33860553 DOI: 10.1002/pon.5703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study evaluated the acceptability and impact of a written oncofertility educational resource (ER), as a self-help intervention (SH), and as an adjunct to a one-hour health-care professional discussion (HP). METHODS Within a randomized control trial (RCT), 194 adults with cancer (175 womens; 19 mens) were allocated to the SH or HP intervention. 127 completed 6-weeks post-intervention measures, a retention rate of 65.85%. RESULTS Across interventions, the ER was rated as highly acceptable and useful, in terms of ease of understanding, and information. Heath literacy significantly increased post-intervention, including functional literacy, communicative literacy, and critical health literacy. There were no significant changes in ratings of fertility distress or general distress pre-post intervention. Quality of life was significantly reduced post intervention. Those in the HP condition reported higher quality of life and greater likelihood of communication with others about fertility, most notably with intimate partners, post-intervention. Qualitative identification of increased knowledge, confidence with communication and normalization of fertility concerns, reflects increased health literacy, and provides explanation for significant reductions in feeling nervous and fearful about fertility treatments post-intervention. CONCLUSIONS Our findings confirm the importance of information provision about the impact of cancer on fertility. Written ERs are a useful adjunct to a patient-clinician discussion, increasing health literacy, which facilitates knowledge, self-efficacy and management of fertility concerns and changes.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
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Salsman JM, Yanez B, Snyder MA, Avina AR, Clayman ML, Smith KN, Purnell K, Victorson D. Attitudes and practices about fertility preservation discussions among young adults with cancer treated at a comprehensive cancer center: patient and oncologist perspectives. Support Care Cancer 2021; 29:5945-5955. [PMID: 33763727 DOI: 10.1007/s00520-021-06158-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young adults (YAs, ages 18-39) diagnosed with cancer face multiple challenges that affect their health-related quality of life, including the potential for cancer-related infertility. Providing information about the risk of infertility and options to maintain fertility is critical for YAs who are newly diagnosed. However, barriers to effective communication exist for oncologists and their patients. The purpose of this study was to interview medical oncologists and YAs from the same cancer center to examine attitudes and practices about fertility preservation. METHODS Semi-structured interviews were conducted with medical oncologists (N=12) and YAs within 2 years post-treatment (N=24), representing the most common cancers affecting YAs. Interviews were audio-recorded, transcribed, and coded using qualitative methodologies with the analysis software NVivo 10. RESULTS Twelve oncologists (50% female, 67% <50 years) and 24 YAs (67% female, M=29 years) completed interviews. Common themes across oncologist and YA interviews were the roles of cancer type or stage and patient interest or parity in influencing the decision. The most important factor for YAs was to receive accurate, in-depth information. Unique themes for oncologists focused on clinical aspects of their patient's disease. For YAs, they shared about the emotional impact of cancer-related infertility and desire for support from trusted others. CONCLUSIONS Results provide a better understanding of the attitudes and practices about fertility preservation discussions among YAs. Given the common factors affecting fertility preservation decisions, models of shared decision-making may be ideal for YAs and oncologists. Future interventions should explore tailored applications of this approach for YAs newly diagnosed with cancer.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine & the Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Mallory A Snyder
- Office of Research and National Laboratories, The University of Chicago, Chicago, IL, USA
| | - Alexis R Avina
- San Diego County Health and Human Services Agency, San Diego, CA, USA
| | - Marla L Clayman
- General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristin N Smith
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
- Center for Fertility and Reproductive Medicine, Northwestern Medicine, Chicago, IL, USA
| | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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How Do Young Women with Cancer Experience Oncofertility Counselling during Cancer Treatment? A Qualitative, Single Centre Study at a Danish Tertiary Hospital. Cancers (Basel) 2021; 13:cancers13061355. [PMID: 33802795 PMCID: PMC8002475 DOI: 10.3390/cancers13061355] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk of therapy-induced infertility. The importance of initial and specialized fertility counselling to this patient group is undisputed. Despite international guidelines, oncofertility counselling is still inadequate. The purpose of this study was to examine how female AYA cancer patients and survivors experienced initial and specialized oncofertility counselling, and to present their specific suggestions on how to improve the oncofertility counselling. METHODS Twelve individual semi-structured interviews were performed with AYAs aged 20-35 with cancer or who were survivors. Participants were recruited via a youth support centre and social organization for AYAs with cancer. Data was analysed using thematic analysis. RESULTS Three main themes were found: Support is needed for navigating the fertility information jungle; The doctor's approach determines the content of the patient consultation; Inadequate and worrying information causes mistrust and frustration. CONCLUSION Results indicate a continuing problem regarding insufficient oncofertility counselling to AYAs with cancer. To ensure adequate and uniform information, especially in the initial oncofertility counselling, national guidelines for oncology specialists are suggested including multidisciplinary effort and collaboration between oncology and fertility specialists in mind. In addition, participants suggest focus on communication skills.
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van den Berg M, van der Meij E, Bos AME, Boshuizen MCS, Determann D, van Eekeren RRJP, Lok CAR, Schaake EE, Witteveen PO, Wondergem MJ, Braat DDM, Beerendonk CCM, Hermens RPMG. Development and testing of a tailored online fertility preservation decision aid for female cancer patients. Cancer Med 2021; 10:1576-1588. [PMID: 33580749 PMCID: PMC7940215 DOI: 10.1002/cam4.3711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Decision making regarding future fertility can be very difficult for female cancer patients. To support patients in decision making, fertility preservation decision aids (DAs) are being developed. However, to make a well-informed decision, patients need personalized information tailored to their cancer type and treatment. Tailored cancer-specific DAs are not available yet. METHODS Our DA was systematically developed by a multidisciplinary steering group (n = 21) in an iterative process of draft development, three rounds of alpha testing, and revisions. The drafts were based on current guidelines, literature, and patients' and professionals' needs. RESULTS In total, 24 cancer-specific DAs were developed. In alpha testing, cancer survivors and professionals considered the DA very helpful in decision making, and scored an 8.5 (scale 1-10). In particular, the cancer-specific information and the tool for recognizing personal values were of great value. Revisions were made to increase readability, personalization, usability, and be more careful in giving any false hope. CONCLUSIONS A fertility preservation DA containing cancer-specific information is important in the daily care of female cancer patients and should be broadly available. Our final Dutch version is highly appraised, valid, and usable in decision making. After evaluating its effectiveness with newly diagnosed patients, the DA can be translated and adjusted according to (inter)national guidelines.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Elleke van der Meij
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Annelies M. E. Bos
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | | | | | - Christianne A. R. Lok
- Centre for Gynecological Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Eva E. Schaake
- Department of RadiotherapyThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | | | - Marielle J. Wondergem
- Department of HematologyVU University Medical Center AmsterdamAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
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Benedict C, Dauber-Decker KL, King D, Hahn A, Ford JS, Diefenbach M. A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype. JMIR Form Res 2021; 5:e20841. [PMID: 33480848 PMCID: PMC7864768 DOI: 10.2196/20841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients' needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users' needs, values, abilities, and limitations. OBJECTIVE This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building. METHODS User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed. RESULTS The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process. CONCLUSIONS The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Palo Alto, CA, United States
- Stanford Cancer Institute, Palo Alto, CA, United States
| | | | - D'Arcy King
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Alexandria Hahn
- Albert Einstein College of Medicine, The Bronx, NY, United States
| | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, NY, United States
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Hawkey A, Ussher JM, Perz J, Parton C. Talking but not always understanding: couple communication about infertility concerns after cancer. BMC Public Health 2021; 21:161. [PMID: 33468106 PMCID: PMC7816453 DOI: 10.1186/s12889-021-10188-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer related infertility can have an impact on couple relationships, with evidence that couple communication facilitates coping. However, little is known about the ways in which couples communicate about cancer-related fertility concerns. The aim of this article is to examine couple communication about fertility concerns in the context of cancer, and the perceived quality of such communication from the perspective of cancer survivors and their partners. METHODS Eight-hundred and seventy-eight cancer survivors (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey which examined cancer related fertility concerns. Seventy-eight survivors (61 women and 17 men), and 26 partners (13 women and 13 men), participated in semi-structured interviews, in order to examine the subjective experience of fertility concerns in-depth. Thematic analysis was used to analyse the interviews and open ended survey questions. Valid percentages for single items from the relationships subscale of the Fertility Preservation Inventory (FPI) related to qualitative themes, identified frequency of responses. RESULTS The major theme was 'talking but not always understanding". 89.6% of cancer survivors and partners (95.1%) reported working well together handling fertility questions (FPI), but agreed that communication could be improved (65.9% survivors; 65% partners). Open and honest couple communication was associated with feelings of support, understanding and relationship growth, including perception of partner comfort (79.2% survivors, 81.6% partners). However, 32% survivors and 31.1% partners concealed fertility concerns to avoid upsetting their partner, or reported that their partner doesn't understand their fertility concerns (survivors 25.5%, partners 14.6%), with 14.1% of cancer survivors and 19.4% partners reporting fear of relationship breakdown because of fertility issues. Fear of rejection when forming new relationships, and concerns about how to talk to future partners, was reported by non-partnered individuals. CONCLUSION Health-care professionals should include partners of cancer survivors in fertility discussions. Couple interventions developed in general psycho-oncology should be extended to the domain of fertility, in order to facilitate effective couple communication. Communication in future relationships needs to be addressed for single people and adolescents and young adults (AYAs) who have fertility concerns.
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Affiliation(s)
- Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
| | - Chloe Parton
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
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Di Mattei VE, Perego G, Rancoita PMV, Taranto P, Carnelli L, Mangili G, Sarais V, Bergamini A, Candiani M. Psychological Aspects Associated With Fertility Preservation in Oncology: An Exploratory Study. Front Psychol 2021; 11:608651. [PMID: 33414749 PMCID: PMC7783324 DOI: 10.3389/fpsyg.2020.608651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Gonadotoxicity is considered one of the most distressing side effects of cancer treatment. Although fertility preservation can be a valid solution, it also involves a challenging process. A clear understanding of the features of women who decide to pursue fertility preservation after cancer diagnosis is missing. The purpose of the present study was therefore to analyze the personality profile of female patients referred to oncofertility prior to gonadotoxic treatment. Methods Fifty-two female cancer patients took part in the study. The Temperament and Character Inventory-Revised (TCI-R), the Response Evaluation Measure-71 (REM-71), the Beck Depression Inventory (BDI-II), and the State-Trait Anxiety Inventory-Y Form (STAI-Y) were administered to examine personality characteristics, defense mechanisms, depression and anxiety symptoms. Results Compared with reference data of the Italian population, our sample reported significantly lower scores in Harm Avoidance and trait anxiety, and significantly higher levels of mature defense mechanisms. Most of the patients reported low scores in immature defense mechanisms, depression, and trait anxiety, and medium scores in state anxiety. Conclusions Our findings suggest that these women display functional personality traits and defensive style, in association with low levels of depression and trait anxiety. These features may enable a proactive attitude to cancer and the ability to make long-term plans. This may favor psychological adjustment to cancer and a projection toward the future.
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Affiliation(s)
- Valentina Elisabetta Di Mattei
- Division of Neuroscience, Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gaia Perego
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Paola Maria Vittoria Rancoita
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Taranto
- Division of Neuroscience, Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Carnelli
- Division of Neuroscience, Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Sarais
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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44
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Silva SD, Boer R, Cruz LAPD, Gozzo TDO. Fertilidade e contracepção em mulheres com câncer em tratamento quimioterápico. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2019-0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo identificar em mulheres em idade reprodutiva, com câncer e durante o tratamento quimioterápico, as orientações sobre preservação de fertilidade e planejamento reprodutivo e conhecer as informações fornecidas pela equipe de saúde. Métodos estudo descritivo, realizado com mulheres na pré-menopausa, com diagnóstico de câncer e em tratamento quimioterápico. A coleta de dados foi realizada com apoio de um instrumento com informações sociodemográficas, sobre o câncer e seus tratamentos, informações referentes a preservação de fertilidade e uso de métodos contraceptivos antes e após o diagnóstico do câncer. A análise dos dados foi feita por meio de estatística descritiva. Resultados a média de idade das 49 participantes foi de 38,2 anos (DP=6,1) e 79,6% estavam em tratamento devido ao câncer de mama. Quanto as informações recebidas sobre a importância do planejamento reprodutivo, 77,6% das participantes referiram que foram orientadas e 59,2% receberam tais orientações da equipe médica. Entretanto, em relação ao aconselhamento sobre métodos para manter a fertilidade, apenas, 6,1% das participantes foram orientadas. Conclusão e Implicações para a prática Deve-se considerar a relevância do aconselhamento especializado e a da manutenção de tomada de decisões ativas da mulher sobre a preservação de sua fertilidade.
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Garg R, Rebić N, De Vera MA. Information Needs About Cancer Treatment, Fertility, and Pregnancy: Qualitative Descriptive Study of Reddit Threads. JMIR Cancer 2020; 6:e17771. [PMID: 33263547 PMCID: PMC7744261 DOI: 10.2196/17771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/11/2020] [Accepted: 08/22/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A reproductive health implication of the increasing incidence of cancer among women is the impact of cancer treatment on fertility. OBJECTIVE As patients are increasingly using the internet, particularly online forums, to seek and share experiences, our objective was to understand information needs about cancer treatment, fertility, and pregnancy of women with cancer as well as their caregivers. METHODS We searched threads (original posts and responses) on four subreddit sites of Reddit ("r/Cancer," "r/TryingForABaby," "r/BabyBumps," and "r/Infertility") over a 5-year period between February 4th, 2014 and February 4th, 2019. Threads with original posts involving a lived experience or question regarding cancer treatment and female fertility and/or pregnancy or parenting/having children from the perspective of either patient or caregiver were included in our analysis. We analyzed threads using thematic analysis. RESULTS From 963 Reddit threads identified, 69 were analyzed, including 56 with original posts by women with cancer and 13 with original posts by caregivers. From threads made by patients, we identified themes on becoming a part of an online community, impacts of cancer treatment and fertility concerns on self and social relationships, making family planning decisions, and experiences with medical team. We also identified a theme on the impact of cancer treatment and fertility concerns on caregivers. CONCLUSIONS Reddit provided a rich pool of data for analyzing the information needs of women facing cancer. Our findings demonstrate the far-reaching impacts of cancer treatment and fertility on physical, mental, and psychosocial health for both patients and their caregivers.
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Affiliation(s)
- Ria Garg
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, BC, Canada
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46
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van den Berg M, Nadesapillai S, Braat DDM, Hermens RPMG, Beerendonk CCM. Fertility navigators in female oncofertility care in an academic medical center: a qualitative evaluation. Support Care Cancer 2020; 28:5733-5741. [PMID: 32198557 PMCID: PMC7686182 DOI: 10.1007/s00520-020-05412-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/13/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To explore patients' and professionals' experiences with fertility navigators in female oncofertility care. METHODS Semi-structured in-depth interviews were conducted with nine female cancer patients and six healthcare professionals to explore their experiences. They were recruited from an academic medical center (referral clinic for female fertility preservation care). Data were analyzed using the concepts of grounded theory. RESULTS Patients were satisfied about the supportive role of the fertility navigator in their fertility preservation process: fertility navigators added value as they became "familiar faces" and provided information, emotional support, personal care, and served as patients' primary contact person. The fertility navigators had a pleasant collaboration with professionals and supported professionals by taking over tasks. To improve the role of fertility navigators, it was suggested that they should always be present in fertility preservation counseling, and attention should be paid to their availability to improve continuity of care. CONCLUSION Fertility navigators provide personal care, improve satisfaction in patients in their oncofertility process, and support professionals. The overview of issues that need to be addressed when assigning fertility navigators in female oncofertility care combined with the improvement suggestions could be used by other centers when considering implementing fertility navigators.
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Affiliation(s)
- M van den Berg
- Radboud Institute for Health Sciences (RIHS), Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands.
| | - S Nadesapillai
- Radboud Institute for Health Sciences (RIHS), Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - D D M Braat
- Radboud Institute for Health Sciences (RIHS), Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - R P M G Hermens
- Radboud Institute for Health Sciences (RIHS), Department of IQ Healthcare, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - C C M Beerendonk
- Radboud Institute for Health Sciences (RIHS), Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
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Anderson RA, Amant F, Braat D, D'Angelo A, Chuva de Sousa Lopes SM, Demeestere I, Dwek S, Frith L, Lambertini M, Maslin C, Moura-Ramos M, Nogueira D, Rodriguez-Wallberg K, Vermeulen N. ESHRE guideline: female fertility preservation. Hum Reprod Open 2020; 2020:hoaa052. [PMID: 33225079 PMCID: PMC7666361 DOI: 10.1093/hropen/hoaa052] [Citation(s) in RCA: 244] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/02/2020] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What is the recommended management for women and transgender men with regards to fertility preservation (FP), based on the best available evidence in the literature? SUMMARY ANSWER The ESHRE Guideline on Female Fertility Preservation makes 78 recommendations on organization of care, information provision and support, pre-FP assessment, FP interventions and after treatment care. Ongoing developments in FP are also discussed. WHAT IS KNOWN ALREADY The field of FP has grown hugely in the last two decades, driven by the increasing recognition of the importance of potential loss of fertility as a significant effect of the treatment of cancer and other serious diseases, and the development of the enabling technologies of oocyte vitrification and ovarian tissue cryopreservation (OTC) for subsequent autografting. This has led to the widespread, though uneven, provision of FP for young women. STUDY DESIGN SIZE DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 November 2019 and written in English were included in the review. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help providers meet a growing demand for FP options by diverse groups of patients, including those diagnosed with cancer undergoing gonadotoxic treatments, with benign diseases undergoing gonadotoxic treatments or those with a genetic condition predisposing to premature ovarian insufficiency, transgender men (assigned female at birth), and women requesting oocyte cryopreservation for age-related fertility loss.The guideline makes 78 recommendations on information provision and support, pre-FP assessment, FP interventions and after treatment care, including 50 evidence-based recommendations-of which 31 were formulated as strong recommendations and 19 as weak-25 good practice points and 3 research only recommendations. Of the evidence-based recommendations, 1 was supported by high-quality evidence, 3 by moderate-quality evidence, 17 by low-quality evidence and 29 by very low-quality evidence. To support future research in the field of female FP, a list of research recommendations is provided. LIMITATIONS REASONS FOR CAUTION Most interventions included are not well studied in FP patients. As some interventions, e.g. oocyte and embryo cryopreservation, are well established for treatment of infertility, technical aspects, feasibility and outcomes can be extrapolated. For other interventions, such as OTC and IVM, more evidence is required, specifically pregnancy outcomes after applying these techniques for FP patients. Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in female FP, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in FP. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. R.A.A. reports personal fees and non-financial support from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA and Merck Serono, outside the submitted work; D.B. reports grants from Merck Serono and Goodlife, outside the submitted work; I.D. reports consulting fees from Roche and speaker's fees from Novartis; M.L. reports personal fees from Roche, Novartis, Pfizer, Lilly, Takeda, and Theramex, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.) †ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Frédéric Amant
- Department of Gynaecological Oncology, Academic Medical Centres Amsterdam, Amsterdam, The Netherlands.,Department of Gynaecology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oncology, Catholic University Leuven, Leuven, Belgium
| | - Didi Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Arianna D'Angelo
- Wales Fertility Institute, Swansea Bay Health Board, University Hospital of Wales, Cardiff University, Cardiff, UK
| | | | - Isabelle Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Lucy Frith
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | | | - Mariana Moura-Ramos
- Reprodutive Medicine Unit, Unit of Clinical Psychology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
| | - Daniela Nogueira
- Laboratory of Reproductive Biology, INOVIE Fertilité Clinique Croix du Sud, Toulouse, France
| | - Kenny Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Division of Gynaecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
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Anazodo AC, Choi S, Signorelli C, Ellis S, Johnston K, Wakefield CE, Deans R, Neville KA, Cohn RJ. Reproductive Care of Childhood and Adolescent Cancer Survivors: A 12-Year Evaluation. J Adolesc Young Adult Oncol 2020; 10:131-141. [PMID: 33180653 DOI: 10.1089/jayao.2020.0157] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Reproductive complications for cancer survivors are identified as one of the top unmet needs in the survivorship period. However, current models of cancer care do not routinely incorporate reproductive follow-up for pediatric or adolescent cancer patients. The Kids Cancer Centre has had a one-stop survivorship clinic that includes the attendance of a gynecologist and fertility specialist for the last 12 years. Methodology: To inform the future development of our reproductive survivorship care, we reviewed the reproductive care our survivorship clinic has provided over a 12-year period, specifically reviewing the electronic and patient records to collect information on the demographics of the patients who used the service and their gonadotoxic risk and associated fertility treatment, their documented reproductive needs and concerns, and information provided on preventative reproductive advice and screening. Main Results: Two hundred seventy-eight patients were seen (397 consultations) for advice and management of reproductive issues, including 189 female patients (68.0%). Survivors' median age at follow-up was 25.0 years (range = 6-50), on average 19.2 years from their primary diagnosis (range = 3-46). The reviewed data had five overarching themes (fertility care, hormone dysfunction, sexual dysfunction, fertility-related psychological distress due to reproductive concerns, and preventative health care), although each theme had a number of components. Patients had on average 2.5 reproductive concerns documented per consultation (range 1-5). The three most commonly documented symptoms or concerns at the initial consultation related to fertility status (43.9%), endocrine dysfunction (35.3%), and contraception advice (32.4%). In patients younger than 25 years, documented discussions were predominately about endocrine dysfunction, fertility status, and contraception, while dominant themes for 26-35-year olds were fertility status, reproductive-related health prevention strategies, contraception, and endocrine dysfunction. Survivors 36-45 years of age prioritized fertility status, pregnancy, and contraception. Fertility preservation (FP) (p = 0.05), preventative health strategies (p = 0.001), and contraception advice (p < 0.001) were more commonly discussed by females than males. Conclusion: Young cancer survivors have multiple ongoing reproductive concerns that change over time. Assessing survivors' reproductive potential following cancer treatment is important as it gives patients who have not completed their family planning an opportunity to explore a possible window to FP or Assisted Reproductive Treatment. Our data can assist in informing the model of care for a reproductive survivorship clinic.
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Affiliation(s)
- Antoinette Catherine Anazodo
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospitals, Sydney, Australia
| | - Sumin Choi
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia
| | - Christina Signorelli
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Sarah Ellis
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Claire E Wakefield
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Rebecca Deans
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Royal Hospital for Women, Sydney, Australia
| | - Kristen A Neville
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Department of Endocrinology, Sydney Children's Hospital, Sydney, Australia
| | - Richard J Cohn
- Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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49
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Hawkey AJ, Ussher JM, Perz J, Parton C, Patterson P, Bateson D, Hobbs K, Kirsten L. The impact of cancer-related fertility concerns on current and future couple relationships: People with cancer and partner perspectives. Eur J Cancer Care (Engl) 2020; 30:e13348. [PMID: 33084134 DOI: 10.1111/ecc.13348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to examine how cancer-related fertility concerns impact on couple relationships from the perspectives of people with cancer (PWC) and partners of people with cancer. METHODS A qualitative research design was used, drawing data from open-ended responses to a survey and in-depth individual interviews. Eight hundred and seventy-eight PWC (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey, and 78 PWC (61 women and 17 men) and 26 partners (13 women and 13 men), participated in semi-structured interviews. RESULTS Thematic analysis identified that many PWC and partners experience a 'double burden', manifested by cancer-related fertility concerns creating relational stress, changes to couple sexual intimacy and feelings of inadequacy when forming new relationships. However, many participants adopted strategies to facilitate coping with infertility or fertility concerns. This included acceptance of infertility and privileging of survival, focusing on relationship growth, optimism and nurturing in other ways. CONCLUSION Cancer-related fertility concerns can have a significant impact on couple relationships. Psychological support from clinicians may facilitate couple coping, as well as help to address concerns about future relationships for un-partnered people with cancer.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Chloe Parton
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | | | - Kim Hobbs
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Laura Kirsten
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, NSW, Australia
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50
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Okamoto S, Fujii N, Yoshioka N, Harada M, Tanimoto M, Maeda Y, Suzuki N, Osuga Y. Nationwide survey of fertility preservation in patients with hematological malignancies in Japan. Int J Clin Oncol 2020; 26:438-442. [PMID: 33068221 DOI: 10.1007/s10147-020-01801-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Worldwide, there has been a growing interest in oncofertility issues. In 2017, the Japanese Society of Clinical Oncology published clinical practice guidelines for fertility preservation (FP) in cancer patients. We conducted a questionnaire survey to explore the FP practices among hematologists before the publication of this guideline. METHODS We sent 427 designated cancer hospitals in Japan a questionnaire about FP treatment for patients with hematological malignancies between January and December 2014. RESULTS Of these, 137 institutions responded, and 81 (19.0%) were included in the analysis. A total of 324 female and 441 male patients, aged < 40 years, were treated. The percentage of patients informed about FP was higher in patients treated with hematopoietic cell transplant than those without. Female patients were less likely to be informed about FP than male patients. FP was performed in a total of 27 female patients: 20 oocyte cryopreservation, 2 embryo cryopreservation, 3 ovarian tissue cryopreservation, and 2 ovarian shielding during total body irradiation. Sperm cryopreservation was performed in 115 male patients. CONCLUSIONS Our findings indicate the reality of fertility preservation in 2014, before the guideline were issued. Further studies are warranted to investigate the improvement in fertility preservation since the guidelines were issued.
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Affiliation(s)
- Sachiyo Okamoto
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Norihito Yoshioka
- Department of Obstetrics and Gynecoclogy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecoclogy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecoclogy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecoclogy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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