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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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2
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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: 8] [Impact Index Per Article: 4.0] [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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3
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Shandley LM, Kipling LM, Spencer JB, Morof D, Mertens AC, Howards PP. Factors Associated with Unplanned Pregnancy Among Cancer Survivors. J Womens Health (Larchmt) 2021; 31:665-674. [PMID: 34860591 PMCID: PMC9133970 DOI: 10.1089/jwh.2021.0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Approximately half of all pregnancies in the United States are unintended. However, women who are diagnosed with cancer in their reproductive years may be a unique population. This study examines the prevalence of and identifies factors associated with unplanned pregnancy among cancer survivors. Methods: Female cancer survivors aged 22-45 years, diagnosed between ages 20-35 years and at least 2 years postdiagnosis, and women with no history of cancer were interviewed about their reproductive histories, including pregnancy intention. Using a random matching process, comparison women were assigned an artificial age at cancer diagnosis equal to that of her cancer survivor match. An adjusted Cox model was fit examining time to unintended pregnancy after cancer for each of 1,000 matches. Cox proportional hazards models were also fit to assess associations between participant characteristics and unplanned pregnancy after cancer among survivors. Results: Cancer survivors (n = 1,282) and comparison women (n = 1,073) reported a similar likelihood of having an unplanned pregnancy in models adjusted for race, income, history of sexually-transmitted infection, and history of unplanned pregnancy before diagnosis (adjusted hazard ratio [aHR] 1.06, 95% simulation interval 0.85-1.36). After adjusting for confounders, unplanned pregnancy among survivors was associated with age <30 years at diagnosis (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.32-2.44), black race (HR: 1.55, 95% CI: 1.13-2.12; referent: white), receiving fertility counseling (aHR: 1.41, 95% CI: 1.04-1.92), and having at least one child before diagnosis (aHR: 1.44, 95% CI: 1.05-1.97). Conclusion: Cancer survivors and comparison women had similar likelihood of unplanned pregnancy. Rates of unplanned pregnancy after cancer were not higher for cancer survivors compared with comparison women, but 46.4% of survivors with a postcancer pregnancy reported an unplanned pregnancy. Cancer patients may benefit from patient-centered guidelines and counseling before cancer treatment that covers both risks of infertility and risks of unplanned pregnancy.
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Affiliation(s)
- Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Diane Morof
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,U.S. Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Ann C Mertens
- Department of Pediatrics, Aflac Cancer Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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4
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Abstract
The 5 principal reasons a patient may consider fertility preservation are: treatment for cancer that may affect fertility, treatment for nonmalignant medical conditions that may affect fertility, planned indications, planned gender-affirming hormone therapy or surgery, or in the setting of genetic conditions that may increase the risks of premature ovarian insufficiency or early menopause. This paper will focus on describing who may consider preserving their fertility, how to provide the best clinical evaluation of those seeking fertility preservation, and current and future fertility preservation techniques. Last, we will highlight a need to continue to expand access to fertility preservation technologies.
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5
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Adams SC, Herman J, Lega IC, Mitchell L, Hodgson D, Edelstein K, Travis LB, Sabiston CM, Thavendiranathan P, Gupta AA. Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research. JNCI Cancer Spectr 2020; 5:pkaa099. [PMID: 33681702 PMCID: PMC7919337 DOI: 10.1093/jncics/pkaa099] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 12/23/2022] Open
Abstract
Survivors of adolescent and young adult cancers (AYAs) often live 50 to 60 years beyond their diagnosis. This rapidly growing cohort is at increased risk for cancer- and treatment-related 'late effects' that persist for decades into survivorship. Recognition of similar issues in pediatric cancer survivors has prompted the development of evidence-based guidelines for late effects screening and care. However, corresponding evidence-based guidelines for AYAs have not been developed. We hosted an AYA survivorship symposium for a large group of multidisciplinary AYA stakeholders (approximately 200 were in attendance) at Princess Margaret Cancer Centre (Toronto, Ontario, Canada) to begin addressing this disparity. The following overview briefly summarizes and discusses the symposium's stakeholder-identified high-priority targets for late effects screening and care and highlights knowledge gaps to direct future research in the field of AYA survivorship. This overview, although not exhaustive, is intended to stimulate clinicians to consider these high-priority screening and care targets when seeing survivors in clinical settings and, ultimately, to support the development of evidence-based late effects screening and care guidelines for AYAs.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Mental Health & Physical Activity Research Centre, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jennifer Herman
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Iliana C Lega
- Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kim Edelstein
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lois B Travis
- Division of Medical Oncology, Melvin and Bren Simon Cancer Centre, Indiana University, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Catherine M Sabiston
- Mental Health & Physical Activity Research Centre, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paaladinesh Thavendiranathan
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abha A Gupta
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Correspondence to: Abha A. Gupta, MD, MSC, FRCPC, Princess Margaret Cancer Centre, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada (e-mail: )
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6
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Abstract
Although a recognized condition, growing teratoma syndrome (GTS) has no guidelines for management, and patients diagnosed with the condition are managed empirically by the most appropriate teams. We report a case of GTS in a 33-year-old patient who was initially treated with unilateral salpingo-oophorectomy and subsequent chemotherapy for a germ cell ovarian tumor. GTS was subsequently diagnosed with massive pelvic and upper abdominal masses as well as lung tumors. We also conducted a literature review on cases of GTS presenting with large tumors. Based on this, we suggest a management plan to guide the care of women with GTS. The condition is best managed in a multidisciplinary team involving the relevant surgeons, including gynecologist, abdominal and thoracic surgeons. Growing teratoma syndrome (GTS) is a rare but recognized condition presenting with an abdominal mass in a woman with history of malignant ovarian tumor treated with chemotherapy. There are no established guidelines for the management of women diagnosed with GTS. We report a case of GTS in a 33-year-old patient requiring major abdominal and thoracic surgery. We also review the literature on previously published cases of GTS and propose a management plan to guide clinicians looking after women with GTS. Collaboration between different surgeons including gynecologists, abdominal and thoracic surgeons as well as radiologists and oncologist should be sought.
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7
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Ovarian Follicle Depletion Induced by Chemotherapy and the Investigational Stages of Potential Fertility-Protective Treatments-A Review. Int J Mol Sci 2019; 20:ijms20194720. [PMID: 31548505 PMCID: PMC6801789 DOI: 10.3390/ijms20194720] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 01/10/2023] Open
Abstract
Ovarian follicle pool depletion, infertility, and premature menopause are all known sequelae of cancer treatment that negatively impact the quality of life of young cancer survivors. The mechanisms involved in this undesired iatrogenic ovarian damage have been intensively studied, but many of them remain unclear. Several chemotherapeutic drugs have been shown to induce direct and indirect DNA-damage and/or cellular stress, which are often followed by apoptosis and/or autophagy. Damage to the ovarian micro-vessel network induced by chemotherapeutic agents also seems to contribute to ovarian dysfunction. Another proposed mechanism behind ovarian follicle pool depletion is the overactivation of primordial follicles from the quiescent pool; however, current experimental data are inconsistent regarding these effects. There is great interest in characterizing the mechanisms involved in ovarian damage because this might lead to the identification of potentially protective substances as possible future therapeutics. Research in this field is still at an experimental stage, and further investigations are needed to develop effective and individualized treatments for clinical application. This review provides an overview of the current knowledge and the proposed hypothesis behind chemotherapy-induced ovarian damage, as well as current knowledge on possible co-treatments that might protect the ovary and the follicles from such damages.
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8
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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9
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Letourneau J, Fair D. Oncofertility in urologic oncology: Fertility preservation for women undergoing cancer treatment. Urol Oncol 2019; 38:14-22. [PMID: 30826168 DOI: 10.1016/j.urolonc.2019.02.008] [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: 11/02/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
Thousands of reproductive age women are treated for urologic malignancies each year in the United States. Treatments for advanced bladder and renal cancers have the potential to affect future fertility in female patients. The American Society of Clinical Oncology and the American Society of Reproductive Medicine recognize the importance of fertility preservation, categorizing it as a necessary part of medical care. Iatrogenic infertility has a tremendous impact on quality of life in survivors' of cancer. Fertility preservation counseling and treatment can improve long-term quality of life, therefore access to such counseling and treatment should be expanded.
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Affiliation(s)
- Joseph Letourneau
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake city, UT; University of Utah School of Medicine Department of Pediatric Oncology and also with Primary Children's Hospital, Salt Lake City, UT.
| | - Douglas Fair
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake city, UT; University of Utah School of Medicine Department of Pediatric Oncology and also with Primary Children's Hospital, Salt Lake City, UT
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10
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Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK. Oncofertility-An emerging discipline rather than a special consideration. Pediatr Blood Cancer 2018; 65:e27297. [PMID: 29972282 PMCID: PMC6150802 DOI: 10.1002/pbc.27297] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
Originally absent from the oncologist's consult, then placed in a 'quality of life' rubric, oncofertility should now be an essential part of a comprehensive cancer treatment plan in patients of reproductive age, including adolescents and young adults (AYAs). Oncofertility encompasses the endocrine health of the patient, as well as fertility management options. Thus, pubertal transitions in males and females, bone health, and menstrual health are all part of this discipline, enabling practitioners to work in interdisciplinary teams to solve problems in reproductive health. This review provides a summary of the essential considerations required for the assessement of reproductive risk and choice of fertility preservation options as well as considerations for developing oncofertility services for AYAs.
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Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women’s and Children’s Hospital, University of New South Wales, Sydney
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology University of Melbourne Royal Women’s Hospital, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Rentea RM, Varghese A, Ahmed A, Kats A, Manalang M, Dowlut-McElroy T, Hendrickson RJ. Pediatric Ovarian Growing Teratoma Syndrome. Case Rep Surg 2017; 2017:3074240. [PMID: 28656118 PMCID: PMC5471592 DOI: 10.1155/2017/3074240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/03/2017] [Accepted: 05/03/2017] [Indexed: 12/31/2022] Open
Abstract
Ovarian immature teratoma is a germ cell tumor that comprises less than 1% of ovarian cancers and is treated with surgical debulking and chemotherapy depending on stage. Growing teratoma syndrome (GTS) is the phenomenon of the growth of mature teratoma elements with normal tumor markers during or following chemotherapy for treatment of a malignant germ cell tumor. These tumors are associated with significant morbidity and mortality due to invasive and compressive growth as well as potential for malignant transformation. Current treatment modality is surgical resection. We discuss a 12-year-old female who presented following resection of a pure ovarian immature teratoma (grade 3, FIGO stage IIIC). Following chemotherapy and resection of a pelvic/liver recurrence demonstrating mature teratoma, she underwent molecular genetics based chemotherapeutic treatment. No standardized management protocol has been established for the treatment of GTS. The effect of chemotherapeutic agents for decreasing the volume of and prevention of expansion is unknown. We review in detail the history, diagnostic algorithm, and previous reported pediatric cases as well as treatment options for pediatric patients with GTS.
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Affiliation(s)
- Rebecca M. Rentea
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Aaron Varghese
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Kansas City, MO, USA
| | - Atif Ahmed
- Department of Pathology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alexander Kats
- Department of Pathology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michelle Manalang
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tazim Dowlut-McElroy
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Kansas City, MO, USA
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12
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Letourneau J, Chan J, Salem W, Chan SW, Shah M, Ebbel E, McCulloch C, Chen LM, Cedars M, Rosen M. Fertility Sparing Surgery for Localized Ovarian Cancers Maintains an Ability to Conceive, but is Associated With Diminished Reproductive Potential. J Surg Oncol 2015; 112:26-30. [PMID: 26193338 DOI: 10.1002/jso.23942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/06/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about fertility outcomes after fertility sparing surgery (FSS) for localized ovarian cancers. METHODS A random sample of 783 women treated for ovarian cancer were identified from the California Cancer Registry for survey (age 18-40 years at diagnosis; diagnosed from 1993-2007). We evaluated outcomes including post-treatment amenorrhea, infertility, early menopause (age <45), and disease recurrence. Logistic regression was used to determine the probability of amenorrhea, infertility, and recurrence. Censored data methods were used to determine the probability of early menopause. RESULTS A total of 382 women replied. One hundred and sixteen and 266 completed our survey. Two hundred and forty-five reported treatment with potential to impact fertility (i.e., systemic chemotherapy ± radiation/surgery to the abdomen/pelvis). A total of 125 had disease/stage eligible for FSS and 82 (66%) underwent FSS. While many who attempted conception did conceive, 32% did not. Younger age at diagnosis was associated with higher rates of early menopause (P < 0.001) after FSS. Recurrence rates for those undergoing FSS were 8-10%, while none of the women who underwent non-FSS surgery had a recurrence. CONCLUSIONS FSS maintains an ability to conceive for most patients. However, after FSS, there may be risks of infertility, early menopause with earlier age of treatment, and increased probability of disease recurrence.
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Affiliation(s)
- Joseph Letourneau
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California.,Department of OBGYN, University of North Carolina, Chapel Hill, North Carolina
| | - Jessica Chan
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California.,Department of OBGYN, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wael Salem
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Sai-Wing Chan
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Meera Shah
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Erin Ebbel
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California.,Department of OBGYN, Cornell University, Ithaca, New York
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Lee-May Chen
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Marcelle Cedars
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Mitchell Rosen
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
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13
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Meissner J, Tichy D, Katzke V, Kühn T, Dietrich S, Schmitt T, Ziepert M, Kuhnt E, Rixecker T, Zorn M, Witzens-Harig M, Pfreundschuh M, Ho A. Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma. Ann Oncol 2015; 26:1771-6. [DOI: 10.1093/annonc/mdv227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/04/2015] [Indexed: 01/01/2023] Open
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14
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Sigismondi C, Papaleo E, Viganò P, Vailati S, Candiani M, Ottolina J, Di Mattei VE, Mangili G. Fertility preservation in female cancer patients: a single center experience. CHINESE JOURNAL OF CANCER 2015; 34:56-60. [PMID: 25556619 PMCID: PMC4302090 DOI: 10.5732/cjc.014.10252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advances in cancer treatment allow women to be cured and live longer. However, the necessary chemotherapy and radiotherapy regimens have a negative impact on future fertility. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer treatment and to facilitate fertility preservation, including oocyte and ovarian tissue cryopreservation. These fertility issues are often inadequately addressed, and referral rates to oncofertility centers are low. The aim of this study was to report the 3-year experience of the San Raffaele Oncofertility Unit. A total of 96 patients were referred to the Oncofertility Unit for evaluation after the diagnosis of cancer and before gonadotoxic treatment between April 2011 and June 2014. Of the 96 patients, 30 (31.2%) were affected by breast cancers, 20 (20.8%) by sarcomas, 28 (29.2%) by hematologic malignancies, 13 (13.5%) by central nervous system cancers, 3 (3.1%) by bowel tumors, 1 (1.0%) by Wilms' tumor, and 1 (1.0%) by a thyroid tumor; 47 (49.0%) were referred for oocyte cryopreservation before starting chemotherapy, 20 (20.8%) were referred for ovarian tissue cryopreservation, and 29 (30.2%) were not recruited. The mean time between the patients' counseling and oocyte retrieval was 15 days (range, 2–37 days). The mean time between the laparoscopic surgery and the beginning of treatment was 4 days (range, 2–10 days). The number of patients who were referred increased over time, whereas the rate of patients who were not recruited decreased, showing an improvement in referrals to the Oncofertility Unit and in the patients' counseling and understanding. Our results indicate that an effective multidisciplinary oncofertility team is necessary for prompt referrals and treatment.
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Affiliation(s)
- Cristina Sigismondi
- Gynecology Department, Preservation of Fertility Unit, IRCCS San Raffaele Hospital, Milano 20132, Italy.
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