The Voices of Young Women with Breast Cancer: Providing Support and Information for Improved Fertility Preservation Discussions

Patient-Reported Outcomes (PROs) and Patient Experiences in Fertility Preservation: A Systematic Review of the Literature on Adolescents and Young Adults (AYAs) with Cancer

With better survival rates for patients diagnosed with cancer, more attention has been focused on future risks, like fertility decline due to gonadotoxic treatment. In this regard, the emphasis during counselling regarding possible preservation options is often on the treatment itself, meaning that the medical and emotional needs of patients regarding counselling, treatment, and future fertility are often overlooked. This review focuses on patient-reported outcomes (PROs) and patient experiences regarding fertility preservation (FP)-among adolescents and young adults (AYAs) with cancer. A systematic review of the literature, with a systematic search of online databases, was performed, resulting in 61 selected articles. A quality assessment was performed by a mixed methods appraisal tool (MMAT). Based on this search, three important topics emerged: initiating discussion about the risk of fertility decline, acknowledging the importance of future fertility, and recognizing the need for more verbal and written patient-specific information. In addition, patients value follow-up care and the opportunity to rediscuss FP and their concerns about future fertility and use of stored material. A clear FP healthcare pathway can prevent delays in receiving a referral to a fertility specialist to discuss FP options and initiating FP treatment. This patient-centered approach will optimize FP experiences and help to establish a process to achieve long-term follow up after FP treatment.

Psychological and reproductive decision-making experiences of young women after breast cancer diagnosis: a qualitative study

BACKGROUND

Breast cancer has the highest incidence rate among malignant tumors in China, with a trend of affecting younger women. The treatment has short- and long-term adverse effects such as damage to the ovaries, which may result in infertility. Such consequences then increase patients' concerns over future reproduction. At present, nor do medical staffs continuously assess their overall well-being, or ensure that they have the knowledge necessary to manage their reproductive concerns. This qualitative study aimed to explore psychological and reproductive decision-making experiences of young women who had experienced childbirth after their diagnosis.

METHODS

The phenomenological research, as a kind of qualitative study, was conducted on 12 young women who experienced childbirth after breast cancer diagnosis. Data collection was from September 2021 to January 2022 and content analysis method was used to analyze the data.

RESULTS

Five main themes were identified: (1) desire for childbearing from individual, familial, and social aspects after the diagnosis of breast cancer; (2) emotional experiences through pregnancy till raising children; (3) support needs from professionals, family, and peer; (4) self and doctors' influencing factors on reproductive decision-making; and (5) satisfaction with the outcome of reproductive decision-making.

CONCLUSIONS

The desire for childbearing of young women should be considered during the reproductive decision-making process. A multidisciplinary team is suggested to be set up to provide professional support. During the reproductive process, professional and peer support should be strengthened to improve decision-making abilities, alleviate negative emotional experience, and smoothen the process of reproductive experience for young patients.

Perceptions and attitudes of medical oncologists regarding fertility preservation and pregnancy in high-risk cancer patients: A survey among Canadian medical oncologists

PURPOSE

Infertility is a critical late toxicity that impacts adolescent and young adult (AYA, ages 15-39 years) cancer survivors. International oncology societies recommend discussing fertility preservation (FP) for all AYA patients, regardless of stage or prognosis. We aim to understand Canadian medical oncologists' perceptions, attitudes, and knowledge toward FP and pregnancy in patients with cancer, including advanced stages and high risk for recurrence.

METHODS

An anonymous electronic survey utilizing hypothetical scenarios was sent to medical oncologists in the province of Ontario, Canada. Descriptive statistics were used to summarize all data. Logistic regression models were constructed to identify factors that predicted FP discussions and referrals.

RESULTS

The survey was received by 91 medical oncologists, and the response rate was 44%. Fifty-eight percent of respondents offer FP for all patients. Physicians are more likely to refer patients for FP before curative intent therapy than before palliative chemotherapy (95% vs. 39.5%, p < 0.001). Most respondents (86%) are comfortable discussing FP; however, only 31% self-reported feeling up-to-date on knowledge of current FP methods. Female physicians were more likely to report up-to-date knowledge and confidence discussing FP with patients. Forty percent of respondents identified that concerns about the welfare of the resulting offspring should not be a cause for denying patients assistance in reproduction.

CONCLUSION

There is a significant difference in physician attitude toward offering FP based on the cancer stage. Increased awareness of standard of care guidelines and resources for difficult situations may improve the frequency of discussions about FP in motivated cancer patients.

"Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research

This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.

Women's fertility decision-making with a diagnosis of breast cancer: A qualitative evidence synthesis

AIM

To synthesize qualitative evidence of premenopausal women's experiences of fertility decision-making with a diagnosis of breast cancer.

BACKGROUND

Breast cancer is increasingly more common in premenopausal women who may have not yet considered starting a family or have completed their families.

DESIGN

Qualitative evidence synthesis guided by Thomas and Harden's three-stage approach to thematic analysis.

DATA SOURCES

Twelve electronic databases were searched: CINAHL, Embase, Pubmed, Proquest, PsychINFO, Lenus, Scopus, Web of Science, Rian.ie, Medline, EThOS e-theses online and DART Europe. No year limit was set.

REVIEW METHODS

The 'Enhancing transparency in reporting the synthesis of qualitative research guidelines' (ENTREQ) statement was followed.

RESULTS

Fifteen qualitative studies were included in the synthesis. Seven review findings under four major themes were identified: (1) first comes survival, (2) making decisions 'under the gun', (3) health-care professionals should not make assumptions and (4) we want accurate, detailed information and we want it early. High confidence in six of the review findings was agreed.

CONCLUSION

Most women experienced rushed fertility preservation decision-making at a time when they also faced cancer treatment decisions. Women want detailed, clear information on fertility preservation early after their diagnosis.

Development and testing of a tailored online fertility preservation decision aid for female cancer patients

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.

Barriers and Facilitators to Fertility-Related Discussions with Teenagers and Young Adults with Cancer: Nurses' Experiences

Introduction: Improvements in cancer survival rates for teenagers and young adults (TYAs) have resulted in quality-of-life issues into survivorship becoming increasingly important. However, infertility is a potential late side effect of cancer treatment, which can negatively impact on quality of life. Advances in assisted reproductive technologies have resulted in increasingly effective fertility preservation (FP) options. Purpose: This study aimed to explore nurses' experiences of undertaking fertility-related discussions with TYAs with cancer aged 13-24 years. Methods: An interpretive phenomenological analysis (IPA) approach was used. Eleven purposively selected nurses working on a specialist TYA cancer unit participated in semistructured interviews. Data were analyzed using IPA. Results: Parents/family were experienced as self-appointed informal gatekeepers who were perceived to hold the power to control nurses' access to communicate with young people about fertility issues. Nurses adopted a supportive role, which was enhanced by the positive nature of their relationship with the TYA. Uncertainty was expressed over whether the TYA had been fully informed of their infertility risk and potential FP options. Conclusions: Nurses should manage parental involvement sensitively if TYAs are to make informed decisions regarding their future reproductive health. There is a need for clear role delineation in fertility discussions to ensure that TYAs are provided with the opportunity to discuss infertility risk and be referred to a specialist before initiating cancer treatment. Nurses should cultivate the primacy of the nurse-TYA relationship to improve fertility care. Further research into the factors that TYAs may consider beneficial within the nurse-patient relationship is required.