Defining and measuring reproductive concerns of female cancer survivors

Fertility preservation in young breast cancer patients: A nationwide survey on knowledge, attitudes, and practices among breast surgical healthcare providers in China

PURPOSE

Fertility preservation (FP) is a critical concern for young breast cancer (YBC) patients receiving gonadotoxic treatments. Breast surgical healthcare providers (HCPs) play a pivotal role in discussing FP options and facilitating timely referrals. This study aimed to assess the knowledge, attitudes, and practices of breast surgical HCPs in China regarding FP, identify barriers to FP discussions, and examine factors influencing referral practices.

METHODS

A nationwide cross-sectional survey was conducted from March to June 2023 among board-certified breast surgeons and nurses across China using a 24-item questionnaire. Participants were recruited via WeChat through BestOnco, a professional platform for oncology HCPs. The survey assessed FP knowledge, attitudes, clinical practices, and perceived barriers. Multivariate logistic regression was performed to determine factors associated with FP referral practices.

RESULTS

A total of 355 valid responses were analyzed. The mean FP knowledge score was 6.05 ± 1.94 (range 0-10), with 49.3 % of HCPs never consulting FP guidelines. While 82.8 % expressed a favorable attitude toward FP, only 42.3 % routinely discussed FP options, and 44.7 % referred patients to reproductive specialists. Major barriers included poor prognosis concerns (87.0 %), treatment urgency (67.9 %), and financial burden (60.0 %). Multivariate analysis revealed that higher FP knowledge (OR = 1.23, p < 0.0001), longer clinical experience (OR = 2.93, p = 0.001), and hospital-based FP integration (OR = 1.83, p < 0.0001) were significant predictors of referral.

CONCLUSIONS

Notable gaps were identified in FP knowledge, discussions, and referrals among breast surgical HCPs in China. Targeted FP training programs, culturally informed shared decision-making strategies, and oncofertility navigation systems are recommended to enhance FP service delivery and improve patient outcomes.

Fertility Preservation Discussions And Decisions: Results From a Pilot Randomized Controlled Trial Among Adolescent Males With Cancer

BACKGROUND/OBJECTIVES

The Family-centered Adolescent Sperm banking values clarification Tool (FAST) was developed to facilitate sperm banking communication and decision-making pre-cancer treatment. The FAST was tested in a pilot parallel randomized controlled trial (Fertility Preservation Discussions And Decisions: "FP-DAD"-NCT04268004), aiming to (i) assess feasibility/acceptability of FP-DAD; and (ii) examine efficacy regarding banking attempts (yes/no) and decision quality. Differences in decision quality by banking attempt were explored.

DESIGN/METHODS

Males (12-25 years, new cancer diagnosis) and caregivers were randomized to standard of care (fertility consult) or FP-DAD (fertility consult + FAST + interventionist-led discussion). One month later, FP-DAD participants completed acceptability surveys. Both arms completed the Brief Subjective Decision Quality measure. Descriptive statistics, chi-square, and independent samples t-tests/mixed-models examined relationships between variables.

RESULTS

Acceptability ratings of FP-DAD were high (88%-100%). Recruitment and participation challenges limited the final sample size (21 adolescents and 32 caregivers). Banking attempts (67% in standard of care vs. 82% in FP-DAD) did not differ by arm. While decision quality was not significantly different between groups, effect sizes were medium-large for four of six items for adolescents (d = 0.6 to -0.90) and two of six for caregivers (d = 0.36 to -0.78). Decision quality was significantly higher across several domains among those who banked.

CONCLUSIONS

FP-DAD had high acceptability, though feasibility challenges (e.g., time contraints) limited full family participation. Findings showed limited efficacy, but effect sizes suggest this may be due to sample size. Relationships between banking attempts and decision quality emphasize banking benefits. Findings will inform adaptations to the FAST for clinical implementation.

Psychological Aspects of and Support for Survivors Attempting to Conceive During or After Cancer Treatments: A Mixed-Methods Systematic Review

Advances in medical technology are expected to increase the possibilities for pregnancy for women during and after cancer treatment. We aimed to clarify the psychological dimensions of cancer diagnosis for patients hoping for a pregnancy (their own or their spouse/partner's) during or post-treatment and identify ways to improve support for these survivors and their families. A systematic literature review was conducted in May 2023 using six electronic databases: PubMed, Web of Science, Cochrane Library, PsycINFO, Ichushi-Web, and CINAHL. The search targeted English and Japanese studies with English abstracts published between January 1, 2001, and May 10, 2023. Search terms related to cancer, pregnancy, and psychological aspects were included. The initial search identified 1328 potentially relevant studies after removing duplicates. Subsequently, two reviewers screened article titles and abstracts to exclude studies with no data, those unrelated to pregnancy, and so on, and identified 44 potentially relevant studies. Two reviewers then reviewed the full text of each study, and 20 articles finally met the inclusion criteria. Several studies indicated that trying to conceive negatively impacts survivors' finances, their relationships with their spouses/partners, and their mental health. Although many participants required fertility counseling, few received such opportunities. When cancer survivors try to conceive, they experience physical, psychological, and social burdens; moreover, many report a lack of access to fertility counseling or sufficient information about reproductive health care. Health care professionals should provide patients with updated and more accurate information on reproductive medicine and fertility counseling to enhance pregnancy support during the survivorship phase.

Evaluation of physical function and quality of life before and after nonradical surgical therapy for stage IA1 and IA2-IB1 cervical cancer (GOG-0278)

OBJECTIVE

To examine patient outcomes before and after cone biopsy (CB) or simple hysterectomy (SH) and pelvic lymph node dissection (PLND) for bladder, bowel, and sexual function, quality of life (QOL), cancer worry, reproductive concerns, and lymphedema.

METHODS

We stratified women with stage IA1 (lymphovascular space invasion-positive) and IA2-IB1 (≤2 cm) cervical carcinoma by fertility preservation (CB) or none (SH) with PLND. All patients completed study questionnaires at baseline (preoperatively) and postoperatively at 4-6 weeks and 6-, 12-, 18-, and 24-months, consisting of: Functional Assessment Cancer Therapy - Cervical Cancer (FACT-Cx); Female Sexual Functioning Index (FSFI), and 2 Patient-Reported Outcomes Measurement Information System (PROMIS) items; Gynecologic Cancer Lymphedema Questionnaire (GCLQ); Impact of Events Scale (IES); and Reproductive Concerns Scale (RCS).

RESULTS

We enrolled 224 patients from 10/12 to 10/21, with 72 choosing CB and 152 SH. A total of 169 patients (54 CB; 115 SH) were eligible for QOL analysis and completed baseline assessment with at least one follow-up assessment. Postoperatively in both groups, bladder and bowel function slightly decreased but recovered over time, sexual function declined at 6 weeks but improved over time, QOL increased, and cancer worry decreased. As per the GCLQ, 12 patients reported a diagnosis of lymphedema with a GCLQ score change ≥4 (6 CB; 6 SH).

CONCLUSIONS

Nonradical surgery for early-stage cervical cancer is associated with excellent QOL and small decreases in physical function (bladder, bowel, sexual) that quickly improve postoperatively to baseline or above. Lymphedema rates were low but present in both groups.

Fertility preservation in female cancer patients: assessing awareness, attitudes, concerns, experiences, and the role of counseling in quality of life

BACKGROUND

Cancer poses significant fertility challenges for women of childbearing age, yet the adoption of fertility preservation (FP) measures remains limited. This study aimed to explore patients' understanding, attitudes, concerns, psychological well-being, and factors influencing their decisions regarding FP during treatment.

METHODS

This prospective cohort study involved women aged 18 to 42 diagnosed with non-metastatic breast cancer or lymphoma, treated at the American University of Beirut Medical Center. Patients completed questionnaires at intervals over a 2- to 3-year period following diagnosis.

RESULTS

Among the 123 women studied, 71.5% were married, and 13.5% had no children. Although 87.8% were informed about the fertility risks of their treatment, only 45.4% expressed a desire for FP. Multivariable analysis revealed that parity was significantly associated with fertility concerns (p = 0.019). Decisions favoring FP were significantly influenced by younger age at diagnosis, lower parity, and higher education levels (p = 0.001, p < 0.001, and p = 0.036, respectively). While 56% of patients received FP counseling-mostly from oncologists (83%)-the preference for FP methods varied, with 47% choosing medical approaches and 53% opting for procedural interventions. Despite recognizing the importance of FP, 91% reported that it did not significantly influence their treatment choices. Patients showed greater satisfaction when oncologists discussed fertility-related topics (p < 0.001). Over time, overall FertiQoL scores and DASS-42 scores indicated improved psychological well-being.

CONCLUSION

Our study highlights the complexities of FP decisions among cancer survivors, emphasizing the need for proper counseling to support their quality of life and psychological well-being.

Self-disclosure and reproductive concerns among breast cancer female patients: the chain mediation model of couples' cancer-related communication problems and relationship intimacy

PURPOSE

Reproductive concerns are prevalent in the female breast cancer patient population and increase existential distress. Although self-disclosure significantly correlated reproductive concerns, the exact mechanism of action is unknown. Based on previous theoretical studies on couples' cancer-related communication problems and intimacy in couples, this study constructed a chain mediation model to investigate whether the two variables mediate the relationship between self-disclosure and reproductive concerns.

METHODS

A cross-sectional survey was conducted from August 2023 to July 2024 at Jiangxi Cancer Hospital. A total of 280 female breast cancer patients completed the Distress Disclosure Index, Couples' Cancer-Related Communication Problems Scale, Quality Relationship Index, and Reproductive Concerns After Cancer Scale. Data description and Pearson's correlation analysis were performed through SPSS 26.0 software. Serial mediation effect analysis and testing were performed through Hayes' Process 4.1 program.

RESULTS

Self-disclosure was found to be negatively associated with reproductive concerns and couples' cancer-related communication problems, but positively associated with intimacy. After controlling for sociodemographic variables, including age, matrimonial, number of children, and hormone receptor, the direct effect of self-disclosure on reproductive concerns was significant (Effect =  - 0.320; 95% CI, - 0.465 to - 0.178). In addition, three other indirect pathways of action were also significant: (1) through couples' cancer-related communication problems (Effect =  - 0.113; 95% CI, - 0.181 to - 0.045), (2) through intimate relationships (Effect =  - 0.110, 95% CI - 0.187 to - 0.043), and (3) through the chain-mediated effects of couples' cancer-related communication problems and intimacy (Effect =  - 0.025; 95% CI, - 0.054 to - 0.007). The total indirect effect of the three pathways of action was 43.66%.

CONCLUSIONS

Self-disclosure not only directly affects reproductive concerns in female breast cancer patients, but also indirectly through couples' cancer-related communication problems and intimacy, as well as sequential mediation of the two. Interventions targeting the above factors can help promote self-disclosure in female breast cancer patients, reduce couples' cancer-related communication problems, and improve intimacy, thereby alleviating reproductive concerns after cancer.

Interventions to mitigate reproductive concerns in individuals with cancer: A systematic review

BACKGROUND

Individuals of reproductive age with cancer may experience reproductive concerns (RCs) due to impaired fertility and disrupted family planning, which can negatively impact their quality of life and psychological well-being. There is limited research on interventions that mitigate the negative effects of RCs among individuals with cancer.

OBJECTIVE

This systematic review aimed to identify and evaluate the effectiveness of interventions developed to mitigate RCs among individuals with cancer.

METHODS

This systematic review was conducted following the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of nine English and Chinese electronic databases including PubMed, Cochrane Library, CINAHL Plus, Embase, PsycINFO, Web of Science, Wan Fang Data, Chinese National Knowledge Infrastructure (CNKI), and SinoMed, was conducted for relevant studies from inception to November 2023. Intervention studies designed to mitigate RCs among individuals with cancer were included. Two reviewers independently performed study selection, data extraction, and quality appraisal where JBI Critical appraisal tools were used. Narrative syntheses were conducted to summarize the characteristics and effectiveness of interventions due to high heterogeneity across studies.

RESULTS

Nine studies were included. Interventions were categorized into psychoeducational interventions (n = 6), couple-based interventions facilitating open communication and intimate relationships (n = 2), and mindfulness-based interventions (n = 1). A statistically significant reduction in RCs was observed in five psychoeducational interventions, two couple-based interventions, and one mindfulness-based stress reduction intervention. The effect sizes (Cohen's d) of the interventions on RCs varied substantially from 0.08 to 5.66.

LINKING EVIDENCE TO ACTION

Psychoeducation, couple-based, and mindfulness-based interventions demonstrated promising findings in mitigating RCs among individuals with cancer. However, more randomized controlled trials with larger sample sizes and rigorous designs are warranted to strengthen the current evidence.

Future Directions for Gestational Trophoblastic Disease

Gestational trophoblastic disease encompasses a spectrum of premalignant and malignant conditions. While centralized care models significantly improve survival rates, many countries still lack such specialized centers, leading to preventable deaths. Current research focuses on refining diagnostic and treatment methods, aiming to better predict the risk of malignancy and reduce the need for aggressive therapies. Immunotherapy has emerged as a promising treatment modality, offering high cure rates with fewer side effects compared to traditional chemotherapy. Global efforts must continue to expand access to specialized care and integrate new therapies to improve outcomes and reduce treatment-related harm.

Quality of Life and Psychological Distress Related to Fertility and Pregnancy in AYAs Treated for Gynecological Cancer: A Systematic Review

BACKGROUND/OBJECTIVES

With growing survival rates for Adolescent and Young Adults (AYAs) diagnosed with gynecological cancer, the focus shifted to Quality of Life (QoL). Fertility-sparing surgery offers a viable alternative to standard, usually fertility-impairing treatments. Treatment choice remains difficult and renders perspectives of AYAs on decision-making and psychological outcomes afterwards. This review examines the impact of (in)fertility on psychological well-being both during cancer treatment, and in the long term.

METHODS

A systematic review of the peer-reviewed literature was conducted by searching Pubmed, Web of Science, Cochrane Trial database and PsycINFO on 30 November 2023. The review included studies with a focus on gynecological cancer, fertility and pregnancy related psychological outcomes, QoL, and psychosocial factors influencing decision-making. Case reports and reviews were excluded. Quality was assessed with the Mixed Methods Appraisal Tool (MMAT).

RESULTS

15 studies, published between 2005 and 2023, involving 1328 participants, were included. Key findings highlight the significance of informing all AYAs about cancer treatment effects on fertility and discussing fertility preservation options. Feeling time-pressured and conflicted between choosing the best oncological outcomes and preserving fertility were common. Factors such as younger age at diagnosis, time pressure, and inadequate counseling by healthcare workers increased reproductive concerns which contributed to long term psychological distress. Research on AYAs with gynecological cancer without fertility preservation possibilities is limited and should be prioritized.

CONCLUSIONS

This review shows that both Shared Decision-Making (SDM) and follow-up processes can be improved by addressing fertility-related questions and concerns, therefore increasing long-term QoL. This review is registered in PROSPERO (ID 448119).

Reproductive Concerns Among Young Adult Women With Breast Cancer: A Systematic Review and Meta-Analysis

OBJECTIVES

Systemic cancer treatments pose threats to fertility, leading to concerns regarding fertility and parenthood in young adult women with breast cancer (YAWBC). This systematic review aimed to synthesize existing evidence on reproductive concerns (RCs) among YAWBC and identify areas where further research in needed.

METHODS

A systematic review was conducted. Nine English and Chinese databases were searched for studies from inception to June 2023. A meta-analysis was employed to pool RC levels measured using the Reproductive Concerns After Cancer scale (RCAC scale; possible total scores: 18-90). Narrative synthesis was conducted in cases where a meta-analysis could not be performed.

RESULTS

Twenty-four cross-sectional studies across seven countries were included in this review. The prevalence of RCs among YAWBC ranged from 21.75% to 80%. The pooled mean total score on the overall RCAC scale was 55.84 (95% confidence interval: 53.26-58.43). "Personal health," "child's health," and "fertility potential" were the top three types of RCs among YAWBC. Sociodemographic, clinical, and psychosocial factors were found to be associated with RCs among YAWBC. Additionally, significant correlations among RCs, nonadherence to treatment, depression, and quality of life were also identified among YAWBC.

CONCLUSION

RCs are a common issue among YAWBC, and age, parenthood status, fertility desire, and chemotherapy treatment are important factors associated with RCs among these women. Further research is needed to clarify RC-related factors to provide evidence aimed at tailoring interventions to mitigate RCs among YWBC.

Reproductive Concerns and Associated Factors Among Adolescent and Young Adult Cancer Survivors in Uganda: A Hospital-Based Cross-Sectional Study

Purpose: Reproductive health (RH) is a critical issue among cancer survivors worldwide. However, in developing countries where RH services for patients with cancer are often lacking, reproductive concerns among adolescent and young adult (AYA) survivors remain uncertain. In this study, we assessed the reproductive concerns of AYA cancer survivors in a resource-limited context of Uganda. Methods: We collected data from AYA cancer survivors at two facilities in Uganda using an interviewer-administered questionnaire. Descriptive statistics were calculated, one-way analysis of variance was used for intergroup comparisons, and multiple regressions were used to test for predictors of reproductive concerns. Results: A total of 110 AYA cancer survivors, with a median age of 20 years (interquartile range [IQR], 18-22), were interviewed. More than half (53.6%) of the respondents were males. The median time since cancer diagnosis was 19 months (IQR, 13.0-35.0). Almost all (91.8%) respondents had a future desire to have children, but only 15.5% received reproductive counseling. The mean total score for the reproductive concern subscales was highest for the fertility concern, followed by the information-seeking and health-related concerns. Reproductive counseling, desire to have children, and respondents' age were the factors influencing reproductive concern. Conclusions: The study shows a strong desire for biological parenthood with very low reproductive counseling among AYA cancer survivors, who remain concerned about their fertility, information needs, and health. This outcome underscores the need to integrate RH services into resource-limited cancer care settings.

Translation and psychometric evaluation of the Korean version of the Reproductive Concerns After Cancer Scale (RCAC)

BACKGROUND

Improving cancer survival rates highlights post-treatment fertility implications for reproductive-aged women. To provide fertility care for cancer survivors, nurses need instruments to assess and communicate reproductive concerns with cancer survivors and healthcare providers. This study aimed to translate the Reproductive Concerns after Cancer Scale (RCAC) into Korean and examine its psychometric properties in young female cancer survivors in South Korea.

METHODS

The RCAC was translated into Korean, involving expert bilingual translators for initial translation and reverse translation for cultural and semantic accuracy. In detail, the RCAC was translated into Korean and evaluated in a preliminary study involving 10 cancer survivors. Subsequently, a revised version of the instrument was administered to 182 cancer survivors and a psychometric evaluation was conducted. The process included verifying content validity, and then assessing construct validity using exploratory factor analysis and criterion validity. The reliability of the instrument was quantified by measuring its internal consistency using Cronbach's alpha.

RESULTS

The translated RCAC demonstrated an item-level content validity index of 1.0 and a scale-level index of 1.0. The content was finalized based on preliminary survey findings, which revealed that all participants thought the instrument was clear. The Korean version of the RCAC demonstrated a satisfactory level of validity per exploratory factor analysis, which resulted in a 14-item instrument consisting of three subscales: "fertility potential" (six items), "health problem" (five items), and "acceptance" (three items). The items and subscales explained 57.6% of the variance. Criterion validity was confirmed through an analysis of the correlation between the Korean version of the RCAC and both the FACT-G (r = -0.36, p < .001) and PHQ-9 (r = 0.38, p < .001). Cronbach's alpha coefficient of the Korean version of the RCAC was 0.83.

CONCLUSIONS

The Korean version of the RCAC is a valid and reliable instrument for assessing reproductive concerns in female cancer survivors. Thus, this instrument can be used to provide tailored care to female cancer survivors of reproductive age by clarifying and assess their reproductive concerns. This may support the development of guidelines or policies to provide care for those with reproductive concerns who require nursing care.

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

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.

Fertility Potential and Gonadal Function in Survivors of Reduced-Intensity Hematopoietic Stem Cell Transplantation

The use of reduced-intensity conditioning (RIC) regimens has increased in an effort to minimize hematopoietic stem cell transplantation (HCT) end-organ toxicity, including gonadal toxicity. We aimed to describe the incidence of fertility potential and gonadal function impairment in adolescent and young adult survivors of HCT and to identify risk factors (including conditioning intensity) for impairment. We performed a multi-institutional, international retrospective cohort study of patients age 10 to 40 years who underwent first allogeneic HCT before December 1, 2019, and who were alive, in remission, and available for follow-up at 1 to 2 years post-HCT. For females, an AMH level of ≥.5 ng/mL defined preserved fertility potential; an AMH level of ≥.03 ng/mL was considered detectable. Gonadal failure was defined for females as an elevated follicle-stimulating hormone (FSH) level >30 mIU/mL with an estradiol (E2) level <17 pg/mL or current use of hormone replacement therapy (regardless of specific indication or intent). For males, gonadal failure was defined as an FSH level >10.4 mIU/mL or current use of hormone replacement therapy. A total of 326 patients (147 females) were available for analysis from 17 programs (13 pediatric, 4 adult). At 1 to 2 years post-HCT, 114 females (77.6%) had available FSH and E2 levels and 71 (48.3%) had available AMH levels. FSH levels were reported for 125 males (69.8%). Nearly all female HCT recipients had very low levels of AMH. One of 45 (2.2%) recipients of myeloablative conditioning (MAC) and four of 26 (15.4%) recipients of reduced-intensity conditioning (RIC) (P = .06) had an AMH ≥.5 ng/m, and 8 of 45 MAC recipients (17.8%) and 12 of 26 RIC recipients (46.2%) (P = .015) had a detectable AMH level. Total body irradiation (TBI) dose and cyclophosphamide equivalent dose (CED) were not associated with detectable AMH. The incidence of female gonadal hormone failure was 55.3%. In univariate analysis, older age at HCT was associated with greater likelihood of gonadal failure (median age, 17.6 versus 13.9; P < .0001), whereas conditioning intensity (RIC versus MAC), TBI, chronic graft-versus-host disease requiring systemic therapy, and CED were not significantly associated with gonadal function. In multivariable analysis, age remained statistically significant (odds ratio [OR]. 1.11; 95% confidence interval [CI], 1.03 to 1.22) for each year increase; P = .012), Forty-four percent of the males had gonadal failure. In univariate analysis, older age (median, 16.2 years versus 14.4 years; P = .0005) and TBI dose (P = .002) were both associated with gonadal failure, whereas conditioning intensity (RIC versus MAC; P = .06) and CED (P = .07) were not statistically significant. In multivariable analysis, age (OR, 1.16; 95% CI, 1.06-1.27 for each year increase; P = .0016) and TBI ≥600 cGy (OR, 6.23; 95% CI, 2.21 to 19.15; P = .0008) remained significantly associated with gonadal failure. Our data indicate that RIC does not significantly mitigate the risk for gonadal failure in females or males. Age at HCT and (specifically in males) TBI use seem to be independent predictors of post-transplantation gonadal function and fertility status. All patients should receive pre-HCT infertility counseling and be offered appropriate fertility preservation options and be screened post-HCT for gonadal failure.

Experiences of Oncofertility Decision-Making and Care in a National Sample of Adolescent and Young Adult Cancer Patients and Parents

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.

The Current Trend of Fertility Preservation in Patients with Cervical Cancer

Although the incidence of most cancers increases with age, a considerable number of patients receive a diagnosis of cancer during their reproductive years. Young women wishing to get pregnant after cancer treatment should be provided consultation for fertility preservation and possible options. In patients with cervical cancer, hysterectomy is often inevitable because the uterus is located too close to the cervix. For young patients with cervical cancer who desire to get pregnant and whose lesion is confined to the cervix, sparing the uterus and, partially, the cervix should be prioritized as much as possible, while simultaneously ensuring favorable oncologic outcomes. In this review, we explore how to choose an adequate fertility-preserving procedure to achieve a balance between favorable oncologic outcomes and fertility and management during pregnancy after a radical trachelectomy in women with early-stage cervical cancer. For patients who require hysterectomy or radiation, evaluation of the ovarian condition and laparoscopic ovarian transposition followed by the use of artificial reproduction techniques and pregnancy by surrogacy should be discussed as options to achieve a successful pregnancy.

Psychological impact over time of women with pregnancy loss due to gestational trophoblastic disease compared with miscarriage

OBJECTIVES

Pregnancy loss, occurring after miscarriage or after gestational trophoblastic disease, has a psychological impact. Besides pregnancy loss, women diagnosed with gestational trophoblastic disease have to deal with a prolonged period of follow-up and potential advice to postpone a future pregnancy. We studied the severity and course of the psychological impact after gestational trophoblastic disease and miscarriage, to identify whether women with gestational trophoblastic disease need different psychological care.

METHODS

A prospective multicenter study using online questionnaires was performed. Women diagnosed with gestational trophoblastic disease or miscarriage received the following questionnaires directly after diagnosis, and after 6, 6, and 12 months: a self-report questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale, and the Reproductive Concerns Scale.

RESULTS

74 women with gestational trophoblastic disease and 76 women with miscarriage were included. At baseline, the proportion of women scoring above the cut-off level for the anxiety subscale of the HADS and for the Impact of Event Scale was significantly higher for women with gestational trophoblastic disease than for women after miscarriage (43.2% vs 28.9%, p=0.02 and 87.8% vs 78.9%, p=0.03, respectively). During follow-up, the differences between both groups vanished and only the Impact of Event Scale after 12 months remained significantly different between women with gestational trophoblastic disease and women after miscarriage (62.7% vs 37.3%, p=0.005). All outcomes, except the Reproductive Concerns Scale, showed a significant decline. However, in women who scored above the cut-off level on the HADS-total or Impact of Event Scale at baseline, and women with psychological or psychiatric history, significant higher scores persisted.

CONCLUSION

Although women with gestational trophoblastic disease at baseline had more anxiety and distress than women after miscarriage, no significant differences were seen using the HADS-total after 12 months. Using the HADS or Impact of Event Scale directly after pregnancy loss is helpful to identify women at risk of remaining psychological symptoms to provide them with extra psychological support.

Mediation Effects of Coping Styles on Fear of Progression and Reproductive Concerns in Breast Cancer Patients of Reproductive Age

PURPOSE

This study aimed to investigate reproductive concerns among breast cancer patients of reproductive age, analyze the influencing factors, explore the relationship between coping styles, fear of progression (FOP), and reproductive concerns, and identify the multiple effects of coping styles on the relationship between FOP and reproductive concerns among Chinese breast cancer patients.

METHODS

A cross-sectional, descriptive study was conducted among breast cancer patients in four tertiary grade A hospitals in Fujian, China, from January 2022 to September 2022. A total of 210 patients were recruited to complete paper-based questionnaires, which included the general data questionnaires, the Reproductive Concerns After Cancer Scale (RCACS), the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), and the Medical Coping Modes Questionnaire (MCMQ). Structural equation models were utilized to evaluate the multiple effects of coping styles on FOP and reproductive concerns.

RESULTS

Reproductive concerns in breast cancer patients had a mean score of 53.02 (SD, 10.69), out of a total score of 90, and coping styles for cancer (confrontation, avoidance) were closely associated with FOP and reproductive concerns. FOP showed a significant positive correlation with reproductive concerns (r = .52, p < .01). At the same time, confrontation was significantly negatively correlated with both FOP (r = -.28, p < .01) and reproductive concerns (r = -.39, p < .01). Avoidance was positively correlated to both FOP (r = .25, p < .01) and reproductive concerns (r = .34, p < .01). The impact of FOP on reproductive concerns is partially mediated by confrontation and avoidance, with effect sizes of .07 and .04, respectively. These mediating factors account for 22.0% of the total effect.

CONCLUSIONS

The FOP directly impacted reproductive concerns, while coping styles could partially mediate the association between FOP and reproductive concerns. This study illustrates the role of confrontation and avoidance in alleviating reproductive concerns, suggesting that it is necessary to focus on the changes in reproductive concerns among reproductive-age breast cancer patients. Healthcare professionals can improve disease awareness and reduce patients' FOP, thereby promoting positive psychological and coping behaviors and ultimately alleviating reproductive concerns.

Shared Decision-Making About Future Fertility in Childhood Cancer Survivorship: Perspectives of Parents in Uganda

Background: Despite a plethora of literature on barriers to addressing future fertility in childhood cancer survivors, the data are not representative of limited middle-income settings. Unique and context-specific factors may influence addressing future fertility care among childhood cancer survivors in Uganda. This study aimed to explore the experiences, attitudes, and perceptions of parents on their interactions with health providers about future fertility, as part of their child's cancer survivorship. Methods: Using grounded theory, semistructured interviews were conducted with parents of children diagnosed with cancer, <18 years of age, and not in the induction or consolidation phases of treatment. Transcripts were thematically analyzed. Results: A total of 20 participants were interviewed, with the majority identifying as female (n = 18). The global theme that arose was the importance of shared decision-making, and the key themes encompassing this were as follows: (1) importance of accurate information, (2) respect of autonomy, and (3) engagement and psychosocial support. Conclusion: In Uganda, parents of children with cancer value a multifaceted approach to satisfactory decision-making within the context of oncofertility.

Fertility concerns in cancer patients: a bibliometric analysis via CiteSpace: A review

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.

Hodgkin lymphoma and female fertility: a multicenter study in women treated with doxorubicin, bleomycin, vinblastine, and dacarbazine

Preservation of fertility has become a growing concern in young females with Hodgkin lymphoma (HL). However, the rate of pregnancy after the current most frequently prescribed ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and darcarbazine) chemotherapy for HL has rarely been studied. In this study, we aim to determine the impact of ABVD on the fertility of women treated for HL. We conducted a noninterventional, multicenter study of female patients of childbearing age who were treated for HL. Two healthy apparied women nonexposed to chemotherapy (our controls) were assigned for each patient. Fertility was assessed by the number of pregnancies and births after HL treatment. Sixty-seven patients were included. The median age at diagnosis was 24.4 years (range, 16-43). HL was a localized disease for 68.7%. Of all the patients, 53.7% started at least 1 pregnancy after treatment vs 54.5% of the controls (P = .92). Of all the patients who desired children, 81% had at least 1 pregnancy. Patients treated with ABVD did not have a longer median time to pregnancy (4.8 years in the group of patients and 6.8 years for controls). Across patients, there were 58 pregnancies and 48 births (ratio, 1:2) and 136 pregnancies and 104 births (ratio, 1:3) for the control cohort. No increase in obstetric or neonatal complications has been reported in HL in our study. The number of pregnancies, births, and the time to start a pregnancy in young women treated with ABVD for HL is not different from that of controls. Therefore, females with HL treated with ABVD should be reassured regarding fertility.

Reproductive concerns among young adult women with breast cancer: a systematic review protocol

INTRODUCTION

Reproductive concerns refer to worries about impaired or lost reproductive ability due to disease or/and treatment. Many young female patients with breast cancer experience reproductive concerns because they still desire to have children at the time of diagnosis. Reproductive concerns can impact patients' treatment decision-making as well as their psychological health and quality of life. Understanding the situation, contributing factors and health-related consequences of reproductive concerns among patients with breast cancer is essential to minimise their impacts.

METHODS AND ANALYSIS

A systematic review will be conducted. We will search five English databases (PubMed, Embase, CINAHL, Web of Science and APA PsycInfo) and four Chinese databases (Wang Fang database, VIP, CBM and CNKI) for pertinent studies. Other relevant studies will be identified from the reference lists of included studies. Two reviewers will independently perform study selection, data extraction and quality appraisal. Any discrepancies between the two reviewers will be resolved through consultation and discussion with the senior reviewer. A formal narrative synthesis will be performed to summarise the findings of individual studies. This review aims to improve understanding of the level of reproductive concerns, factors associated with reproductive concerns and health-related consequences of reproductive concerns among patients with breast cancer. The findings can contribute to the development of tailored interventions to alleviate reproductive concerns of patients with breast cancer, enhancing their psychological health and quality of life.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review, as it will be based on published studies. The findings will be disseminated by publishing in a journal.

PROSPERO REGISTRATION NUMBER

CRD42022375247.

Fertility Preservation Decisional Turning Points for Adolescents and Young Adults With Cancer: Exploring Alignment and Divergence by Race and Ethnicity

PURPOSE

For adolescents and young adults (AYAs) with cancer, fertility preservation (FP) decision making is complex and distressing. Racial/ethnic minority (REM) AYAs experience disparities in FP awareness, uptake, and outcomes. A turning point (TP) is a point of reflection, change, or decisive moment(s) resulting in changes in perspectives or trajectories. To enhance understanding of AYAs' diverse experiences, this study examined alignment and/or divergence of FP decisional TPs among non-Hispanic White (NHW) AYAs and REM AYAs.

METHODS

Qualitative semistructured interviews were conducted in person, by video, or phone with 36 AYAs (20 NHW and 16 REM [nine Hispanic and seven Black/multiracial Black). The constant comparative method was used to identify and analyze themes illustrating participants' conceptualization and/or experience of FP decisional TPs.

RESULTS

Seven thematic TPs emerged: (1) emotional reaction to discovering FP procedures exist; (2) encountering unclear or dismissive communication during initial fertility conversations with health care providers; (3) encountering direct and supportive communication during initial fertility conversations with health care providers; (4) participating in critical family conversations about pursuing FP; (5) weighing personal desire for a child against other priorities/circumstances; (6) realizing FP is not feasible, and (7) experiencing unanticipated changes in cancer diagnosis or treatment plans/procedures. TP variations include REM participants reported dismissive communication and suggested cost was prohibitive. NHW participants emphasized more forcefully that biological children may become a future priority.

CONCLUSION

Understanding how clinical communication and priorities/resources may vary for NHW and REM AYAs can inform future interventions aimed at reducing health disparities and enhancing patient-centered care.

Assessing gaps in motherhood after cancer: development and psychometric testing of the Survivorship Oncofertility Barriers Scale

OBJECTIVE

With a growing population of young cancer survivors, there is an increasing need to address the gaps in evidence regarding cancer survivors' obstetric outcomes, fertility care access, and experiences. As part of a large research program, this study engaged survivors and experts in co-developing and testing the validity, reliability, acceptability, and feasibility of a scale to assess survivor-reported barriers to motherhood after cancer.

METHODS

Scale items were developed based on literature and expert review of 226 reproductive health items, and six experience and focus groups with 26 survivors of breast and gynecological cancers. We then invited 128 survivors to complete the scale twice, 48 hours apart, and assessed the scale's psychometric properties using exploratory factor analyses including reliability, known-group validity, and convergent validity.

RESULTS

Item development identified three primary themes: multifaceted barriers for cancer survivors; challenging decisions about whether and how to pursue motherhood; and a timely need for evidence about obstetric outcomes. Retained items were developed into a 24-item prototype scale with four subscales. Prototype testing showed acceptable internal consistency (Cronbach's alpha=0.71) and test-retest reliability (intraclass correlation coefficient=0.70). Known-group validity was supported; the scale discriminated between groups by age (x=70.0 for patients ≥35 years old vs 54.5 for patients <35 years old, p=0.02) and years since diagnosis (x=71.5 for ≥6 years vs 54.3 for<6 years, p=0.01). The financial subscale was correlated with the Economic StraiN and Resilience in Cancer measure of financial toxicity (ρ=0.39, p<0.001). The scale was acceptable and feasibly delivered online. The final 22-item scale is organized in four subscales: personal, medical, relational, and financial barriers to motherhood.

CONCLUSION

The Survivorship Oncofertility Barriers Scale demonstrated validity, reliability, and was acceptable and feasible when delivered online. Implementing the scale can gather the data needed to inform shared decision making and to address disparities in fertility care for survivors.

Conservative surgical staging as a means to preserve fertility in patients with dysgerminoma: a case report

Ovarian tumor is a rare condition in pediatrics. Due to the improvement in surgical techniques and chemotherapy in recent years, it is currently possible to preserve fertility in selected cases of patients who desire motherhood.

Case presentation

We present a case of pregnancy following conservative surgery and complete chemotherapy for ovarian dysgerminoma stage IIA. A 16-year-old female presented with complaints of abdominal mass and discomfort. Histopathological examination displayed dysgerminoma arising from the right ovary. Conservative treatment with right salpingo-oophorectomy and six cycles of chemotherapy was performed. Within 2 years following the surgery, the patient conceived and did not indicate tumor recurrence.

Clinical discussion

Dysgerminoma is the most common ovarian malignant germ cell tumor and usually affects women at a young age. Conservative surgery followed by chemotherapy is the treatment of choice, particularly in young patients with a strong desire to have a family. Conservative fertility-sparing surgery does not have inferior outcomes in terms of survival or recurrence. It is possible that in certain cases, patients previously treated for ovarian cancer may retain their fertility, thereby improving their quality of life.

Conclusion

Most patients with dysgerminoma can be treated with the maintenance of normal reproductive function. Reassurance regarding the high probability of conceiving and having normal children after conservative surgery and chemotherapy should be informed to the patient and family.

Adolescent and young adult cancers: unmet needs and closing the gaps

PURPOSE OF REVIEW

There is a growing population of adolescent and young adult (AYA, ages 15-39 years) cancer patients and survivors, and the field of AYA oncology is rapidly evolving. Despite an increased focus on survival and quality of life for AYAs, gaps in knowledge remain. The current review focuses on what is known across several domains unique to AYA cancer care as well as areas of improvement and future directions in research and intervention.

RECENT FINDINGS

Due to the developmental stages included in the AYA age range, a cancer diagnosis and treatment can affect relationships, education and employment, finances, and long-term health differently than diagnoses in younger or older populations. Recent studies that have focused on these unique aspects of AYA cancer care, including health-related quality of life (HRQoL), fertility, financial toxicity, barriers to clinical trial enrollment, genetic predisposition, and survivorship care are included in the current review.

SUMMARY

Although studies have described many of the challenges faced by AYAs across the cancer continuum from diagnosis to survivorship, more work is needed, particularly in systematically measuring HRQoL, eliminating barriers to clinical trial enrollment, addressing financial toxicity, and increasing access to fertility preservation and high-quality survivorship care.

[The Experience of Gynecologic Cancer in Young Women: A Qualitative Study]

PURPOSE

This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer.

METHODS

Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories.

RESULTS

Grounded theory analysis revealed nine categories and a core category of 'the journey to find my life after losing the life as a typical woman.' The categories that emerged as the conditions are 'Unwelcomed guest, cancer,' 'Completely devastated life as an ordinary woman,' 'Uncertain future,' 'Losing my physical characteristics as a woman,' and 'Life tied with treatments.' The actions/interactions were'Decrease of interpersonal relationships,' 'A lonely battle to overcome alone,' and 'The power to overcome hardships.' The consequence was 'Live my own life.'

CONCLUSION

This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study's results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.

Brachytherapy impacts on sexual function: An integrative review of the literature focusing on cervical cancer

There is growing awareness of the importance of sexual health in the quality of life of cancer patients and survivors. Brachytherapy, a vital component for the curative treatment of cervical cancer, leads to both direct and indirect sequelae that result in vaginal and sexual morbidity. The emergence of 3D image-guided adaptive brachytherapy has led to a better understanding of dose-and-effect relationships for critical organs-at-risk and there are new recommendations for vaginal dose reporting in the ongoing EMBRACE II study. An understanding of the vagina as an organ-at-risk and its dose-and-effect relationships can help brachytherapists limit dose to the vagina and improve sexual morbidity. Brachytherapists play a critical role in the primary and secondary prevention of vaginal and sexual sequelae resulting from treatment. Through close surveillance and recognition of common symptoms, brachytherapists can intervene with effective strategies to prevent and treat vaginal and sexual symptoms. This review summarizes the current literature on dosimetric factors that may predict for vaginal morbidity. It will focus on quantitative and qualitative reports of brachytherapy-related vaginal toxicity and sexual dysfunction. Lastly, it will review the available evidence supporting clinical interventions to mitigate the development and progression of vaginal and sexual sequelae to improve functional quality post-treatment.

Oncofertility Perspectives for Girls with Cancer

Infertility is a serious early, as well as late, effect of childhood cancer treatment. If addressed in a timely manner at diagnosis, fertility preservation measures can be taken, preferably before the start of cancer treatment. However, pediatric oncologists might remain reluctant to offer counseling on fertility-preservation methods, although infrastructure to freeze ovarian tissue has become available and is currently considered standard care for pre- and postpubertal girls at high risk of gonadal damage. More importantly, risk factors have been identified for cancer treatment-related impairment of gonadal function, and the first successful pregnancies have been reported after autotransplanted ovarian tissue, which has been harvested from children. Additionally, great progress has been made in the field of ex vivo maturation of oocytes in frozen ovarian tissue, which provides opportunities for those at risk of ovarian micrometastasis. Hence, it is time to counsel girls at risk and make every effort to cryopreserve their ovarian tissue, now more than ever before.

Experience of reproductive concerns in women with schizophrenia: A descriptive phenomenological study

BACKGROUND

Reproductive concerns significantly affect the mental health of people, causing more serious psychological stress than disease. The reproductive concerns faced by women with schizophrenia are issues that have been neglected in the areas of psychiatry and women's health.

OBJECTIVES

To explore the experience of reproductive concerns through the perspective of women with schizophrenia.

DESIGN

Descriptive phenomenology interview study.

SETTING

Data collection was carried out in a psychiatric hospital in China.

PARTICIPANTS

15 women with schizophrenia were recruited with a prospective sampling. All participants were 26-40 years old.

METHODS

The interview recordings were transcribed by the research team, and transcripts were analyzed by two independent coders with Colaizzi's descriptive analysis framework. The process employed NVivo 12 software.

RESULTS

Data analysis identified 9 subthemes falling into the 4 macrothemes: (a) Potential risks of reproduction; (b) The difficulties in raising children; (c) Significance of reproduction; (d) Multiparty cooperation is needed to relieve reproductive concerns.

CONCLUSION

Women with schizophrenia have reproductive concerns under the conflict between the significance of reproduction and obstacles. Interventions to address the reproductive problems of women with schizophrenia should be developed in three areas: the women themselves, the women's spouses and the medical staff.

Standardization of Fertility Preservation Discussion Among Pediatric Oncology and Bone Marrow Transplant Patients: A Single Institution Experience

Purpose: Infertility is an impactful late effect of cancer therapy. Options for fertility preservation exist, however, barriers remain. Within our division, we lacked a standard approach to discussing fertility preservation. Methods: During the time period of 2014-2020, a fertility preservation program was developed with program improvements implemented over time and provider comfort with fertility identified and addressed through educational intervention. To evaluate how our improvements affected frequency of documented reproductive health discussions, 474 pubertal pediatric patients with new oncological diagnoses were reviewed. Descriptive analysis of sociodemographic determinants was performed. Results: One hundred seventy-five patients met inclusion criteria. Racial/ethnic composition was similar in those receiving and not receiving a fertility consult. Although 19.3% of Caucasians pursued fertility preservation, none of the eight African Americans or five Hispanic females did. Division feedback identified a lack of knowledge regarding available fertility preservation options and diagnoses that should prompt this conversation as barriers to the consulting fertility preservation team. Pre- and posteducation assessments demonstrated increased comfort in discussing fertility preservation and knowledge regarding diagnoses at higher risk of infertility. Integration of a standardized fertility preservation process and addressing barriers identified led to a 33.6% increase in fertility discussions. Conclusion: The establishment of a fertility preservation process and team and division-wide education has led to improvement in rates of fertility discussion in pediatric and adolescent and young adult cancer patients. Similar to young adult data, our data suggest that some racial health disparities may exist in the utilization of fertility preservation in the pediatric oncology population.

Perspectives of Young Women With Gynecologic Cancers on Fertility and Fertility Preservation: A Systematic Review

BACKGROUND

Gynecologic cancers standard treatment often requires the removal of some reproductive organs, making fertility preservation a complex challenge. Despite heightened oncofertility awareness, knowledge about fertility attitudes and decisions of young patients with gynecologic cancer is scarce. The aim of this systematic review was to highlight what is currently known about knowledge, attitudes, and decisions about fertility, fertility preservation, and parenthood among these patients.

METHODS

Peer-reviewed journals published in English were searched in PubMed, Web of Science and EMBASE from January 1, 2000 to July 1, 2020. Childbearing, fertility, fertility preservation, pregnancy, and parenthood attitudes/decisions after gynecologic cancer from women's perspective were evaluated.

RESULTS

A total of 13 studies comprised the review. Most of the women valued fertility preservation procedures that could be regarded as a means to restore fertility. A unique feature identified was that fertility preservation was seen also as a way to restore gender identity perceived to be lost or threatened during diagnosis and treatment. Fertility counseling was suboptimal, with wide variability among studies reviewed. Comparisons between gynecologic cancers and other cancer types about fertility counseling rates were inconclusive. The potential negative impact of impaired fertility on patients' mental health and quality of life was also documented.

CONCLUSIONS

Fertility and parenthood were important matters in patients' lives, with the majority of patients expressing positive attitudes toward future childbearing. Results confirm that the inclusion of patients with gynecologic cancer in research studies focusing on this topic still remains low. Additionally, the provision of fertility counseling and referral by health professionals is still suboptimal.

Does women's health matter for fertility? Evidence from Norwegian administrative data

Women's health status may affect their opportunities and preferences for children through various mechanisms. We examine the relationship between health and fertility using Norwegian registry data (2004-18). Measuring verifiable and persistent health problems, we use uptake of doctor-certified sickness absence and long-term health-related benefits as proxies for health. In contrast to the expectation that poor health limits women's opportunities for children, our results show that sickness absence is positively associated with transitions to parenthood. The uptake of long-term benefits is, however, negatively associated with fertility. The selection of healthy women into parenthood weakens the association for higher-order births. The impact of long-term health indicators on fertility is comparable in magnitude to that observed for more conventional predictors, such as education and income. With continued postponement of childbearing and thus higher maternal ages, the influence of health as a fertility determinant is likely to grow and further research appears warranted.Supplementary material for this article is available at: http://doi.org/10.1080/00324728.2022.2041075.

Barriers to Oncofertility Care among Female Adolescent Cancer Patients in Canada

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.

Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians

Purpose: Treatment of transgender adolescents with puberty suppression (PS) was developed to provide time for exploration before pursuing gender affirming medical treatment (GAMT) with irreversible effects. It may also result in a more satisfactory physical outcome for those who continue with GAMT. Despite being the current first choice treatment, little research has examined the function of PS from the perspectives of transgender adolescents, their parents, and clinicians. Insight into the perceived functions of PS will help to adequately support adolescents in their decision-making process and give them the care they need. Methods: Qualitative study using interviews with eight transgender adolescents who proceeded with GAMT after PS ("continuers"), six adolescents who discontinued PS ("discontinuers") and 12 parents, and focus groups with ten clinicians. Results: All informants considered inhibition of development of secondary sex characteristics an important function of PS. Most continuers saw PS as the first step of GAMT. Nevertheless, some were glad that the effects were reversible even if they didn't expect to change their minds. Some discontinuers did experience PS as an expanded diagnostic phase. One continuer used the time on PS to get used to living in the affirmed gender role, and several parents found the time helpful to adapt to their child's new gender role. PS provided clinicians more time for diagnostic assessment. Conclusions: Adolescents, parents and clinicians do not all report the same functions of PS. Although international guidelines emphasize providing time for exploration of gender identity as an important reason for PS, many adolescents nowadays seem to have clear ideas about their gender identity and treatment wishes, and experience PS as the first step of GAMT. For some discontinuers however, PS offered a valued period of exploration. Guidelines could be modified to provide more customized care, taking adolescents' and parents' ideas about the functions of PS into account.

A conceptual model of fertility concerns among adolescents and young adults with cancer

OBJECTIVE

For adolescents and young adults (AYAs), cancer-related fertility concerns (FC) are salient, disruptive, and complex. Clinical communication about FC and fertility preservation options are suboptimal, increasing patient distress. The purpose of this study is to construct a conceptual model of FC among AYAs with cancer to inform future measurement development.

METHODS

Concept elicitation interviews were conducted with a purposive sample of stakeholders: 36 AYAs (10 adolescents, 12 emerging adults, and 14 young adults), 36 AYA oncology health care providers, and 12 content experts in cancer-related infertility. The constant comparative method was used to identify themes and properties that illustrate AYAs' conceptualization and/or experience of FC.

RESULTS

Thirteen themes characterized FC among AYAs with cancer, varying by stakeholder group and domain affiliations. Themes were grouped by four domains (e.g., affective, information, coping, and logistical), which organized the conceptual model. Affective experiences were further determined to be an important component within the other three domains. AYAs' fertility and fertility preservation experiences were shaped by communication factors and timing factors including placement along the lifespan/cancer continuum.

CONCLUSIONS

AYA FC are characterized by uncertainty and confusion that may contribute to future decisional regret or magnify feelings of loss. Results add to previous research by examining individual, relational, and health care factors that fluctuate to inform fertility preservation perceptions and decision-making across the AYA age spectrum. Findings will be used to develop and test new self-report measures of FC among AYAs with cancer and survivors using classic and modern measurement theory approaches.

The psychological impact of gestational trophoblastic disease: a prospective observational multicentre cohort study

OBJECTIVE

To evaluate the short-term psychological consequences of gestational trophoblastic disease (GTD).

DESIGN

A prospective observational multicentre cohort study.

SETTING

Nationwide in the Netherlands.

POPULATION

GTD patients.

METHODS

Online questionnaires directly after diagnosis.

MAIN OUTCOME MEASURES

Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), Impact of Event Scale (IES) and Reproductive Concerns Scale (RCS).

RESULTS

Sixty GTD patients were included between 2017 and 2020. Anxious feelings (47%) were more commonly expressed than depressive feelings (27%). Patients experienced moderate to severe adaptation problems in 88%. Patients who already had children were less concerned about their reproductivity than were patients without children (mean score 10.4 versus 15.0, P = 0.031), and patients with children experienced lower distress levels (IES mean score 25.7 versus 34.7, P = 0.020). In addition, patients with previous pregnancy loss scored lower for distress compared with patients without pregnancy loss (IES mean score 21.1 versus 34.2, P = 0.002).

DISCUSSION

We recommend that physicians monitor physical complaints and the course of psychological wellbeing over time in order to provide personalised supportive care in time for patients who have high levels of distress at baseline.

CONCLUSIONS

GTD patients experience increased levels of distress, anxiety and depression, suggesting the diagnosis has a substantial effect on the psychological wellbeing of patients. The impact of GTD diagnosis on intrusion and avoidance seems to be ameliorated in patients who have children or who have experienced previous pregnancy loss.

TWEETABLE ABSTRACT

Patients with gestational trophoblastic disease (GTD) experience short-term psychological consequences such as distress, anxiety and depression, suggesting that the diagnosis GTD has a substantial effect on the psychological wellbeing of patients. Various patient characteristics affect the impact of GTD diagnosis.

Evaluation of the Modified Reproductive Concerns Scale Among Emerging Adult Cancer Survivors

Purpose: The reproductive concerns of emerging adult survivors of childhood cancer are not well described, and valid measurement tools tailored to this population are lacking. The purpose of this analysis was to evaluate a modified version of the Reproductive Concerns Scale (mRCS) among male and female survivors of childhood cancer. Methods: This is a secondary analysis of cross-sectional survey data collected from patients enrolled on an infertility-educational intervention study. Participants completed the mRCS at baseline. Cancer treatment data were abstracted from participant medical records. Principal component analyses were conducted to evaluate the factor structure of the mRCS for males, females, and the entire sample. Internal consistency was evaluated using Cronbach's alpha. Open-ended responses were analyzed and used to assess the validity of relevant quantitative items on the mRCS. Results: The sample consisted of N = 98 participants who were an average of 19.1 (±1.1) years of age, 45.9% were male, and 61.2% were non-Hispanic white. Factor analyses revealed three domains: Fertility Concerns (Cronbach's alpha = 0.77), Health Concerns (α = 0.74), and Information Seeking (α = 0.57). Sex-specific factor analyses identified differences in scale items for males. The open-ended responses aligned well with participant scores on the Fertility Concerns subscale. Conclusion: The mRCS consists of three subscales relevant to emerging adult survivors of childhood cancer. Further analysis by sex suggests that separate scales for males and females are warranted. Future research is warranted to determine the clinical utility of using the mRCS as a screening tool to identify and address reproductive concerns among emerging adult survivors.

Impact of a novel family-centered values clarification tool on adolescent sperm banking attempts at the time of a new cancer diagnosis

PURPOSE

Over half of males experience fertility impairment after childhood cancer therapy, which often causes psychosocial distress. Yet, fertility preservation (FP) remains underutilized. The goals of this study were to determine the feasibility and impact of implementing a family-centered FP values clarification tool on sperm banking attempts among adolescent males newly diagnosed with cancer, and identify key determinants of banking attempts.

METHODS

A prospective pilot study was conducted among families of males (12-25 years old), prior to cancer therapy. Thirty-nine of 41 families agreed to participate (95%); 98 participants (32 adolescents, 37 mothers, 29 fathers) completed the Family-centered Adolescent Sperm banking values clarification Tool (FAST). Analyses assessed the impact of the FAST on banking attempts and examined associations between demographic/medical characteristics, FAST subscales (perceived threat, benefits, barriers), and banking attempts.

RESULTS

Twenty-three (59%) adolescents attempted to bank, compared to 8 adolescents (33%) during baseline assessment (p=.04). Significant associations were identified between banking attempts and adolescents' report of perceived threat (r_pb=.45, p=.01) and benefits (r_pb=.57, p=.01). Only mothers' proxy reports of adolescent perceived threat (r_pb=.42, p=.01) and benefits (r_pb=.47, p=.003) were associated with banking attempts, while fathers' self-reported perceived benefits (r_pb=.43, p=.03), self-reported barriers (r_pb=.49, p=.01), and proxy reports of adolescent perceived threat (r_pb=.38, p=.04) and benefits (r_pb=.59, p=.02) were associated with banking attempts.

CONCLUSION

Adolescent sperm banking attempt rates significantly increased after implementation of a family-centered FP values clarification tool prior to cancer treatment. Findings underscore the importance of targeting both adolescents and their parents, particularly fathers, in FP efforts.

Identifying the Need to Discuss Infertility Concerns Affecting Testicular Cancer Patients: An Evaluation (INDICATE Study)

Simple Summary

Testicular cancer is the most common malignancy in young males affecting the ability to father children. It’s important that effects on fertility are discussed before starting treatment so patients are aware of the risks and their options. The objective of our study was to evaluate the manner in which men with testicular cancer are counselled about implications on fertility and the possibility of semen preservation. Furthermore, we aimed to evaluate satisfaction with provided information and to identify reproductive concerns. In a sample of 201 patients, one out of ten patients reported not to be informed about the risk of subfertility. Sperm banking was performed by 41.3%, of which 13 men made use of preserved sperm, resulting in paternity for 7 men. The subjects fertility and semen preservation need to be broached promptly after diagnosis of testicular cancer because they cause dissatisfaction with care and grief if fertility problems occur afterwards.

Abstract

Men with testicular cancer (TC) risk impaired fertility. Fertility is a major concern for TC patients due to diagnosis in almost always reproductive ages and high overall survival. This study assessed counselling in regards to the risk of impaired fertility and sperm cryopreservation. A cross-sectional survey was performed on 566 TC patients diagnosed between 1995–2015. Of the 566 survivors, 201 questionnaires were completed (35.5%). Eighty-eight percent was informed about possible impaired fertility, 9.5% was not informed. The majority (47.3%) preferred the urologist to provide information. Collecting sperm was troublesome but successful for 25.6%, 4.8% did not succeed in collecting sperm. The reasons were high pressure due to disease, pain after surgery and uncomfortable setting. Due to impaired fertility, 19% of the respondents reported grief and 9.3% stated as being less satisfied in life. Sperm cryopreservation was performed by 41.3% (n = 83). One third (n = 63, 31.3%) had children after treatment, of which 11.1% made use of preserved sperm (n = 7). The results of this survey indicate the importance of timely discussion of fertility issues with TC patients. While being discussed with most men, dissatisfaction and grief may occur as a result of impaired fertility and a lack of counselling. Overall, 6.5% made use of cryopreserved sperm (n = 13). Men prefer their urologist providing counselling on fertility.

Identification of differentially expressed proteins and clinicopathological significance of HMGB2 in cervical cancer

To investigate the complexity of proteomics in cervical cancer tissues, we used isobaric tags for relative and absolute quantitation (iTRAQ)-based mass spectrometry analysis on a panel of normal cervical tissues (N), high-grade squamous intraepithelial lesion tissues (HSIL) and cervical cancer tissues (CC). Total 72 differentially expressed proteins were identified both in CC vs N and CC vs HSIL. The expression of HMGB2 was markedly higher in CC than that in HSIL and N. High HMGB2 expression was significantly correlated with primary tumor size, invasion and tumor stage. The up-regulated HMGB2 was discovered to be associated with human cervical cancer. These findings suggest that HMGB2 may be a potentially prognostic biomarker and a target for the therapy of cervical cancer.

The Knowledge, Attitude, and Self-Reported Behaviors of Oncology Physicians Regarding Fertility Preservation in Adult Cancer Patients

There is a growing concern about the fertility preservation for adult cancer patients of reproductive age. Very little literature exists about fertility preservation of cancer survivors in Chinese text. This study is first to describe the knowledge level, attitude, and practice behaviors among physicians concerning fertility preservation in adult cancer patients in China. A cross-sectional survey with 30-item was conducted to assess Chinese oncology physicians' knowledge, attitude, and behaviors regarding fertility issues. Of 360 oncology physicians, 206 (57.2%) submitted valid questionnaires. With possible overall scores for knowledge and attitude of 9 and 15, respectively, physicians' responses to the questionnaires were 3.91 ± 1.67 and 12.29 ± 1.23. Only 49.5% of physicians routinely informed their cancer patients of childbearing age about the risk of infertility with cancer treatment. The knowledge score of the men physicians was 2-fold that of the women. Physicians aged 20-29 years were significantly more likely than other age groups to prioritize cancer treatment over fertility concerns. Men physicians were significantly more comfortable than the women discussing fertility preservation issues and cooperating with fertility specialists. The oncology physicians in China had limited knowledge of fertility preservation and rarely discussed these issues with their patients, although their attitude was positive. Results suggest that oncology physicians would welcome an in-house fertility-related training program. KEY MESSAGES: This is the first study to address the topic of fertility preservation as it relates to the care that oncologists provide to cancer patients in China. These results revealed the importance of providing fertility-related training program to oncology physicians. Moreover, this study should provide useful information for other Asian countries, and highlight both the similarities and differences between China and Western countries concerning the reproductive rights of patients. This study should encourage international cooperation with institutions of scientific research and education.

Early-life cancer, infertility, and risk of adverse pregnancy outcomes: a registry linkage study in Massachusetts

PURPOSE

Investigate the relationship between history of cancer and adverse pregnancy outcomes according to subfertility/fertility treatment.

METHODS

Deliveries (2004-2013) from Massachusetts (MA) Registry of Vital Records and Statistics were linked to MA assisted reproductive technology data, hospital discharge records, and Cancer Registry. The relative risks (RR) and 95% confidence intervals of adverse outcomes (gestational diabetes (GDM), gestational hypertension (GHTN), cesarean section (CS), low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), neonatal mortality, and prolonged neonatal hospital stay) were modeled with log-link and Poisson distribution generalized estimating equations. Differences by history of subfertility/fertility treatment were investigated with likelihood ratio tests.

RESULTS

Among 662,630 deliveries, 2,983 had a history of cancer. Women with cancer history were not at greater risk of GDM, GHTN, or CS. However, infants born to women with prior cancer had higher risk of LBW (RR: 1.19 [1.07-1.32]), prolonged neonatal hospital stay (RR: 1.16 [1.01-1.34]), and PTB (RR: 1.19 [1.07-1.32]). We found clinically and statistically significant differences in the relationship between cancer history and SGA by subfertility/fertility treatment (p value, test for heterogeneity = 0.02); among deliveries with subfertility or fertility treatment, those with a history of cancer experienced a greater risk of SGA (RRsubfertile: 1.36 [1.02-1.83]).

CONCLUSIONS

Women with a history of cancer had greater risk of some adverse pregnancy outcomes; this relationship varied by subfertility and fertility treatment.

Current Approaches to Fertility Preservation

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.

Reproductive intentions in childless female adolescent and young adult cancer survivors

OBJECTIVE

To examine the association between prior cancer treatments, medical comorbidities, and voluntary childlessness in reproductive-age women who are survivors of cancers diagnosed as adolescents and young adults (AYA survivors).

DESIGN

Cross-sectional analysis.

SETTING

Participants were recruited from California and Texas cancer registries, fertility preservation programs, and cancer advocacy groups.

PATIENT(S)

Women (n = 413) ages 18-40 who were diagnosed with cancer between ages 15 and 35, completed primary cancer treatments, had at least one ovary, and were nulliparous.

INTERVENTION(S)

Cancer treatment gonadotoxicity and medical comorbidities.

MAIN OUTCOME MEASURE(S)

Voluntary childlessness.

RESULT(S)

The mean age of survivors was 31.8 years (SD, 4.9) with a mean of 6.5 years (SD, 4.4) since cancer diagnosis. Breast (26%), thyroid (19%), and Hodgkin lymphoma (18%) were the most common cancers. Twenty-two percent of the cohort was voluntarily childless. Medical comorbidities, cancer diagnosis, prior surgery, prior chemotherapy, and prior gonadotoxic treatments were not significantly associated with voluntary childlessness. In adjusted analysis, survivors of older reproductive age (adjusted odds ratio = 2.97 [1.71-5.18]) and nonheterosexual participants (adjusted odds ratio = 4.71 [2.15-10.32]) were more likely to report voluntary childlessness.

CONCLUSION(S)

A moderate proportion of AYA cancer survivors are voluntarily childless, but reproductive intentions were not related to cancer type or cancer treatments. AYA survivors of older age and nonheterosexual identification were more likely to be voluntarily childless. These data support assessing reproductive intentions and tailoring reproductive care such as fertility and contraception counseling that is appropriate for a survivor's intentions.

The European Portuguese version of the Reproductive Concerns After Cancer Scale (RCACS): A psychometric validation for young adult female cancer survivors

PURPOSE

The purpose of this study was to evaluate the psychometric properties of the Portuguese version of the 18-item Reproductive Concerns After Cancer Scale (RCACS) among young adult female cancer survivors.

METHODS

The psychometric validation was conducted based on a convenience sample of 192 cancer survivors aged between 18 and 40 years. An exploratory factor analysis (EFA) was used to test the factor structure of the Portuguese version of RCACS and reliabilities were examined. Convergent and discriminant validity was also used to assess the construct validity. The Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORT QLQ-C30) and the need for parenthood and rejection of child-free lifestyle subscales of the Fertility Problem Inventory (FPI) were used as convergent measures.

RESULTS

A five-factor model was obtained with acceptable fit indexes and internal consistencies (.72<α<.89): (1) fertility potential, (2) children's health risk and future life, (3) partner disclosure, (4) barriers to getting pregnant/having children and (5) acceptance. Overall, convergent and discriminant validities were confirmed. Levels of anxiety and depression symptoms as well as health-related quality of life (QoL) had weak-to-moderate associations with reproductive concerns. Women who had a child or did not want a biological child were less concerned.

CONCLUSION

This scale proved to be a reliable and valid measure of reproductive concerns for the Portuguese population with potential relevance for application in clinical practice.

Psychosocial challenges and hormonal treatment in gender diverse children and adolescents. A narrative review

Gender dysphoria (GD) in children and adolescents is a condition that is characterized by an incongruence between the assigned and experienced gender. Despite the diversity in clinical presentation, literature demonstrates that GD might lead to poor mental health and high rates of co-occurring psychopathology. Due to the overlap of physical aspects as well as psychological needs in these children, a multidisciplinary approach is highly desirable. The aim of this narrative review is to give an overview of recent literature on several topics relevant in this domain. Guidelines on psychological counseling and hormonal treatment are given and challenging topics subject to controversy are explained. Furthermore, attention is drawn to the risks and protective factors in psychological functioning, including the growing evidence of a frequent co-occurrence with Autism Spectrum Disorder. Finally the psycho-sexual development in these children, the impact on fertility and fertility preservation are discussed.

Fertility preservation and fulfillment of parenthood after treatment of hematological malignancies: results from the 'Aftercare in Blood Cancer Survivors' (ABC) study

Purpose

Treatment of hematological malignancies carries the risk of lasting sterility. We aimed to identify fertility-related unmet needs.

Methods

The ‘Aftercare in Blood Cancer Survivors’ study is a cohort study of hematological patients who were in treatment-free remission for ≥ 3 years or stable under continuous oral medication. Female patients age 18–45 years and male patients age 18–65 years without a history of pre-treatment infertility were asked to answer a structured questionnaire including questions addressing fertility issues. Multivariable analyses were performed to detect risk factors.

Results

Of 1562 study participants, 1031 met the inclusion criteria for the fertility sub-study. A high proportion of patients (72.4%) received information about the risk of losing fertility, but only a minority (15%) took steps to preserve it. Female and older patients were less likely to be informed. A post-treatment wish for parenthood was expressed by 19.3% of patients. It was strongly associated with childlessness at time of diagnosis and could be fulfilled by 29.4%. Fulfillment of desired parenthood increased with increasing time from diagnosis and was low after allogeneic transplantation.

Conclusions

Female and older hematological patients are less likely to be informed about fertility-related issues than other patients. With societal changes towards first parenthood at higher age, the proportion of patients desiring a child after treatment is likely to increase. Fulfillment of desired parenthood remains challenging, especially after allogeneic transplantation.

Implications for cancer survivors

In patients likely to express a wish for post-treatment parenthood, fertility-related issues should routinely be addressed before gonadotoxic treatment is started.

Electronic supplementary material

The online version of this article (10.1007/s10147-020-01639-4) contains supplementary material, which is available to authorized users.

Taboo Topics in Adolescent and Young Adult Oncology: Strategies for Managing Challenging but Important Conversations Central to Adolescent and Young Adult Cancer Survivorship

Research on adolescents and young adults (AYAs) with cancer has flourished over the past decade, underscoring the unique medical and psychosocial needs of this vulnerable group. A cancer diagnosis during adolescence and young adulthood intersects with the developmental trajectory of AYAs, derailing critical physical, social, and emotional development. AYAs face these abrupt life changes needing age-appropriate information and resources to offset these challenges. Greater attention is needed to address AYA-specific concerns on reproductive and sexual health, financial security and independence, emotional well-being, social support, and end-of-life care. If these unique needs are unaddressed, this can adversely affect AYAs' health care engagement and overall quality of life, increasing their risk for cancer-related morbidity and early mortality. In particular, health care decisions made during treatment have important implications for AYA patients' future health. Oncology clinicians are well positioned to address AYA patients' concerns by anticipating and addressing the challenges this age group is likely to face. In this paper, we explore several core topics that affect AYAs' quality of life and that can be challenging to address. Starting from the moment of diagnosis, through cancer treatment and post-treatment survivorship, and into end of life, each section highlights critical developmental-centric life domains that are affected by the cancer experience. Specifically, we discuss resources, tools, and strategies to navigate these challenging conversations. Taking a risk-reduction approach that invites two-way communication and facilitates referral to age-appropriate resources would help destigmatize these experiences and, in turn, would support the provision of compassionate and effective age-concordant care to this vulnerable group.