The psychological importance of fertility preservation counseling and support for cancer patients

Fertility preservation counselling and practice among women with lymphomas: a retrospective study

BACKGROUND

Research on fertility preservation among women diagnosed with lymphoma is very limited. We aimed to assess the receipt of fertility preservation information and use of fertility preservation among women diagnosed with lymphoma.

METHODS

This was a retrospective, single-centre study. Patients with Hodgkin and non-Hodgkin lymphoma were screened from the electronic medical records of individuals who attended the Haematology Department at the study site between 2000 and 2018 and were followed-up for obstetric outcomes and onset of menopause until December 2023.

RESULTS

Forty-three patients had available electronic health records. Overall, 13 (36.1%) of the 36 patients ≤45 years old received fertility preservation counselling; it was more frequent among nulliparous women (11/23, 47.8%), women aged ≤35 years (11/26, 42.3%), and those diagnosed in the latest study period from 2015 to 2018 (9/16, 56.3%). Of the 13 patients who were informed about fertility preservation, 2 patients refused this intervention, and fertility preservation was contraindicated for 3 patients, leading to a total of eight women who underwent fertility preservation strategies: six underwent ovarian cortex cryopreservation, and two underwent oocyte vitrification. Among the participants aged ≤45 years, 10 (27.8%) had at least one live birth after diagnosis. Fifteen (34.9%) of the 43 participants exhibited amenorrhoea after the initiation of chemotherapy, including 4 women ≤35 years of age. The median (range) age at menopause in this series was 45 (27-50) years.

CONCLUSION

Even though the situation appears to have improved in recent years, we are far from reaching the target of all women with lymphoma who are of reproductive age receiving fertility preservation counselling before initiating chemotherapy.

Global, regional, and national time trends in mortality for breast cancer, 1992-2021: an age-period-cohort analysis for the global burden of disease 2021 study

BACKGROUND

Breast cancer remains a major global health concern. This study aims to assess the epidemiological trends of breast cancer, with a focus on mortality rates, primary risk factors, and their associations with age, time period, and birth cohort.

METHODS

Mortality data were obtained from the Global Burden of Disease Study 2021. An age-period-cohort model was employed to analyze trends in breast cancer mortality and its primary risk factors.

RESULTS

Globally, breast cancer outcomes remained poor between 1992 and 2021, with an estimated 660925.3 deaths in 2021. Mortality rates declined significantly in high and high-middle socio-demographic index (SDI) countries [-1.56%, 95% CI (-1.7 to -1.43)], [-1.03% (-1.11 to -0.94), respectively], but increases markedly in low-middle SDI countries [1.18% (1.13 to 1.23)], with little change in other regions. A global shift in breast cancer-related deaths from younger to older age groups was observed, and mortality increased sharply with advancing age. Positive period and cohort effects were primarily seen in high and high-middle SDI countries, whereas adverse effects were more common in lower-SDI regions. Diets high in red meat emerged as the leading risk factor for breast cancer mortality worldwide, although favorable trends were noted in high and high-middle SDI countries.

CONCLUSIONS

Despite a global decline in breast cancer mortality, many countries continue to experience unfavorable period and cohort effects. A notable rise in mortality among individuals aged 80 and older was observed across all SDI quintiles, underscoring the urgent need to strengthen healthcare systems for aging breast cancer populations worldwide.

Treatment Access and Caregiver Experience in Pediatric Rhabdomyosarcoma: Results of an Online Survey

BACKGROUND/OBJECTIVES

Pediatric rhabdomyosarcoma is a rare and poorly understood disease. Patients and parents can have varying experiences including barriers to care, time to treatment, and treatments offered. Here, we report on patient experiences regarding their care of pediatric rhabdomyosarcoma.

METHODS

Two separate online parent support groups were invited to participate in a survey. The survey included questions that sought to collect patient demographics, history of rhabdomyosarcoma, treatment timelines, and barriers to care.

RESULTS

A total of 215 surveys were completed. The average time from diagnosis to treatment was 12 days (SD = 14). Only 26% were offered fertility preservation prior to treatment. For patients with recurrence, an average of 75 days passed between detection of recurrence and treatment re-initiation. Patients traveled to centers with a dedicated sarcoma program in 52% of the cases. A total of 42% of parents sought a second opinion. Of those, the majority had to wait between one week and one month to be seen by another expert.

CONCLUSIONS

The data collected from the survey suggests there are several opportunities to improve care among patients with pediatric rhabdomyosarcoma. Many patients may benefit from more efficient rhabdomyosarcoma referral networks, delivering patients to experts who can quickly begin multidisciplinary treatment.

The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges

Introduction

Global cancer cases are increasing, but fortunately, cancer is becoming more treatable. By 2050, the number of cancer cases is projected to reach 35 million. These numbers are certainly correlated with the aging population, early diagnoses due to screenings, and the broad current treatment options. However, life-saving therapies are often gonadotoxic, significantly impacting the lives of cancer patients. Fertility preservation following life-saving oncological treatments is one of the challenges faced by patients with cancer.

Material and method

We analyzed 73 articles to investigate the current state of fertility preservation in oncology, also evaluating the medico-legal implications.

Results

The data indicate a growing trend of cancer recoveries and survivorship with opportunities to access fertility preservation through various methods, which are not entirely known or consistently offered to patients in the appropriate manner.

Conclusions

The ethical and medico-legal aspects are numerous and seem to be still evolving.

Psychosocial programs to alleviate fertility-related distress in patients with cancer: A mixed-methods systematic review

PURPOSE

This mixed-methods systematic review aimed to identify the key components of psychosocial programs for fertility-related distress in patients with cancer and integrate the findings from quantitative and qualitative studies.

METHODS

A search for relevant studies published between January 2012 and March 2024 was conducted in the PubMed, EMBASE, CINAHL, MEDLINE, PsycINFO, and Cochrane Review Library databases. Data were synthesized using a sequential descriptive design.

RESULTS

Eight studies were included: six randomized controlled trials (two of which also included qualitative data) and two qualitative studies. The quantitative data found direct effects such as increased fertility-related knowledge, although the results on psychological outcomes such as anxiety and depression were inconsistent. The qualitative findings confirmed patients' ambivalence about facing their fertility issues, increased knowledge for decision-making, and unmet needs such as information overload and a lack of psychological support. For the cognitive-behavioral outcomes, fertility-related concerns were examined in greater depth in the quantitative studies, whereas the qualitative studies focused more on empowerment.

CONCLUSION

This review emphasizes the need for the careful design of psychosocial interventions to prevent negative emotional impacts while supporting the long-term self-management of fertility-related issues. Tailoring these interventions to meet the specific needs of patients is essential for improving psychosocial outcomes.

Breast cancer Treatment and Fertility Preservation: A Narrative Review of Impacts, Strategies and Ethical Considerations

PURPOSE OF REVIEW

At present, breast cancer represents the most common malignancy diagnosed in women worldwide. Due to the trend toward delayed childbearing, many women of reproductive age are being diagnosed with breast cancer and treated with chemotherapy or hormone therapy which can adversely affect their fertility. This literature review discusses the effects of breast cancer treatment on fertility and options for fertility preservation.

RECENT FINDINGS

Treatments used in the management of breast cancer often result in a diminished ovarian reserve, premature ovarian insufficiency, and treatment-related amenorrhea. Chemotherapy may cause direct damage to oocytes and deplete ovarian reserve, while hormone therapies such as tamoxifen can cause amenorrhea and delay childbearing. Targeted therapies and radiotherapy may also pose risks to reproductive health. Fertility preservation is a concern for patients, and many of them may refuse or prematurely discontinue treatment to preserve their fertility. It is relevant to incorporate considerations of fertility at the time of treatment planning for breast cancers and to provide information to appropriate patients regarding their options. Current techniques available for fertility preservation include ovarian suppression, oocyte and embryo cryopreservation, and ovarian tissue cryopreservation. In spite of these techniques being in existence, there are plenty of barriers that deter the patients from availing them, including lack of awareness, financial constraints, and the need for timely treatment. This review implicates that these challenges require multidisciplinary approaches and a patient-centered approach. Further research is warranted toward the improvement of fertility preservation techniques, individual variability in protocols, and newer advances in reproductive medicine to further optimize quality of life in survivors of breast cancer.

Out-of-pocket fertility preservation expenses: data from a Japanese nationwide multicenter survey

BACKGROUND

The expenses related to fertility preservation or subsequent assisted reproductive treatments are significant for adolescents and young adult patients in Japan's current healthcare system. With fertility preservation becoming more widespread in developed countries, it is expected that these costs will be covered by insurance or subsidies. It is critical for patients, healthcare providers, and the government to know the costs that patients will be responsible for. In Japan, the costs of fertility preservation and subsequent assisted reproductive technology are not covered by insurance, but patients can apply for subsidies from the local and central governments if certain conditions are met. Presently, the above-mentioned costs, as well as the amount paid by the patient, vary by facility. Therefore, it is essential to ensure patients' continued access to necessary medical care despite the associated costs.

METHODS

In this study, questionnaires were mailed to 186 certified fertility preservation facilities in Japan to assess patients who had undergone fertility preservation or assisted reproduction. The questionnaires were sent between October 27, 2023 and March 31, 2024, with 140 of the 186 facilities responding (response rate: 75.3%).

RESULTS

Our findings show that approximately one-third of the costs was borne by the patients.

CONCLUSION

Given these circumstances, sustainable pricing and insurance coverage are necessary for both patients and facilities.

Current practices in oncofertility counseling: updated evidence on fertility preservation and post-treatment pregnancies in young women affected by early breast cancer

INTRODUCTION

Anticancer treatments have significantly contributed to increasing cure rates of breast cancer in the last years; however, they can also lead to short- and long-term side effects, including gonadotoxicity, and compromised fertility in young women. Oncofertility is a crucial issue for young patients who have not yet completed their family planning at the time of cancer diagnosis.

AREAS COVERED

This review aims to cover all the latest available evidence in the field of oncofertility, including the gonadotoxicity of currently adopted anticancer therapies in the curative breast cancer setting, the available strategies for fertility preservation and the feasibility of achieving a pregnancy following anticancer treatment completion.

EXPERT OPINION

Over the past years, a significant progress has been made in oncofertility care for young women with breast cancer. In the context of the currently available evidence, every young woman with newly diagnosed breast cancer should receive a proper and complete oncofertility counseling before starting any anticancer treatment to increase her chances of future pregnancies.

[Factors Influencing Oncofertility in Gynecological Cancer Patients: Application of Mixed Methods Study]

PURPOSE

This study aimed to identify factors influencing oncofertility and to explore the oncofertility experiences of patients with gynecological cancer using quantitative and qualitative methods, respectively.

METHODS

An explanatory sequential mixed-methods study was conducted. The quantitative study involved 222 patients with gynecological cancer recruited from online cafes and hospitals. Data were analyzed using IBM SPSS Statistics 28. For qualitative research, eight patients with gynecological cancer were interviewed. Data were analyzed using theme analysis method.

RESULTS

Oncofertility performance was quantitatively assessed in 40 patients (18.0%). Factors that significantly affected oncofertility were fertility preservation awareness (odds ratio [OR] = 14.97, 95% confidence interval [CI]: 4.22~53.08), number of children planned before cancer diagnosis (OR = 6.08, 95% CI: 1.89~19.62; OR = 5.04, 95% CI: 1.56~16.29), monthly income (OR= 3.29, 95% CI: 1.23~8.86), social support (OR = 1.08, 95% CI: 1.01~1.17), and anxiety (OR = 0.79, 95% CI: 0.66~0.95). Qualitative results showed three theme clusters and eight themes: (1) themes for determinant factors affecting oncofertility selection: 'desire to have children' and 'special meaning of the uterus and ovaries;' (2) themes for obstructive factors affecting oncofertility selection: 'fertility preservation fall behind priorities,' 'confusion caused by inaccurate information,' and 'my choice was not supported;' (3) themes for support factors affecting oncofertility selection: 'provide accurate and reasonable information about oncofertility,' 'addressing the healthcare gap,' and 'need financial support for oncofertility.'

CONCLUSION

Financial support, sufficient information, social support, and anxiety-relief interventions are required for oncofertility in patients with gynecological cancer.

Self-disclosure, perceived social support, and reproductive concerns among young male cancer patients in China: A mediating model analysis

Objective

Many young male cancer patients experience reproductive concerns. Self-disclosure might be able to improve patients' perceived social support and reproductive concerns. Nevertheless, these relationships have not yet been confirmed among young male cancer patients. This study aims to investigate the level of reproductive concerns and to identify the mediating role of perceived social support between self-disclosure and reproductive concerns among young male cancer patients in China by developing a structural model.

Methods

This study was a quantitative, cross-sectional design. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines to report this study. A total of 369 young male cancer survivors were recruited by convenience sampling from two tertiary hospitals in Taiyuan, Shanxi, China. Data were collected using a "general data questionnaire", "distress disclosure index" (DDI), "perceived social support scale" (PSSS), and "reproductive concerns after cancer-male" (RCAC-M) via the WeChat mini program "Questionnaire Star" and paper questionnaire. Descriptive statistics, Pearson correlation analyses, and structural equation models were adopted to analyze the data.

Results

Reproductive concerns were at moderate levels and negatively associated with self-disclosure (r = -0.619, P < 0.01) and perceived social support (r = -0.599, P < 0.01). Self-disclosure indirectly influenced reproductive concerns (-0.328∼-0.159, P < 0.001) through perceived social support.

Conclusions

Self-disclosure and perceived social support are closely associated with reproductive concerns in young male cancer patients, and perceived social support is a mediator between self-disclosure and reproductive concerns. Healthcare providers could reduce reproductive concerns by enhancing self-disclosure and improving perceived social support.

Trial registration

This study was registered on ClinicalTrials.gov on June 13, 2023 (NCT05914181).

Oncofertility as an Essential Part of Comprehensive Cancer Treatment in Patients of Reproductive Age, Adolescents and Children

The number of children, adolescents and young adults diagnosed with cancer has been rising recently. Various oncological treatments have a detrimental effect on female fertility, and childbearing becomes a major issue during surveillance after recovery. This review discusses the impact of oncological treatments on the ovarian reserve with a thorough explanation of oncologic treatments' effects and modes of oncofertility procedures. The aim of this review is to help clinicians in making an informed decision about post-treatment fertility in their patients. Ultimately, it may lead to improved overall long-term outcomes among young populations suffering from cancer.

Psychological distress in adult women of reproductive age at different stages after breast cancer diagnosis: A qualitative study

AIM

To explore the actual experience of psychological distress of adult women of reproductive age at different stages after breast cancer diagnosis.

DESIGN

Qualitative.

METHODS

Eighty-one patients with breast cancer-related distress thermometer scores >4 were selected using a purposive sampling method. Patients were divided into newly diagnosed and 1-, 3-, 6-, 9- and 12-month groups according to time since diagnosis and then interviewed. A phenomenological approach was adopted to analyse interview content, and different themes were extracted.

RESULTS

Women exhibited different levels of psychological distress depending on the time since diagnosis, with newly diagnosed patients showing the highest distress. Within 1 year post-diagnosis, different events caused patients distress. Themes extracted at new diagnosis and 1-, 3-, 6-, 9- and 12 months post-diagnosis included sadness and disbelief, loss of control, optimistic but concerned, physical and mental exhaustion, difficulties returning to society and limited sexual intimacy, respectively; all groups expressed reproductive concerns.

CONCLUSION

Clinical nurses should focus on different psychologically distressing events to provide targeted interventions at distinct phases. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and reproductive concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

During the year after a breast cancer diagnosis, patients of childbearing age experience events that cause psychological distress that differ depending on time since diagnosis. Nurses should focus on core stressful events and perform specific nursing interventions.

IMPACT

To provide holistic care, nurses should consider the psychological and emotional changes patients may undergo. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and fertility concerns, and be able to provide evidence-based professional guidance on reproductive preservation techniques.

REPORTING METHOD

The study was reported using the consolidated criteria for reporting qualitative research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed to data collection through interviews.

Testicular function after non-cytotoxic and immunotherapy drug treatment

BACKGROUND

The effects of novel non-cytotoxic and immunotherapy drugs for cancer treatment on human testicular function have not been studied systematically.

OBJECTIVES

The present study aimed to characterize effects of non-cytotoxic and immunotherapy drugs in patients with cancers who had not been previously treated with gonadotoxic chemo- or radiotherapy.

MATERIALS AND METHODS

This study involved 34 men, not previously treated with gonadotoxic regimens, in a mixed longitudinal (Cohort 1: 19 men about to start and approximately 1 year on non-cytotoxic and immunotherapy treatment) and cross-sectional (Cohort 2: 15 men already on non-cytotoxic and immunotherapy treatment) study using data modeling to estimate within-person time-course changes in testicular exocrine and endocrine functions. Cohort 1 provided 45 paired semen and blood samples (34 prior to and nine during treatment) and Cohort 2 provided 45 sets of samples (15 pre-treatment, 30 on treatment), including six men in Cohort 2 who had pre-treatment spermatozoa cryostorage prior to the study. Men on non-cytotoxic and immunotherapy treatment had undergone a median of 33.5 months long-term treatment.

RESULTS

Spermatozoa output and concentration were reduced by about 50%, with corresponding increases in serum follicle-stimulating hormone and decreases in serum inhibin B. Serum testosterone, luteinizing hormone, and sex hormone-binding globulin were unaffected by non-cytotoxic and immunotherapy treatment.

CONCLUSION

Within limits of the present study of sample size and duration of on-non-cytotoxic and immunotherapy treatment, non-cytotoxic and immunotherapy drugs have a modest effects on testicular exocrine function (sperm production) or its hormonal correlates (follicle-stimulating hormone, inhibin B), with minimal impact on testicular endocrine (testosterone, luteinizing hormone) function.

An update on oncofertility in prepubertal females

Cancer is a life-threatening event for pediatric patients. Treatment advancements in pediatric cancer have improved prognosis, but some of these treatments have gonadotoxic potential and may affect fertility in different ways. Due to the growing interest of the research community in the life prospects of young cancer survivors, there has been a demand to intersect reproductive medicine and oncology, which is referred to as "oncofertility". There are various fertility preservation options according to gender and pubertal status, and shared decisions must take place at the time of diagnosis. This study aims to provide a critical review of current and emerging strategies for preserving and restoring fertility in prepubertal females, ranging from established methods to experimental approaches that can be offered before, during, and after anticancer therapies. Additionally, the author aims to review how clinicians' awareness of oncofertility options and the latest advancements in this field, timely referral, and proper consultations with patients and their families are vital in addressing their concerns, providing emotional support, and guiding them through the decision-making process, as well as potential barriers that may hinder the fertility preservation process.

Examining the Role of Nutrition in Cancer Survivorship and Female Fertility: A Narrative Review

Female cancer survivors have a higher chance of experiencing infertility than females without a history of cancer diagnosis. This risk remains high despite advances in fertility treatments. There is a need to augment fertility treatments with cost-effective methods such as nutritional guidance to improve fertility chances. The aim of this review article is to connect the current literature on cancer survivorship nutrition and fertility nutrition, focusing on the importance of integrating nutritional guidance into fertility counseling, assessment, and treatment for female cancer survivors. Consuming a healthful diet comprising whole grains, soy, fruits, vegetables, seafood, and unsaturated fats has improved both female fertility and cancer survivorship. Similarly, maintaining a healthy body weight also improves female fertility and cancer survivorship. Therefore, dietary interventions to support female cancer survivors with fertility challenges are of immense importance. The period of follow-up fertility counseling and assessment after cancer treatment may provide a unique opportunity for implementing nutritional guidance for female cancer survivors. Dietary interventions are a promising strategy to improve pregnancy chances and overall quality of life among female cancer survivors; thus, researchers should investigate perceptions regarding fertility, barriers, and challenges to changing nutrition-related behaviors, and preferences for nutritional guidance to support fertility treatments in this population.

Evaluating the safety and efficacy of cryopreserved ovarian tissue transplantation in leukemia patients with different bone marrow remission status using xenotransplantation

Background

Leukemia patients undergoing cryopreserved ovarian tissue transplantation (OTT) may carry a high risk of disease induction. Measurable residual disease (MRD) in bone marrow is linked to an elevated risk of relapse. It is controversial whether leukemia patients must be allowed to achieve measurable residual disease negative (MRD-negative) status instead of measurable residual disease positive (MRD-positive) status before ovarian tissue cryopreservation (OTC).

Objective

To explore the safety and efficacy of OTT in acute leukemia patients with different MRD status by using xenotransplantation.

Method

Cryopreserved ovarian tissue from 19 leukemia patients was thawed and xenotransplanted to ovariectomized BALB/C nude mice (n=36). The mice were divided into 2 groups based on the patient's MRD status before OTC: MRD-negative group (n=18) and MRD-positive group (n=18), additionally, a control group consisted of ovariectomized mice (n=9). Body weight was measured weekly and mortality, emaciation, and other abnormalities were recorded. Twenty-six weeks post-surgery, livers, spleens, uteruses, and ovarian grafts were removed for macroscopic and histological examinations to evaluate the efficacy of xenotransplantation and assess malignant cell contamination in mice.

Results

Follicle growth was visible in the ovarian grafts of the MRD-negative and MRD-positive groups. Compared with the ovariectomized group, a significant decrease in body weight (p<0.01) was noted, the uterine volume was notably larger, estradiol (E2) levels were significantly higher (p<0.01), and follicle-stimulating hormone (FSH) levels were significantly lower (p<0.001) in the other two groups. Mice in the MRD-positive group showed a significantly higher incidence of death (p<0.001) and emaciation (p<0.01), compared to the MRD-negative group. Histological observation revealed the presence of malignant cells in the grafts, livers, and spleens of 3 mice in the MRD-positive group. No abnormalities were observed in the mice from the MRD-negative group in both macroscopic and histological observations except one mouse was sacrificed for ascites unrelated to leukemia relapse.

Conclusion

For leukemia patients having ovarian tissue preserved in the first and only centralized human ovarian tissue cryobank in China, immunodeficient mice xenotransplantation can be a method to evaluate the safety and efficacy of OTT; the risk of malignant cell reimplantation due to OTT is higher in leukemia patients with MRD-positive status than those with MRD-negative status before OTC.

Perceptions and experiences of fertility preservation in female patients with cancer in Greece

BACKGROUND

As advances in oncology have led to remarkable and steady improvements in the survival rates of patients with cancer and anticancer treatment can cause premature ovarian failure in women, fertility preservation (FP) has become a global public health concern and an integral part of the care for women diagnosed with cancer during reproductive age. However, for various reasons, FP remains underutilized for patients with cancer. There are substantial gaps in our knowledge about women's experiences and perceptions of the issue. This study aims to contribute to bridging that gap.

METHODS

This prospective qualitative study was conducted from March 2018 to February 2023. A combination of purposive and snowball sampling was used. Data were collected by semistructured interviews with nineteen reproductive-age women who had been recently diagnosed with cancer. Data were classified and analysed with a thematic analysis approach.

RESULTS

A variety of distinct themes and subthemes emerged from the analysis of the interview data. The cancer diagnosis emerged as a factor that considerably affects the women's attitudes towards biological parenthood: It can further increase their (strong) previous desire or decrease their previous (weak) desire. Women with a recent cancer diagnosis had not received adequate and multidisciplinary counselling, including clear and sufficient information. However, participants felt satisfied with the information they received because they either received the information they requested or remained in denial about the need to be informed (i.e., because they felt overwhelmed after the cancer diagnosis). Embryo cryopreservation emerged as a less desirable FP option for women with cancer. Participants showed respect for human embryos, not always for religious reasons. Surrogacy emerged as the last resort for most participants. Religious, social or financial factors did play a secondary (if any) role in women's decision-making about FP. Finally, male partners' opinions played a secondary role in most participants' decision-making about FP. If embryo cryopreservation was the selected option, partners would have a say because they were contributing their genetic material.

CONCLUSIONS

The findings that emerged from the data analysis were partly consistent with prior studies. However, we identified some interesting nuances that are of clinical importance. The results of this study may serve as a starting point for future research.

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.

Evaluating fertility preservation interventions for alignment with ASCO Guidelines for reproductive aged women undergoing cancer treatment: a systematic review

PURPOSE

While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework.

METHODS

We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability.

RESULTS

Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders' views. All interventions were implemented in real-world contexts, and only three discussed sustainability.

CONCLUSIONS

This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.

Actual situation of decision-making support from medical staff when cancer patients make treatment choices

Background: We investigated factors involved in decision-making support provided by physicians, nurses, pharmacists and medical and psychiatric social workers involved in cancer care. Materials & methods: A questionnaire survey on decision-making support was conducted. The level of clinician support was classified as 'supporting patients' 'decision-making process regarding cancer treatment', 'no support for patients' 'decision-making process regarding cancer treatment' or 'team-based support for patients' 'decision-making process regarding cancer treatment'. Results: Physicians estimated that 83.7% of patients made a cancer treatment decision within 1 week, but 45.4% of patients had difficulty making a decision. Conclusion: Medical personnel should support patients who have difficulty making decisions, establish a screening method to identify those needing support and develop a system providing decision-making support through interprofessional work.

Polish Female Cancer Survivors' Experiences Related to Fertility Preservation Procedures

Purpose: The aim of the study was to assess the experience of Polish female cancer patients related to fertility preservation (FP) after gonadotoxic treatment. Methods: A cross-sectional study was performed among young women, who were diagnosed with a neoplasm. The questionnaire was distributed via the Internet. Results: The study group consisted of 299 women. Most of them had breast cancer (34%) or Hodgkin lymphoma (20%). The most popular treatment regimen was a combination of surgery, chemotherapy, and radiation (30%). Almost 78% of study participants underwent potentially gonadotoxic treatment. Fifty-seven percent of study participants admitted that oncologist had not informed them about FP methods, while only 19% were encouraged to visit fertility specialists. Seventeen percent of women decided to preserve fertility before malignancy treatment, 11.8% of women cryopreserved oocytes, 16% cryopreserved embryos, 16% cryopreserved ovarian tissue and 55% had ovarian suppression. Conclusion: The access to fertility counseling in Poland is limited. Emphasis should be placed on the coordination between cancer treatment centers and reproductive specialists.

Should we perform oocyte accumulation to preserve fertility in women with Turner syndrome? A multicenter study and systematic review of the literature

STUDY QUESTION

Should we perform oocyte accumulation to preserve fertility in women with Turner syndrome (TS)?

SUMMARY ANSWER

The oocyte cryopreservation strategy is not well adapted for all TS women as their combination of high basal FSH with low basal AMH and low percentage of 46,XX cells in the karyotype significantly reduces the chances of freezing sufficient mature oocytes for fertility preservation.

WHAT IS KNOWN ALREADY

An oocyte cryopreservation strategy requiring numerous stimulation cycles is needed to preserve fertility in TS women, to compensate for the low ovarian response, the possible oocyte genetic alterations, the reduced endometrial receptivity, and the increased rate of miscarriage, observed in this specific population. The validation of reliable predictive biomarkers of ovarian response to hormonal stimulation in TS patients is necessary to help practitioners and patients choose the best-personalized fertility preservation strategy.

STUDY DESIGN, SIZE, DURATION

A retrospective bicentric study was performed from 1 January 2011 to 1 January 2023. Clinical and biological data from all TS women who have received from ovarian stimulation for fertility preservation were collected. A systematic review of the current literature on oocyte retrieval outcomes after ovarian stimulation in TS women was also performed (PROSPERO registration number: CRD42022362352).

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 14 TS women who had undergone ovarian stimulation for fertility preservation were included, representing the largest cohort of TS patients published to date (n = 14 patients, 24 cycles). The systematic review of the literature identified 34 additional TS patients with 47 oocyte retrieval outcomes after ovarian stimulation in 14 publications (n = 48 patients, n = 71 cycles in total).

MAIN RESULTS AND THE ROLE OF CHANCE

The number of cryopreserved mature oocytes on the first cycle for TS patients was low (4.0 ± 3.7). Oocyte accumulation was systematically proposed to increase fertility potential and was accepted by 50% (7/14) of patients (2.4 ± 0.5 cycles), leading to an improved total number of 10.9 ± 7.2 cryopreserved mature oocytes per patient. In the group who refused the oocyte accumulation strategy, only one patient exceeded the threshold of 10 mature cryopreserved oocytes. In contrast, 57.1% (4/7) and 42.9% (3/7) of patients who have underwent the oocyte accumulation strategy reached the threshold of 10 and 15 mature cryopreserved oocytes, respectively (OR = 8 (0.6; 107.0), P = 0.12; OR= 11 (0.5; 282.1), P = 0.13). By analyzing all the data published to date and combining it with our data (n = 48 patients, n = 71 cycles), low basal FSH and high AMH concentrations as well as a higher percentage of 46,XX cells in the karyotype were significantly associated with a higher number of cryopreserved oocytes after the first cycle. Moreover, the combination of low basal FSH concentration (<5.9 IU/l), high AMH concentration (>1.13 ng/ml), and the presence of 46,XX cells (>1%) was significantly predictive of obtaining at least six cryopreserved oocytes in the first cycle, representing objective criteria for identifying patients with real chances of preserving an adequate fertility potential by oocyte cryopreservation.

LIMITATIONS, REASONS FOR CAUTION

Our results should be analyzed with caution, as the optimal oocyte number needed for successful live birth in TS patients is still unknown due to the low number of reports their oocyte use in the literature to date.

WIDER IMPLICATIONS OF THE FINDINGS

TS patients should benefit from relevant clinical evaluation, genetic counseling and psychological support to make an informed choice regarding their fertility preservation technique, as numerous stimulation cycles would be necessary to preserve a high number of oocytes.

STUDY FUNDING/COMPETING INTEREST(S)

This research received no external funding. The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Male pediatric, adolescent, and young adult reproductive survivorship

As pediatric, adolescent, and young adult cancer survival rates increase, emphasis is placed on reducing late effects, including reproductive complications and potential impact to fertility. Male survivors are at risk of abnormalities in sperm, hormone deficiencies, and sexual dysfunction. This can impact one's progression into puberty and ability to have a biological child and impacts quality of life following treatment. Access to reproductive care is important and requires patient assessment and appropriate referral to reproductive specialists. This review addresses reproductive complications associated with therapy, standard-of-care testing, and therapeutic interventions. The psychologic impact on psychosexual functioning is also addressed.

Psychometric properties of the Korean version of the oncofertility barriers scales among nurses: A methodological study

Objective

This study aimed to examine the psychometric properties of the Korean version of the Oncofertility Barrier Scale (K-OBS).

Methods

This methodological study investigated the validity and reliability of the K-OBS for measuring barriers to oncofertility care among nurses. A total of 270 nurses who had experience in rendering nursing care to cancer survivors were recruited, and the instrument was translated, assessed for content validity, and tested using a preliminary survey. Construct validity was established through explanatory factor analysis. Convergent validity and discriminant validity were analyzed using a multitrait-multimethod (MTMM) matrix. Reliability was assessed using Cronbach's alpha and McDonald's omega.

Results

The K-OBS demonstrated satisfactory validity and reliability, with seven factors, including 27 items explaining 60.42% of the total variance, a Cronbach's alpha of 0.86, and a McDonald's omega of 0.83. The seven factors were labeled, "Lack of information and education" (8 items), "Rigid thinking toward oncofertility care" (5 items), "Cancer patient stereotypes" (4 items), "Insufficient support" (4 items), "Desire for fertility preservation" (2 items), "Interrupted oncofertility care" (2 items), and "Fertility risk" (2 items).

Conclusions

The results of this study indicate that the K-OBS may be a suitable instrument with acceptable validity and reliability for evaluating barriers to oncofertility among Korean nurses. This instrument can be used to identify obstacles that make oncofertility care difficult, thereby contributing to new insights for improving the future quality of oncofertility care in Korea.

Psychological states and needs among post-allogeneic hematopoietic stem cell transplantation survivors

OBJECTIVES

To analyze psychological states and needs of patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS

Questionnaires were sent to 101 allo-HSCT survivors and 96 questionnaires were returned. The questionnaire covered several categories: (1) demographics and general information, (2) physical conditions, (3) psychologic status and sleep quality, (4) survivor's comments on transplantation, (5) demands and needs, (6) preferred forms and channels of information.

RESULTS

Depression and poor sleep quality were major concerns troubling allo-HSCT survivors. A notable discrepancy exists between clinically diagnosed depression (4.2%) and self- reported depression based on BDI-13 (55.2%). Young adults (18-49 years old), chronic graft-versus-host disease, the ECOG performance score of 2-4, surviving within 5 years since HSCT, no or low dose of ATG used and being single were significantly associated with self-reported depression. Based on the PSQI score, 75% of survivors experienced varying degrees of sleep quality impairment. Young adults, chronic GVHD and the ECOG score of 2-4 were significantly associated with worse sleep quality. The majority of patients reported unmet needs on physical and psychosocial aspects. Nutrition information was the most important topic, followed by disease treatments and fatigue. Differences in informational needs were found in the survivors according to age, time since HSCT and gender. WeChat public account and WeChat applet, mobile interactive platform and one-to-one conversation were the favorite channel for information.

CONCLUSIONS

Clinicians should establish more appropriate survivorship care plans focusing on survivors' psychologic states, demands and needs.

Fertility preservation provision in the NHS: a national assessment of care policies

Fertility preservation has gained momentum in recent years. As cancer survival rates improve, late effects of loss of gonadal function have increased the need to consider fertility preservation. NICE recommends offering cryopreservation of gametes or embryos to patients undergoing gonadotoxic therapy, highlighting that this should be extrapolated to those with non-malignant conditions that pose a risk to fertility. We investigated whether variation in fertility preservation provision exists across the United Kingdom, with a view to identifying equitable models of provision. In England, cryopreservation of gametes and embryos is funded for all patients undergoing treatment for cancer, but eligibility criteria and duration of storage funding vary widely. In Scotland, a national policy is applied, with health boards equitably providing funding for cryopreservation of gametes, embryos, and ovarian and testicular tissue for those undergoing treatment for benign and malignant conditions which impair fertility, including gender incongruence. In Wales and Northern Ireland, cryopreservation of gametes and embryos is funded for those undergoing treatment likely to make them infertile, but ovarian tissue cryopreservation is not funded. Funding criteria for fertility preservation in England, Wales, and Northern Ireland deviates from NICE guidance. Standardization of fertility preservation policies is needed to provide equity of access for patients.

Knowledge and beliefs about oocyte cryopreservation for medical and social reasons in female students: a cross-sectional survey

BACKGROUND

With the increasing number of young women surviving cancer and a growing trend among highly educated women to postpone childbearing for educational or professional pursuits, there is a rising demand for egg freezing services to ensure a successful pregnancy. This study aims to assess the knowledge and beliefs surrounding oocyte cryopreservation, both for medical and social reasons, among female students in Tehran, Iran.

METHODS

An online cross-sectional survey was carried out from March to August of 2022, involving a total of 1279 childless students pursuing master's and doctoral degrees at universities in Tehran. The participants were between the ages of 18 and 38. Knowledge and beliefs about medical and social oocyte cryopreservation were assessed through Fertility Preservation Survey (FPS) instrument.

RESULTS

The mean age of the participants was 26.38 ± 4.9. The majority of students expected to be "30-34 years" when they become pregnant with their first child (41.1%, M: 30.3 ± 4.13 years) and "35-39 years" when they give birth to their last child (46.7%, M: 35.28 ± 4.18 years). The students agreed with preserving fertility with medical (93.3%) and social (86.9%) indications and believed the medical (95.1%) and social (87.4%) costs of cryopreservation should be covered by the healthcare system. Among the participants, 75.6% considered cost to be a definite or probable factor in their decision to pursue fertility preservation. The oncology team's recommendation was identified as the most important factor in deciding on medical egg freezing (92.6%, M: 3.46 ± 0.71). The overall correct response rate for the knowledge questions was 57.7%. The majority of participants (95.5%) agreed that physicians should routinely provide information about egg freezing to women of childbearing age during their regular healthcare visits.

CONCLUSIONS

The research results revealed that female students in Tehran universities have a positive attitude towards medical and social egg freezing, but lack sufficient knowledge about the ideal timing of childbearing. Health professionals could provide detailed information about fertility preservation and age-related infertility as part of routine healthcare visits or reproductive health planning. Additionally, expanding supportive policies and incentives for childbearing established by the government to cover the costs of fertility preservation would be beneficial.

Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review

Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy.

Fertility discussions and concerns in childhood cancer survivors, a systematic review for updated practice

PURPOSE

To provide ways to improve the clinical practice of fertility preservation (FP) for children, adolescents, and young adults (AYA) with cancer.

DESIGN

A systematic research of online databases was undertaken in March 2020 following the PRISMA criteria, including Medline and Web of Science.

RESULTS

Fifty-nine articles were included. Surveys, interviews, and focus groups were used to collect data from patients, parents, and health care providers (HCPs). Four themes worth exploring emerged: (a) what do patients and professionals think of and know about FP? (b) what makes the fertility discussion happen or not? (c) what, retrospectively, led to FP being pursued or not? and (d) how do patients and HCPs feel about fertility issues?

CONCLUSION

A minority of AYAs preserve their fertility (banking assay for 45% of boys and 23% of girls). Yet fertility concerns have a significant impact on the quality of life of young cancer survivors. Although recommendations and guidelines regarding FP are available internationally, there are no specific guidelines as to how to conduct fertility counseling for children and adolescents. Some barriers are not removable, such as a poor prognosis of an obvious severe disease, time constraints for starting treatment, and cultural and religious beliefs. In response to aspects hindering patients and families to be receptive to any discussion at the time of diagnosis, psychological support could reduce the level of emotional distress and help restore a degree of open-mindedness to open a window for discussion. Moreover, as the lack of knowledge of professionals about fertility is frequently pointed out as a limiting factor for fertility discussion, reinforcing professional training regarding FP could be proposed to promote fertility discussion and eventually referral for FP.

Telemedicine for Virtual Consultations During COVID-19 Pandemic in a Medically Assisted Reproduction Center: Patients' Perspective

Background: Restrictive measures imposed to prevent COVID-19 contagion have caused an increase in waiting times for other health procedures. During the pandemic, utilization of telemedicine has increased to ensure patient care safely. The aim of this study was to evaluate the perspective of infertile patients who underwent virtual consultations for infertility. Materials and Methods: This was an observational study. A survey was submitted to patients who attended a virtual consultation at a single in vitro fertilization (IVF) unit between March 2020 and July 2021. The survey concerned their experience with telemedicine assessing the experience of video consulting and the software characteristics. Results: The survey response rate was 50.3% (n = 159). In total, 98.8% of patients positively rated the experience of telemedicine. Regarding the software itself, it was defined as intuitive and easy to use by 87.4% of patients. A majority (92.5%) of interviewed patients reported that they were able to receive the information and clear any doubts they had and 85.5% of interviewed patients would repeat the experience of video consultation. Conclusions: The acceptance of telemedicine was very high among infertile patients. However, IVF treatments have a strong emotional component and face-to-face consultation with medical staff might help to create the right climate of trust, and the empathy that can be demonstrated during a vis-à-vis meeting cannot be achieved through a screen. The use of telemedicine should be considered in those situations where it is not possible to attend an in-person consultation or when couples prefer it.

Fertility preservation in women with benign gynaecological conditions

Although a wealth of data has been published regarding fertility preservation (FP) in women with malignant diseases who receive gonadotoxic treatment, the role of FP in non-malignant conditions has been studied to a much lesser extent. These include benign haematological, autoimmune, and genetic disorders, as well as a multitude of benign gynaecological conditions (BGCs) that may compromise ovarian reserve and/or reproductive potential due to pathogenic mechanisms or as a result of medical or surgical treatments. Alongside accumulating data that document the reproductive potential of cryopreserved oocytes and ovarian tissue, there is potential interest in FP for women with BGCs at risk of infertility; however, there are currently insufficient data about FP in women with BGCs to develop guidelines for clinical practice. The purpose of this article is to appraise the available evidence regarding FP for BGC and discuss potential strategies for FP based on estimated ovarian impairment and on short-term and long-term reproductive goals of patients. Cost-effectiveness considerations and patients' perspectives will also be discussed.

Experiences of young girls and women undergoing ovarian tissue cryopreservation: a systematic review and thematic synthesis

The aim of this study was to explore the experiences of young girls and women who underwent or considered ovarian tissue cryopreservation (OTC) using a systematic review of qualitative studies with thematic synthesis framework. Major electronic databases: MEDLINE, EMBASE, the Cochrane Library, CINAHL and PsycINFO were searched from 1946 to May 2020 and reference lists of relevant articles were hand searched. Any studies that described a qualitative inquiry and highlighted the experiences of women with regards to OTC were included. Two independent reviewers screened the title and abstracts and made a selection against inclusion criteria. Main outcomes measures were experiences of women who have considered and/or undergone OTC, decision making in women who underwent or considered OTC and patient education. Nineteen studies were assessed for full text eligibility and four were included in analysis. 144 verbatim quotations from 85 participants in high income countries (UK, USA and Denmark) were included. Two studies adopted grounded theory approach, one phenomenology and one inductive content analysis. Four themes were generated; participants described their experiences as emotional, involving complex decision-making, helping them prepare for the long-term consequences of potentially losing their fertility and hormonal function, as well as their experience being educational. Additionally, the more practical aspects of the procedure such as OTC being invasive as well as costs implications were highlighted. Women and young girls are often involved in making time-sensitive decisions whether or not to undergo OTC. Healthcare professionals involved in the care of young girls and women undergoing this method need to also take into consideration the emotional wellbeing of the patients as well as the time and expertise it requires to help them make an informed decision.

Sexual Dysfunction among Gynaecological Cancer Survivors: A Descriptive Cross-Sectional Study in Malaysia

BACKGROUND

Sexual dysfunction is a major issue among gynaecological cancer survivors. This study aimed to evaluate the prevalence of sexual dysfunction among survivors of gynaecological cancer in Malaysia and to determine its risk factors.

METHODS

A cross-sectional study was conducted of 116 married women with gynaecological cancer who attended the gynaeoncology and oncology clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Sociodemographic and clinical data were collected. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI). Univariate and multivariate logistic regression analyses were used to determine the risk factors of female sexual dysfunction.

RESULTS

The prevalence of sexual dysfunction among gynaecological cancer survivors was 60% (70 out of 116). Sexual dissatisfaction was the most prevalent domain of sexual dysfunction at 68.1%. Sexual dysfunction was significantly associated with low education levels (Primary level, AOR = 4.92, 95% CI: 1.12-21.63; secondary level, AOR = 4.06, 95% CI: 1.14-14.44). Non-Malays were significantly more likely to have sexual dysfunction compared with Malays (AOR = 3.57, 95% CI: 1.16-11.06). In terms of treatment, combinations of surgery and radiotherapy (AOR = 4.66, 95% CI: 1.01-21.47) as well as surgery and chemoradiation (AOR = 5.77, 95% CI: 1.20-27.85) were considered.

CONCLUSIONS

Gynaecological cancer survivors with lower education levels, non-Malay ethnicity, and receiving treatment combinations of surgery and radiotherapy or surgery and chemoradiation have a higher risk of sexual dysfunction. A holistic approach in managing the various sociocultural and clinical issues is required to prevent sexual dysfunction among these patients.

Assessment of depression and sexual quality of life in postmenopausal women

PURPOSE

To determine the prevalence of depression, review some variables that are believed to be associated and assess the relationships between depression and sexual quality of life in postmenopausal women.

DESIGN AND METHODS

This is a cross-sectional study conducted on postmenopausal women in Ankara, Turkey from February to June 2020. The study group consisted of 242 postmenopausal women. The Beck Depression Inventory and Sexual Quality of Life Questionnaire were used to assess the level of depression and sex life, respectively. Online questionnaire forms (Google Form) prepared by using the literature in line with the study objective were completed by the women online. Independent t-test, analysis of variance, Tukey's test, and Pearson's correlation analysis were used for statistical analyses. Statistical significance was accepted as p ≤ 0.05.

FINDINGS

The of women was found to be 52.64 (±6.245) years and the average menopause age was found to be 47.81 (±4.039) years in this study. The mean score obtained by the women from the Beck Depression Inventory was 13.04 (±7.82). It was determined that the women showed "mild depressive symptoms" mostly. As for the women's sexual quality of life, the mean score obtained from the Sexual Quality of Life Questionnaire was 61.32 (±14.70). A statistically significant and moderate negative correlation was detected between the mean scores obtained by the women from the Beck Depression Inventory and the Sexual Quality of Life Questionnaire (r = -0.305; p < 0.01).

PRACTICE IMPLICATIONS

It was determined in the study that sexual quality of life is affected by menopause negatively and the women had mild depressive symptoms. Depression among postmenopausal women is an important women's health problem that should be addressed. A negative correlation was found between depression and sexual quality of life. Early diagnosis and treatment of menopause as well as activities for raising awareness among postmenopausal women will be effective in improving quality of life.

A comparison of fertility preservation outcomes in patients who froze oocytes, embryos, or ovarian tissue for medically indicated circumstances: a systematic review and meta-analysis

OBJECTIVE

To compare obstetric outcomes in patients cryopreserving reproductive cells or tissues before gonadotoxic therapy.

DESIGN

A literature search was conducted following PRISMA guidelines on Embase, Medline, and Web of Science. Studies reporting obstetric outcomes in cancer patients who completed cryopreservation of oocyte, embryo, or ovarian tissue were included.

SETTING

Not applicable.

PATIENT(S)

Cancer patients attempting pregnancy using cryopreserved cells or tissues frozen before cancer therapy.

INTERVENTION(S)

Oocyte, embryo, or ovarian tissue cryopreservation for fertility preservation in cancer.

MAIN OUTCOME MEASURE(S)

The total numbers of clinical pregnancies, live births, and miscarriages in women attempting pregnancy using cryopreserved reproductive cells or tissues were calculated. A meta-analysis determined the effect size of each intervention.

RESULT(S)

The search returned 4,038 unique entries. Thirty-eight eligible studies were analyzed. The clinical pregnancy rates were 34.9%, 49.0%, and 43.8% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. No significant differences were found among groups. The live birth rates were 25.8%, 35.3%, and 32.3% for oocyte, embryo, and ovarian tissue cryopreservation, respectively, with no significant differences among groups. The miscarriage rates were 9.2%, 16.9%, and 7.5% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. Significantly fewer miscarriages occurred with ovarian tissue cryopreservation than with embryo cryopreservation.

CONCLUSION(S)

This enquiry is required to counsel cancer patients wishing to preserve fertility. Although the limitations of this study include heterogeneity, lack of quality studies, and low utilization rates, it serves as a starting point for comparison of reproductive and obstetric outcomes in patients returning for family-planning after gonadotoxic therapy.

Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates

BACKGROUND

Young adults (YA) diagnosed with rectal cancer are disproportionately impacted by the gonadotoxic effects of treatment and potential subsequent infertility.

OBJECTIVE

The purpose of this study was to characterize the prevalence of fertility preservation measures used, reasons why such measures were not used, and correlates of discussion between providers and YA rectal cancer survivors.

DESIGN

An online, cross-sectional survey was administered on the Facebook page of a national colorectal cancer (CRC) advocacy organization. Eligible participants were rectal cancer survivors diagnosed before age 50, between 6 and 36 months from diagnosis or relapse, and based in the US.

RESULTS

Participants were 148 rectal cancer survivors. Over half of the survivors reported that their doctor did not talk to them about potential therapy-related fertility complications. Only one-fifth of survivors banked sperm (males) or eggs/embryos (females) prior to their cancer therapy. Older age at diagnosis and greater quality of life were significantly associated with a higher likelihood of fertility discussions among males. Greater quality of life was significantly associated with a higher likelihood of fertility discussion among females.

CONCLUSIONS

These findings indicate that the majority of YA rectal cancer survivors do not receive, or cannot recall, comprehensive cancer care, and help to identify patients with rectal cancer who may be at risk for inadequate fertility counseling. Clinicians should provide proper counseling to mitigate this late effect and to ensure optimal quality of life for YA rectal cancer survivors.

Psychological State and Decision Perceptions of Male and Female Cancer Patients on Fertility Preservation

OBJECTIVE

This study explored the emotional state and decision perceptions of fertility preservation (FP) decisions of male and female cancer patients undergoing FP.

SETTING

Obstetrics & Gynecology Hospital of Fudan University.

METHOD

All patients with a cancer diagnosis were referred by their physician to contact a fertility preservation specialist for FP plan discussion. After FP counseling, participants completed sociodemographic and basic information surveys and validated psychological and decisional scales.

RESULTS

The final sample included 17 male and 16 female cancer FP patients. Overall, 85% of participants reported currently undergoing moderate to severe depression and anxiety states. Sex differences were found in both depression and anxiety states (P < 0.05). Both genders demonstrated a low level of regret in the decision to preserve fertility, indicating that participants felt they had made the right decision. However, there displayed decisional conflict, suggesting that cancer patients felt high conflict when making decisions.

CONCLUSION

In conclusion, there is a nonnegligible emotional burden on FP patients who have already undergone a painful situation before the start of oncological treatment. This is the first study to use validated DRS to examine emotional problems occurring in both men and women during FP decision-making.

Fertility preservation in female cancer sufferers: (only) a moral obligation?

PURPOSE

Advances in cancer diagnostics and therapeutics have thankfully led to high numbers of young cancer survivors, although some interventions may sometimes threaten fertility. The authors aimed to assess how evidence-based oncofertility counselling can be adequately fulfilled for the sake of female cancer patients, in light of its complexities and multidisciplinary nature, which require thorough counselling and consent pathways.

MATERIALS AND METHODS

A search has been conducted in the databases PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Google Scholar via search strings such as fertility preservation, reproductive counselling, oncofertility, cancer survivors, in order to identify relevant meaningful sources spanning the 2010-2021 period.

RESULTS

Counselling needs to be implemented in compliance with international guidelines, so as to avoid medicolegal repercussions. Albeit fertility preservation is supported by most health care institutions, actual conditions at health care facilities often reflect several lingering difficulties in the oncofertility process. Oncofertility counselling should foster access to fertility preservation procedures. To best serve that purpose, it should be implemented in a manner consistent with ethical and legal standards, so that patients can make an informed decision based on comprehensive and relevant data.

CONCLUSIONS

Counselling needs to be rooted in a close cooperation of oncologists, reproductive endocrinologists, mental health counsellors and clinical researchers. The provision of oncofertility services is grounded in the moral obligation to uphold individual autonomy, which is essential in a free society, unless the exercise thereof could pose a risk to the children conceived or to others.

Oncofertility and Reproductive Counseling in Patients with Breast Cancer: A Retrospective Study

Introduction. Improving the prognosis of breast cancer patients is of utmost importance in terms of increasing survival rates. Modern medicine has therefore prioritized better quality of life for patients, even after the disease, through a better management of the potential long-term side effects induced by anticancer treatments. Fertility preservation and family planning are therefore crucial issues to be addressed in all cancer patients of reproductive age. Along those lines, a new branch of medicine with distinct multidisciplinary characteristics has developed over the years: oncofertility. Although both national and international guidelines value reproductive counseling as an essential aspect of the diagnostic-therapeutic pathway, part and parcel of the informed consent process, it is not included within the protocols adopted by the operating units for the care and management of neoplastic diseases. Objective. This study aimed to evaluate the activity of the Breast Unit of the Policlinico Umberto I Hospital, Rome, Italy, and the degree of compliance with guidelines. By knowing the strengths and weaknesses of such approaches, the standards of care offered to breast cancer patients can be improved. Materials and methods. A retrospective study based on a review of medical records was conducted between 2014 and 2021. Patients under 40 years of age diagnosed with non-metastatic malignancies were included who received chemotherapy treatment, namely neoadjuvant, adjuvant or adjuvant hormone therapy. Results. The data were extracted from the medical records of 51 patients who met the inclusion criteria, 41% of whom received reproductive counseling, and of these, 43% decided to undertake a path of fertility preservation. Factors such as the absence of children and young age reportedly favored both the interest in counseling proposals by the medical staff and the decision to undertake a path of fertility preservation. Conclusions. The study shows that there has been growing interest in the topic of oncofertility, especially in light of law 219/2017. Therefore, since 2018, multiple proposals for reproductive counseling have been set forth, but there was not an equally growing demand for fertility preservation practices, which can be explained by the invasive nature of such practices, the patients’ concern about their own state of health, and poor or inadequate information. Such impediments highlight the importance of standardized counseling and the need for a multidisciplinary medical team to support the patient in the decision-making process. The study also revealed a drop in the number of patients receiving counseling due to the COVID-19 pandemic, contrary to the positive trend that was recorded prior to the pandemic.

Fertility preservation in boys facing gonadotoxic cancer therapy

Patient survival following childhood cancer has increased with contemporary radiation and chemotherapy techniques. However, gonadotoxicity associated with treatments means that infertility is a common consequence in survivors. Novel fertility preservation options are emerging, but knowledge about these options amongst urologists and other medical professionals is lacking. Pre-pubertal boys generally do not produce haploid germ cells. Thus, strategies for fertility preservation require cryopreservation of tissue containing spermatogonial stem cells (SSCs). Few centres worldwide routinely offer this option and fertility restoration (including testicular tissue engraftment, autotransplantation of SSCs and in vitro maturation of SSCs to spermatozoa) post-thaw is experimental. In pubertal boys, the main option for fertility preservation is masturbation and cryopreservation of the ejaculate. Assisted ejaculation using penile vibratory stimulation or electroejaculation and surgical sperm retrieval can be used in a sequential manner after failed masturbation. Physicians should inform boys and parents about the gonadotoxic effects of cancer treatment and offer fertility preservation. Preclinical experience has identified challenges in pre-pubertal fertility preservation, but available options are expected to be successful when today's pre-pubertal boys with cancer become adults. By contrast, fertility preservation in pubertal boys is clinically proven and should be offered to all patients undergoing cancer treatment.

Factors Associated With a High Motivation to Undergo Fertility Preservation in Female Cancer Patients

Objective: Fertility loss due to cancer treatment can be a devastating experience for women and the couple. Undergoing fertility preservation can be a complex decision from both a medical and emotional point of view. The aim of the present study was to evaluate which socio-demographic and psychological factors predict a high motivation to undergo fertility preservation.

Methods: Fifty-eight female cancer patients who accessed an Oncofertility Unit completed: a questionnaire to collect socio-demographic characteristics and the level of motivation, the Beck-Depression Inventory-II, the State-Trait Anxiety Inventory-Y, and the Fertility Problem Inventory.

Results: Almost half of the sample (44.8%) declared a high motivation. At multiple logistic regression analysis only the “Need for parenthood” subscale of the FPI predicted a high motivation. We alternatively evaluated as possible predictor the construct “Representations about the importance of parenthood” (i.e., the sum of the “Need for Parenthood” and “Rejection of childfree lifestyle” subscales) in place of the two separate subscales. At multiple logistic regression analysis, only this variable predicted a high motivation to undergo fertility preservation.

Conclusion: The most important predictor of a high motivation to undergo fertility preservation is the individual desire for parenthood. This implies that, regardless of socio-demographic characteristics, any woman of childbearing age should receive an appropriate counseling about fertility preservation.

Decisional Regret in Female Oncofertility Decision Making-An Integrative Narrative Review

It is well established that fertility is an important issue for young women with cancer at reproductive age, as many have not initiated or completed their parenthood goals when diagnosed. Because cancer treatments may impair fertility, women face fertility decisions that are often complex and surrounded by uncertainty. This may put patients at risk for psychological distress and the experience of regret regarding decisions made at diagnosis, which may be associated with a negative impact on women's QoL. This narrative review addresses current knowledge about decisional regret regarding fertility preservation decisions in adult female cancer patients at reproductive age. Electronic searches were conducted on Pubmed database for articles published in English from 1 January 2000 to 1 July 2021 that assessed decisional regret following fertility decisions in young women diagnosed at childbearing age. Of the 96 articles identified, nine provided information on decisional regret regarding fertility decisions. Studies reported that, overall, decisional regret regarding oncofertility decisions was low. Factors associated with the experience of decisional regret were patients' perceived quality and satisfaction with fertility counseling received, the decision to undergo fertility preservation, desire for children and decisional conflict. Health providers should be aware of the factors that are potentially modifiable and prone to improvement in order to reduce decisional regret. All efforts should be made to improve availability of and access to tailored high quality fertility counseling and fertility preservation. Given the growing evidence that decision aids (DAs) are effective in increasing knowledge and reducing decisional conflict and regret, their use in a routine and timely manner to complement fertility counseling is recommended.

Targeted cancer treatment and fertility: effect of immunotherapy and small molecule inhibitors on female reproduction

Targeted cancer therapy is rapidly evolving the landscape of personalized health care. Novel approaches to selectively impeding tumour growth carry significant potential to improve survival outcomes, particularly for reproductive-aged patients harbouring treatment refractory disease. Current agents fall within two classes: immunotherapy and small molecule inhibitors. These are collectively divided into the following subclasses: monoclonal antibodies; immunomodulators; adoptive cell therapy; treatment vaccines; kinase inhibitors; proteasome inhibitors; metalloproteinase and heat shock protein inhibitors; and promoters of apoptosis. The short- and long-term effects of these treatments on the female reproductive system are not well understood. As a result, clinicians are rendered unable to appropriately counsel women on downstream effects to their fertility. Data-driven consensus recommendations are desperately needed. This review aims to characterize the effect of targeted cancer therapy on the female hypothalamic-pituitary-ovary axis, direct ovarian function and conception.

Parenthood among men diagnosed with cancer in childhood and early adulthood: trends over time in a Danish national cohort

STUDY QUESTION

Is the rate of fatherhood among men diagnosed with cancer in childhood and early adulthood different from men without cancer, and, if so, have the differences changed over time?

SUMMARY ANSWER

Men diagnosed with cancer have had significantly reduced rates of fatherhood compared with undiagnosed men; however, the rates of fatherhood among the cancer survivors have increased markedly over time.

WHAT IS KNOWN ALREADY

The number of children and young adolescents who survive cancer has steadily increased over recent decades, with a current 5-year survival rate of approximately 80%. Consequently, life circumstances after cancer have gained increasing importance, including the desire among survivors to have children and a family. ARTs to aid reproduction among cancer survivors have been developed, and fertility preservation is increasingly a topic being discussed before undergoing cancer treatment. But the potential for fertility preservation differs dependent on age at diagnosis and type of cancer. Earlier studies have shown a decreased fertility rate among survivors of child and adolescent cancer compared to those diagnosed in early adulthood.

STUDY DESIGN, SIZE, DURATION

This study is a national, register-based cohort study. Men diagnosed with cancer in childhood and early adulthood (<30 years of age) were registered in the Danish Cancer Register in 1978-2016 (n = 9353). According to the time of diagnosis, each cancer-diagnosed man was randomly matched with 150 undiagnosed men from the background population within the same birth year. The men were followed until having their first child, death, migration or the end of the study (31 December 2017) in medical registers and socio-demographic population registers.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Fatherhood among the boys and young men diagnosed with cancer were compared with the age-matched comparison group in all statistical analyses. Cancer diagnoses were categorised as central nervous system (CNS) cancers, haematological cancers or solid cancers. Analyses were stratified by age at diagnosis (0-9, 10-19, 20-29 years) and time of diagnosis (1978-1989, 1990-1999, 2000-2009, 2010-2016). Death was incorporated as a competing risk in all analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

The study population consisted of 9353 boys and young men diagnosed with cancer between 1978 and 2016 and 1 386 493 men in the age-matched comparison group. Those surviving CNS cancer as young men had the lowest hazard ratio (HR) of fatherhood compared with the age-matched comparison group (HR 0.67, 95% CI 0.57-0.79), followed by survivors of haematological cancers (HR 0.90, 95% CI 0.81-1.01), while the highest chance of fatherhood was among survivors of solid cancers (HR 1.16, 95% CI 1.12-1.20) with a slightly increased HR compared with undiagnosed males. The HR of becoming a father increased over time. From the first decade to the last decade 30 years later, the HR of becoming a father increased for solid tumours (HR 0.78, 95% CI 0.73-0.83 to HR 1.08, 95% CI 0.95-1.22), haematological cancers (HR 0.64, 95% CI 0.53-0.79 to HR 0.97, 95% CI 0.73-1.30) and CNS cancers (HR 0.44, 95% CI 0.34-0.57 to HR 0.98, 95% CI 0.49-1.95) compared to the age-matched comparison group. Also, when compared with the age-matched comparison group, men diagnosed with cancer when aged 20-29 years were more likely became fathers over the time of the study (HR 0.80, 95% CI 0.74-0.86 to HR 1.08, 95% CI 0.96-1.22).

LIMITATIONS, REASONS FOR CAUTION

The study was based on register data, and information was not available about the men's fertility potential, whether they had a desire to have children and whether it was possible for them to find a partner. Information about fertility preservation, e.g. sperm freezing, could also have provided additional insights. Furthermore, information about diagnosis and ART treatment would have been beneficial.

WIDER IMPLICATIONS OF THE FINDINGS

Information and education of male patients diagnosed with cancer about fertility preservation options and their chances to create their own family is crucial. Reassuringly, time trends showed more men with a previous cancer diagnosis becoming fathers in recent years than in earlier years, reflecting that survival and fertility preservation have improved over time.

STUDY FUNDING/COMPETING INTEREST(S)

R.S. received a PhD grant from the Rosa Ebba Hansen Foundation and from the Health Foundation (J.nr. 15-B-0095). The funding for the establishment of the DANAC II Cohort was obtained from the Rosa Ebba Hansen Foundation. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

A randomized controlled evaluation of an educational resource to address fertility concerns after cancer

OBJECTIVE

This study evaluated the acceptability and impact of a written oncofertility educational resource (ER), as a self-help intervention (SH), and as an adjunct to a one-hour health-care professional discussion (HP).

METHODS

Within a randomized control trial (RCT), 194 adults with cancer (175 womens; 19 mens) were allocated to the SH or HP intervention. 127 completed 6-weeks post-intervention measures, a retention rate of 65.85%.

RESULTS

Across interventions, the ER was rated as highly acceptable and useful, in terms of ease of understanding, and information. Heath literacy significantly increased post-intervention, including functional literacy, communicative literacy, and critical health literacy. There were no significant changes in ratings of fertility distress or general distress pre-post intervention. Quality of life was significantly reduced post intervention. Those in the HP condition reported higher quality of life and greater likelihood of communication with others about fertility, most notably with intimate partners, post-intervention. Qualitative identification of increased knowledge, confidence with communication and normalization of fertility concerns, reflects increased health literacy, and provides explanation for significant reductions in feeling nervous and fearful about fertility treatments post-intervention.

CONCLUSIONS

Our findings confirm the importance of information provision about the impact of cancer on fertility. Written ERs are a useful adjunct to a patient-clinician discussion, increasing health literacy, which facilitates knowledge, self-efficacy and management of fertility concerns and changes.

Oncofertility Information Available for Recently Approved Novel Non Cytotoxic and Immunotherapy Oncology Drugs

We reviewed the available animal and human reproductive function studies of recently approved noncytotoxic oncology drugs. We reviewed the oncofertility information in the prescribing information for the US Food and Drug Administration (FDA)-approved products and/or the product information and consumer medicine information for Therapeutic Goods Administration (TGA)-approved drugs of 32 novel oncology drugs approved between 2014 and 2018 in the United States and/or Australia supplemented by a literature review for additional reproductive effects. No human studies were available on the reproductive effects of all 32 drugs. A systematic literature review of animal reproductive toxicity studies provided only very limited data with nine drugs displaying impaired male fertility, three impaired female fertility, and nine producing impaired fertility in both male and female animals. Two drugs in the study are reported to have no demonstrable impact on fertility in animal reproductive toxicity studies and nine are reported to have unknown effects on fertility. Of the 32 newly listed drugs, only 4 had recommendations regarding potential human fertility risks and accordingly advised clinicians about fertility preservation procedures for patients. The lack of human data and limited animal reproductive toxicity data raises concerns about the potential impact of these novel oncology drugs on human fertility and reproductive function. Consequently, adequate oncofertility recommendations, including for fertility preservation procedures, counselling for psychological or cost implications, and future prognosis for fertility are hindered by this paucity of relevant data. More data on human reproductive effects of novel oncology drugs is urgently required to facilitate effective use of the growing array of oncofertility care options available.

Attitudes and practices about fertility preservation discussions among young adults with cancer treated at a comprehensive cancer center: patient and oncologist perspectives

BACKGROUND

Young adults (YAs, ages 18-39) diagnosed with cancer face multiple challenges that affect their health-related quality of life, including the potential for cancer-related infertility. Providing information about the risk of infertility and options to maintain fertility is critical for YAs who are newly diagnosed. However, barriers to effective communication exist for oncologists and their patients. The purpose of this study was to interview medical oncologists and YAs from the same cancer center to examine attitudes and practices about fertility preservation.

METHODS

Semi-structured interviews were conducted with medical oncologists (N=12) and YAs within 2 years post-treatment (N=24), representing the most common cancers affecting YAs. Interviews were audio-recorded, transcribed, and coded using qualitative methodologies with the analysis software NVivo 10.

RESULTS

Twelve oncologists (50% female, 67% <50 years) and 24 YAs (67% female, M=29 years) completed interviews. Common themes across oncologist and YA interviews were the roles of cancer type or stage and patient interest or parity in influencing the decision. The most important factor for YAs was to receive accurate, in-depth information. Unique themes for oncologists focused on clinical aspects of their patient's disease. For YAs, they shared about the emotional impact of cancer-related infertility and desire for support from trusted others.

CONCLUSIONS

Results provide a better understanding of the attitudes and practices about fertility preservation discussions among YAs. Given the common factors affecting fertility preservation decisions, models of shared decision-making may be ideal for YAs and oncologists. Future interventions should explore tailored applications of this approach for YAs newly diagnosed with cancer.

Preservation of fertility in teenagers and young adults treated for haematological malignancies

As survival rates in teenagers and young adults diagnosed with haematological malignancies now exceed 70%, it is important that long-term quality of life, including measures to protect future fertility, are considered and discussed with patients and their families. Although discussion on the effect of planned cancer treatment on fertility is standard of care, knowledge of potential fertility treatment options and when they should be offered in haematological malignancies is not always so clear. In each case, the advice on the appropriate preservation of fertility depends upon a complex interplay of factors, weighing out the risk of future infertility against the risk of fertility preservation treatment, and recommendations must be made on a case-by-case basis. The aim of this Review is to evaluate the gonadotoxicity of treatments of prevalent haematological malignancies in teenagers and young adults, and provide an evidence-based framework to help with fertility discussion and management at the time of diagnosis, relapse or resistant disease, and in long-term follow-up settings.

Talking but not always understanding: couple communication about infertility concerns after cancer

BACKGROUND

Cancer related infertility can have an impact on couple relationships, with evidence that couple communication facilitates coping. However, little is known about the ways in which couples communicate about cancer-related fertility concerns. The aim of this article is to examine couple communication about fertility concerns in the context of cancer, and the perceived quality of such communication from the perspective of cancer survivors and their partners.

METHODS

Eight-hundred and seventy-eight cancer survivors (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey which examined cancer related fertility concerns. Seventy-eight survivors (61 women and 17 men), and 26 partners (13 women and 13 men), participated in semi-structured interviews, in order to examine the subjective experience of fertility concerns in-depth. Thematic analysis was used to analyse the interviews and open ended survey questions. Valid percentages for single items from the relationships subscale of the Fertility Preservation Inventory (FPI) related to qualitative themes, identified frequency of responses.

RESULTS

The major theme was 'talking but not always understanding". 89.6% of cancer survivors and partners (95.1%) reported working well together handling fertility questions (FPI), but agreed that communication could be improved (65.9% survivors; 65% partners). Open and honest couple communication was associated with feelings of support, understanding and relationship growth, including perception of partner comfort (79.2% survivors, 81.6% partners). However, 32% survivors and 31.1% partners concealed fertility concerns to avoid upsetting their partner, or reported that their partner doesn't understand their fertility concerns (survivors 25.5%, partners 14.6%), with 14.1% of cancer survivors and 19.4% partners reporting fear of relationship breakdown because of fertility issues. Fear of rejection when forming new relationships, and concerns about how to talk to future partners, was reported by non-partnered individuals.

CONCLUSION

Health-care professionals should include partners of cancer survivors in fertility discussions. Couple interventions developed in general psycho-oncology should be extended to the domain of fertility, in order to facilitate effective couple communication. Communication in future relationships needs to be addressed for single people and adolescents and young adults (AYAs) who have fertility concerns.