Reproductive concerns and fear of cancer recurrence: a qualitative study of women's experiences of the perinatal period after cancer

Women's perspectives on communication following the diagnosis of gestational or postpartum cancer: A qualitative study

BACKGROUND

Cancer during pregnancy or the postpartum period is rare, and the clinical management of cancer during this period is complex due to a lack of evidence-based approaches and logistical challenges. Effective communication between women and healthcare providers (HCPs) is critical in navigating these challenges, and communication gaps may contribute to unmet informational and emotional needs, affecting decision-making and overall care experiences.

AIM

This study aimed to understand women's perspectives on communication with their healthcare providers (HCPs) following a gestational cancer diagnosis.

METHODS

We conducted semi-structured interviews with women who experienced cancer during pregnancy or the postpartum period (12 months after giving birth). Data were analysed thematically.

RESULTS

17 women participated in this study. Participants varied in age, timing, and cancer diagnosis. Seven women were diagnosed with breast cancer, while the remaining were diagnosed with a variety of cancers, including melanoma, lymphoma, thyroid, ovarian, uterine, bowel, and oropharyngeal cancer. Notably, 10 participants were diagnosed with cancer in the postpartum period, whereas seven were diagnosed during pregnancy. Three overarching themes emerged from the thematic analysis: 1) "Scarcity of information," 2) "Not involved in treatment decisions," and 3) "Centralised resources and advocacy."

CONCLUSIONS

This study provides crucial insights into the challenges faced by women diagnosed with cancer during pregnancy and the postpartum period, particularly regarding communication with HCPs. This highlights the urgent need for enhanced communication, education, and support for HCPs along with tailored resources for women with gestational cancer. Coordinated multidisciplinary care and dedicated advocacy by nurses or midwives are essential to address these challenges and improve health care outcomes for women and their families.

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

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

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review

PURPOSE

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum.

METHODS

This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care.

CONCLUSIONS

Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care.

IMPLICATIONS FOR CANCER SURVIVORS

Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review

Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.

The experiences of reproductive concerns in cancer survivors: A systematic review and meta-synthesis of qualitative studies

AIM

The aim of this study was to synthesize qualitative research evidence on cancer survivors' experiences with reproductive concerns (RC).

METHODS

We conducted a systematic search of qualitative studies and utilized the meta-aggregation approach. The database searches were extended up to May 14, 2023, encompassing 12 databases, specifically MEDLINE, CINAHL, PubMed, EMBASE, Scopus, Web of Science (Core Collection), AMED, PsycINFO, The Cochrane Library, CNKI, Wan Fang Data, and VIP.

RESULTS

Three overarching themes were synthesized from the analysis of 21 studies that explored cancer patients' awareness of reproductive concerns, their perceptions, needs, and coping styles. These themes encapsulate the multifaceted aspects of cancer patients' reproductive concerns: "Gender differences in fertility concerns among cancer patients: Perspectives from men and women"; "The influence of age: Experiences with fertility issues among cancer patients at different life stages"; "The impact of treatment stages on fertility concerns: The evolution of perception and coping strategies in the course of cancer treatment".

CONCLUSION

Our study presents an in-depth exploration of the reproductive concerns experienced by cancer patients from various perspectives. We found that the internal experiences of reproductive concerns, their perceptions, needs, and coping mechanisms differ based on their roles. This comprehensive understanding of the complex emotions and needs of cancer patients when confronted with fertility issues can guide clinicians in providing more effective medical assistance, psychological counseling, and fertility-related information services.

The Artificial Ovary: the Next Step in Fertility Preservation in Cancer Patients

The cryopreservation procedure of ovarian tissue is used for subsequent transplantation to preserve fertility in cancer patients. In the case of cancers with possible ovarian damage, due to the increased risk of transmission of malignant cells in the cryopreserved ovarian tissue, after remission of the disease, the transplant cannot be performed due to the high rate of recurrence. Thus, to resolve fertility preservation in these cancer patients, making an artificial ovary that could be transplanted under maximum safety conditions was necessary. This was not easy to achieve because it was essential to develop a porous and rigid matrix that could encapsulate and protect the ovarian follicles and, at the same time, create an optimal neuroendocrine environment. The present article analyzes the technological progress in creating an artificial ovary, the opportunity for transplantation, the proper counseling of these patients, and the prognosis regarding using this modern technique to preserve fertility.

Including a discussion forum in a web-based intervention on fertility and sexuality following cancer - Usage and content

AIM

The aim of the study was to investigate how young adult survivors of childhood cancer used an online discussion forum as part of a web-based psycho-educational intervention. Specifically, we aimed to characterize users of the discussion forum, investigate how they used the discussion forum (type of usage) and content of the posted messages.

METHODS

This study is a part of a randomized controlled trial, Fex-Can Childhood RCT. Participants with self-reported sexual dysfunction or fertility-related distress were drawn from a population-based national cohort. Sociodemographic and clinical characteristics of the intervention group (n = 322) and data on usage of the discussion forum were analysed with descriptive statistics and compared between subgroups. Messages posted in the online discussion forum were analysed with qualitative thematic analysis.

RESULTS

Approximately half (48 %) of participants in the intervention group accessed the discussion forum and most of them (76 %) without writing own posts. Users of the discussion forum did not statistically differ in sociodemographic or clinical characteristics from the rest of the intervention group. The 97 written posts, written by 38 individuals, were mainly descriptions of own experiences and thoughts and concerned three themes: A changed body, Concerns around family building and Longing for support. Peer-support and interaction between participants were seen in some forum threads and the 'like'-function was frequently used, demonstrating engagement and activity. Participants expressed that they felt affinity with and appreciated sharing own experiences and to recognize themselves in others' stories.

CONCLUSIONS

A discussion forum as part of a web-based intervention appears to be a valuable component by giving participants an opportunity to share intimate experiences and concerns related to surviving cancer.

TRIAL REGISTRATION

ISRCTN Registry, trial number: 33081791 (registered on November 27, 2019).