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Vesztergom D, Székely B, Hegyi B, Masszi A, Pintér T, Csákó B, Kenessey I, Rubovszky G, Novák Z. [Fertility preservation in female cancer patients.]. Orv Hetil 2023; 164:1134-1145. [PMID: 37481767 DOI: 10.1556/650.2023.32824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 07/25/2023]
Abstract
In Hungary, an average of 2066 women under the age of 40 are diagnosed with cancer each year according to data from the National Cancer Registry. Approximately two-thirds of these patients require gonadotoxic treatment for their disease, which could potentially reduce their chances of future conception and childbirth. Currently, there are no professional guidelines on fertility preservation in Hungary, however, it is important to inform patients about their options. In our previous paper, we presented the gonadotoxic effects of oncotherapies and the currently available fertility preservation techniques. This second paper provides current treatment methods and recommends fertility preservation techniques in different cancer types. The success of an oncofertility program relies heavily on the effective communication and collaboration between oncologists and reproductive specialists involved in fertility preservation. This paper may be the first step in elaborating a guideline towards improving access to oncofertility services and ultimately improving the quality of life for young cancer survivors in Hungary. Orv Hetil. 2023; 164(29): 1134-1145.
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Affiliation(s)
- Dóra Vesztergom
- 1 Országos Kórházi Főigazgatóság, Humánreprodukciós Igazgatóság Budapest Magyarország
- 6 Szegedi Tudományegyetem, Szentgyörgyi Albert Orvostudományi Kar, Klinikai Orvostudományi Doktori Iskola Szeged Magyarország
- 7 Semmelweis Egyetem, Általános Orvostudományi Kar, Asszisztált Reprodukciós Centrum Budapest Magyarország
| | - Borbála Székely
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - Barbara Hegyi
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - András Masszi
- 4 Országos Onkológiai Intézet, Gyógyszerterápiás Központ, Hematológia és Lymphoma Osztály, "Kemoterápia A" Budapest Magyarország
| | - Tamás Pintér
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - Bence Csákó
- 2 Országos Onkológiai Intézet, Nőgyógyászati Osztály Budapest Magyarország
| | - István Kenessey
- 5 Országos Onkológiai Nemzeti Rákregiszter és Biostatisztikai Központ Budapest Magyarország
- 8 Semmelweis Egyetem, Általános Orvostudományi Kar, Patológiai Igazságügyi és Biztosítási Orvostani Intézet Budapest Magyarország
| | - Gábor Rubovszky
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - Zoltán Novák
- 2 Országos Onkológiai Intézet, Nőgyógyászati Osztály Budapest Magyarország
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Ahmed Y, Khan AMH, Rao UJ, Shaukat F, Jamil A, Hasan SM, Abrar S, Qureshi BM, Abbasi AN. Fertility preservation is an imperative goal in the clinical practice of radiation oncology: a narrative review. Ecancermedicalscience 2022; 16:1461. [PMID: 36819826 PMCID: PMC9934885 DOI: 10.3332/ecancer.2022.1461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Indexed: 02/24/2023] Open
Abstract
With reduced cancer mortality in recent years, increased efforts must be put into safeguarding cancer survivors' long-term quality of life (QOL). Fertility preservation is recognised as a key component of QOL in survivorship. Concerns about fertility have been seen to significantly impact cancer patients' emotional and mental health as, generally, both malignancy and its treatment may cause a temporary or permanent reduction in infertility. This article reviews the primary effects of radiation therapy on male and female gonads and has further highlighted procedures through which the functioning of these organs can be protected before or during radiation treatment. We have also emphasised the importance of the establishment of multidisciplinary tumour boards and patient education regarding future reproductive function which is an important component of the care of individuals with cancer. This article highlights that infertility is a persistent and major concern that can add to long-term stress in cancer survivors, and education about fertility preservation before the initiation of any treatment is especially important.
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Affiliation(s)
- Yumna Ahmed
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | | | | | - Fatima Shaukat
- Department of Radiation Oncology, Cyberknife and Tomotherapy Centre, JPMC, Karachi 75510, Pakistan
| | - Arhum Jamil
- Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Sehrish Abrar
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Bilal Mazhar Qureshi
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ahmed Nadeem Abbasi
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
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Stal J, Yi SY, Cohen-Cutler S, Gallagher P, Barzi A, Freyer DR, Milam JE, Lenz HJ, Miller KA. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist 2022; 27:579-586. [PMID: 35427410 PMCID: PMC9255970 DOI: 10.1093/oncolo/oyac052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Julia Stal
- Corresponding author: Julia Stal, Department of Population and Public Health Sciences, Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA 90032, USA. Tel: +1 858 997 4071;
| | - Serena Y Yi
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA,Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Joel E Milam
- School of Medicine, Department of Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Heinz-Josef Lenz
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Prentice R, Al-Ani A, Cherry T, Dixon-Douglas J, Eccles-Smith J, Matheson J, Tie J, Thevathasan I, McCormick JJ, Christensen B. Evaluation and management of rectal bleeding in pregnancy. Med J Aust 2021; 215:377-382. [PMID: 34601746 DOI: 10.5694/mja2.51267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rectal bleeding occurs in about 40% of pregnant women, and is predominantly attributed to benign perianal pathology (haemorrhoids or anal fissures). More sinister causes of rectal bleeding may be heralded by key red flag clinical and biochemical features. These features should be evaluated in all women with rectal bleeding. Imaging investigations or flexible sigmoidoscopy may be warranted. The latter can be performed safely by experienced operators in pregnant women. Women with evidence of haemodynamic compromise, elevated inflammatory markers, significant anaemia, signs of intestinal obstruction or compromise to the fetus should be evaluated urgently. Providers must be mindful of the changes in normal ranges for common haematological and biochemical parameters in pregnancy compared with the non-pregnant state. Faecal calprotectin is an established tool for identification of intestinal inflammation and is valid in pregnancy. An elevated faecal calprotectin level (≥ 50 µg/g) signifies a need for further diagnostic evaluation. Inflammatory bowel disease may present initially, or with worsening disease activity, in pregnancy. Expedient diagnosis with the use of faecal calprotectin, sigmoidoscopy with or without intestinal ultrasound, exclusion of alternative or compounding infective aetiologies, and institution of appropriate therapy are critical. Medical therapies for management of inflammatory bowel disease can be safely instituted in pregnancy. Colorectal cancer incidence is increasing in younger age groups, but fortunately remains rare. When diagnosed in pregnancy, colorectal cancer can be successfully and safely managed with a collaborative multidisciplinary team approach. Early diagnosis is key to optimising outcomes.
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Affiliation(s)
- Ralley Prentice
- Monash Health, Melbourne.,St Vincent's Hospital Melbourne, Melbourne, VIC
| | | | | | | | | | | | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Jacob J McCormick
- Royal Melbourne Hospital, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
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Henry L, Labied S, Jouan C, Nisolle M. Preservation of female fertility: The current therapeutic strategy. Int J Gynaecol Obstet 2021; 156:3-9. [PMID: 33829509 DOI: 10.1002/ijgo.13698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Preservation of female fertility is a relatively new field in medicine that has grown very rapidly in recent decades. At the beginning, embryo freezing remained the most effective technique. Thereafter, cryopreservation of oocytes and ovarian tissue was considered a secure tool in human fertility preservation. Storage of cortical ovarian tissue is moreover relevant for children, prepubertal girls, and adult patients who cannot benefit from cryopreservation of oocytes. OBJECTIVE To analyze and review recent and relevant scientific literature on medical and social reasons for preservation of fertility. METHODS The review was conducted based on articles identified from PubMed databases using keywords. MAIN RESULTS Oocyte vitrification allows women to preserve their fertility without the need for fertilization. Nowadays, thousands of healthy children have been born from this procedure. Occurrence of pregnancy depends on two main factors: the number of mature oocytes in storage and the age of the patient at the time of vitrification. Numerous adaptations have been developed to suit the ovarian stimulation regiments to patients with cancer. In young prepubertal girls, freezing of ovarian tissue remains the best and only option. CONCLUSION Oocyte vitrification therefore appears to be the gold standard technique of preserving fertility in young women.
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Affiliation(s)
- Laurie Henry
- Center for Assisted Medical Procreation-University of Liège, CHR Liège Hospital, Liège, Belgium.,Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
| | - Soraya Labied
- Center for Assisted Medical Procreation-University of Liège, CHR Liège Hospital, Liège, Belgium
| | - Caroline Jouan
- Center for Assisted Medical Procreation-University of Liège, CHR Liège Hospital, Liège, Belgium
| | - Michelle Nisolle
- Center for Assisted Medical Procreation-University of Liège, CHR Liège Hospital, Liège, Belgium.,Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
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Buonomo B, Orecchia R, Tomao F, Pup LD, Garcia-Faura A, Peccatori FA. Uterine irradiation as a determinant of infertility and pregnancy losses in young cancer survivors. Ecancermedicalscience 2020; 14:1032. [PMID: 32419844 PMCID: PMC7221126 DOI: 10.3332/ecancer.2020.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
Several concerns exist regarding the impact of anticancer treatments on fertility and pregnancy outcome. The detrimental effects of both chemotherapy and radiotherapy on the ovaries are well reported in the available literature. Fewer data are focused on the importance of a functioning uterus to conceive and carry on a healthy pregnancy. The aim of this paper is to provide a narrative review of the current literature to assess the role of uterine irradiation as a potential determinant of infertility and poor obstetrical outcomes. This review addresses the need for multidisciplinary counselling in order to face the poor reproductive and obstetrical outcomes of women who had uterine radiation, according to the different backgrounds (radiotherapy during adulthood versus childhood; total body irradiation versus pituitary, spinal and/or abdominal-pelvic irradiation).
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Affiliation(s)
- Barbara Buonomo
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Tomao
- Department of Gynaecologic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lino Del Pup
- University Sanitary Agency Friuli Central (ASU FC) Italy; Board Italian Society of Third Age Gynaecology (SIGiTE), Italy
| | | | - Fedro A Peccatori
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
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