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Sandheinrich T, Chase JA, Armer J. Examining Factors in the Decision to Sperm Bank by Adolescent and Young Adult Males Diagnosed With Cancer: A Review of the Literature. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024:27527530241267299. [PMID: 39257019 DOI: 10.1177/27527530241267299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Background: Despite American Society of Clinical Oncology and Children's Oncology Group recommendations, the rate of sperm-banking for newly diagnosed adolescent and young adult males with cancer remains between 18% and 35%. The purpose of this study was to examine recent literature regarding decision-making and fertility preservation prior to the initiation of therapy for adolescents and young adults diagnosed with cancer. Method: A search of multiple online databases was undertaken for peer-reviewed studies between the years of 2010 and 2022. The databases CINAHL, PubMed, PsycInfo, Scopus, Google Scholar, and forward citation search was employed using the same Boolean search phrases in each database. Some 402 articles were then screened for relevance by title, abstract, and full review based on inclusion/exclusion criteria for synthesis. Results: Ten articles met criteria to be included in this review. Three themes were identified as impacting the decision to cryopreserve sperm prior to the initiation of therapy. Provider recommendation, parent recommendation, and referral for fertility specialist consult emerged as statistically significant factors in the decision to attempt sperm banking. Discussion: While the most significant factor impacting the decision to preserve fertility, parents reported they were more likely to recommend this to their child if they received clear recommendations from the medical team. Pediatric oncology physicians and nurses are in a unique position to positively impact quality of life and psychosocial outcomes in survivors of pediatric cancer by providing up-to-date evidence-based information, risk assessment, recommendations, and/or referral to fertility preservation specialists to families and patients.
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Affiliation(s)
- Taryn Sandheinrich
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- Siteman Kids Pediatric Oncology Program, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jo-Ana Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Jane Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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2
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Mercier A, Johnson J, Kallen AN. Prospective solutions to ovarian reserve damage during the ovarian tissue cryopreservation and transplantation procedure. Fertil Steril 2024:S0015-0282(24)01961-7. [PMID: 39181229 DOI: 10.1016/j.fertnstert.2024.08.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/16/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
Birth rates continue to decline as more women experience fertility issues. Assisted reproductive technologies are available for patients seeking fertility treatment, including cryopreservation techniques. Cryopreservation can be performed on gametes, embryos, or gonadal tissue and can be used for patients who desire to delay in vitro fertilization treatment. This review focuses on ovarian tissue cryopreservation, the freezing of ovarian cortex containing immature follicles. Ovarian tissue cryopreservation is the only available treatment for the restoration of ovarian function in patients who undergo gonadotoxic treatments, and its wide adoption has led to its recent designation as "no longer experimental" by the American Society for Reproductive Medicine. and subsequent transplantation can restore native endocrine function and can support the possibility of pregnancy and live birth for the patient. Importantly, there are multiple steps in the procedure that put the ovarian reserve at risk of damage. The graft is highly susceptible to ischemic reperfusion injury and mass primordial follicle growth activation, resulting in a "burnout", phenomenon. In this review, we summarize current efforts to combat the loss of primordial follicles in grafts through improvements in freeze and thaw protocols, transplantation techniques, and pharmacologic adjuvant treatments. We conducted a review of the literature, with emphasis on emergent research in the last 5 years. Regarding freeze and thaw protocols, we discuss the widely accepted slow freezing approach and newer vitrification protocols. Discussion of improved transplantation techniques includes consideration of the transplantation location of the ovarian tissue and the importance of graft sites in promoting neovascularization. Finally, we discuss pharmacologic treatments being studied to improve tissue performance postgraft. Of note, there is significant research into the efficacy of adjuvants used to reduce ischemic injury, improve neovascularization, and inhibit hyperactivation of primordial follicle growth activations. Although the "experimental" label has been removed from ovarian tissue cryopreservation and subsequent transplantation, there is a significant need for further research to better understand sources of ovarian reserve damage to improve outcomes. Future research directions are provided as we consider how to reach the most hopeful results for women globally.
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Affiliation(s)
- Abigail Mercier
- Divisions of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Joshua Johnson
- Divisions of Reproductive Endocrinology and Infertility and Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amanda N Kallen
- Divisions of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Vermont Larner College of Medicine, Burlington, Vermont.
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Dorfman CS, Stalls JM, Arrato NA, Shelby RA, Woodward JT, Acharya K, Davidson B, Wagner L, Corbett C, Greenup RA. Adoption as an Alternative Family-Building Strategy: Perceptions of Female, Young Adult Cancer Survivors Receiving Gonadotoxic Treatments. J Adolesc Young Adult Oncol 2024; 13:708-713. [PMID: 38588577 PMCID: PMC11322616 DOI: 10.1089/jayao.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Female survivors of young adult (YA) cancers are at risk of fertility impacts following cancer treatment. For these women, fertility-related distress is both prevalent and persistent. Yet there is little research regarding survivors' perspectives on alternative family-building options, particularly adoption. This exploratory secondary data analysis analyzed semistructured interviews and explored survivors' views of adoption. Overall, female YA survivors reported openness to adoption as a possible substitute for biological conception and an alternative to fertility preservation. It is imperative that this population receives support in decision-making around and consideration of the unique barriers to adoption for cancer survivors.
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Affiliation(s)
- Caroline S. Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Juliann M. Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Nicole A. Arrato
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A. Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Julia T. Woodward
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly Acharya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brittany Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lars Wagner
- Division of Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cheyenne Corbett
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Rachel A. Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Nyeko R, Okello N, Abeja CJ, Adyanga P, Apio B, Nabasirye CK, Mwa PA, Angom R, Geriga F, Buser J. Reproductive Concerns and Associated Factors Among Adolescent and Young Adult Cancer Survivors in Uganda: A Hospital-Based Cross-Sectional Study. J Adolesc Young Adult Oncol 2024; 13:629-636. [PMID: 38578003 DOI: 10.1089/jayao.2023.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: Reproductive health (RH) is a critical issue among cancer survivors worldwide. However, in developing countries where RH services for patients with cancer are often lacking, reproductive concerns among adolescent and young adult (AYA) survivors remain uncertain. In this study, we assessed the reproductive concerns of AYA cancer survivors in a resource-limited context of Uganda. Methods: We collected data from AYA cancer survivors at two facilities in Uganda using an interviewer-administered questionnaire. Descriptive statistics were calculated, one-way analysis of variance was used for intergroup comparisons, and multiple regressions were used to test for predictors of reproductive concerns. Results: A total of 110 AYA cancer survivors, with a median age of 20 years (interquartile range [IQR], 18-22), were interviewed. More than half (53.6%) of the respondents were males. The median time since cancer diagnosis was 19 months (IQR, 13.0-35.0). Almost all (91.8%) respondents had a future desire to have children, but only 15.5% received reproductive counseling. The mean total score for the reproductive concern subscales was highest for the fertility concern, followed by the information-seeking and health-related concerns. Reproductive counseling, desire to have children, and respondents' age were the factors influencing reproductive concern. Conclusions: The study shows a strong desire for biological parenthood with very low reproductive counseling among AYA cancer survivors, who remain concerned about their fertility, information needs, and health. This outcome underscores the need to integrate RH services into resource-limited cancer care settings.
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Affiliation(s)
- Richard Nyeko
- Department of Paediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda
- Paediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda
| | - Nelson Okello
- Department of Paediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda
| | | | - Proscovia Adyanga
- Department of Paediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda
| | - Betty Apio
- Lira Regional Referral Hospital, Lira, Uganda
| | | | - Pamella Aol Mwa
- Department of Paediatrics and Child Health, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Racheal Angom
- Paediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda
| | - Fadhil Geriga
- Paediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda
| | - Julie Buser
- University of Michigan, Ann Arbor, Michigan, USA
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Luong S, Mockler C, Pudwell J, Li W, Dudebout J, Velez MP. Chemotherapy alone vs. chemotherapy plus radiotherapy in female adolescent and young adults with Hodgkin's lymphoma: reproductive health outcomes. J Cancer Surviv 2024; 18:1434-1441. [PMID: 37148406 PMCID: PMC11324694 DOI: 10.1007/s11764-023-01388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To examine the effects of Hodgkin's lymphoma and its treatment on reproductive health in female adolescent and young adults (AYA). METHODS We conducted a retrospective, population-based, matched-cohort study of female patients with Hodgkin's lymphoma diagnosed at 15-39 years of age from 1995 to 2014 in Ontario, Canada. Three female individuals with no history of cancer (unexposed) were matched by birth year and census subdivision to each patient with cancer (exposed). In a subset of the cohort (2005 onwards), the Hodgkin's lymphoma patients were further classified into two groups for analysis based on treatment exposure: (1) chemotherapy alone or (2) combined chemotherapy and radiation. Reproductive health outcomes were infertility, childbirth, and premature ovarian insufficiency (POI). Relative risks (RR) were calculated using modified Poisson regression adjusted for income quintile, immigration status, and parity. RESULTS A total of 1443 exposed and 4329 unexposed individuals formed our cohort. Hodgkin's lymphoma patients were at an increased risk of infertility (aRR 1.86; 95% CI 1.57 to 2.20) and POI (aRR 2.81; 95% CI 2.16 to 3.65). While the risk of infertility persisted in both treatment groups (chemotherapy alone, combined chemotherapy plus radiotherapy), the increased risk of POI was only statistically significant in the chemotherapy plus radiotherapy group. No differences in childbirth rates were observed, overall or by treatment exposure compared with unexposed individuals. CONCLUSIONS Female AYA survivors of Hodgkin's lymphoma face an increased risk of infertility, independent of exposure to chemotherapy alone, or chemotherapy plus radiotherapy. The risk of POI is higher in those requiring radiotherapy vs. chemotherapy alone. IMPLICATIONS FOR CANCER SURVIVORS These results emphasize the importance of pre-treatment fertility counseling and reproductive health surveillance for AYAs diagnosed with Hodgkin's lymphoma.
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Affiliation(s)
- Susan Luong
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
| | - Claire Mockler
- School of Medicine, Queen's University, Kingston, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
| | - Wenbin Li
- ICES Queen's University, Kingston, Canada
| | - Jill Dudebout
- Department of Oncology, Queen's University, Kingston, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada.
- ICES Queen's University, Kingston, Canada.
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Roberts JE, Benoit J, Foong S, Saumet J, Korkidakis A, Marr K, McQuillan S, Todd N. Fertility preservation in patients undergoing gonadotoxic treatments: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2024; 48:103767. [PMID: 38458057 DOI: 10.1016/j.rbmo.2023.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 03/10/2024]
Abstract
The management of young patients with cancer presents several unique challenges. In general, these patients are ill prepared for the diagnosis and the impact on their fertility. With the improved survival for all tumour types and stages, the need for adequate fertility counselling and a multidisciplinary approach in the reproductive care of these patients is paramount. Recent advances in cryopreservation techniques allow for the banking of spermatozoa, oocytes, embryos and ovarian tissue without compromising survival. This Canadian Fertility and Andrology Society (CFAS) guideline outlines the current understanding of social and medical issues associated with oncofertility, and the medical and surgical technologies available to optimize future fertility.
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Affiliation(s)
- Jeffrey E Roberts
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada.
| | - Janie Benoit
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Shu Foong
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Julio Saumet
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Ann Korkidakis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard University, Boston, MA, USA
| | - Kristin Marr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
| | - Sarah McQuillan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, B.C., Canada
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Affdal AO, Salama M, Ravitsky V. Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review. J Assist Reprod Genet 2024; 41:999-1026. [PMID: 38430324 PMCID: PMC11052756 DOI: 10.1007/s10815-024-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. METHODS A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. RESULTS Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. CONCLUSION This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC.
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Affiliation(s)
| | | | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- The Hastings Center, Garrison, USA
- Harvard Medical School, Boston, USA
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Yoshida K, Matsui Y. An Examination of the Association Between Psychosocial Aspects of Fertility Issues and Demographic Characteristics of Unmarried Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2024; 13:293-299. [PMID: 37902972 DOI: 10.1089/jayao.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Purpose: The purpose of this study was to examine the association between fertility issues and demographic characteristics of unmarried adolescent and young adult cancer survivors. Methods: We conducted a survey among cancer survivors who were 15-39 years old and unmarried at the time of cancer diagnosis and 20-45 years old at the time of the survey. Views on fertility issues, originally developed based on the results of a qualitative study conducted with the same inclusion criteria, were used to assess thoughts and feelings regarding fertility issues. Results: Through exploratory factor analysis of the 128 respondents who either had children or desired children, two factors related to fertility issues were identified: "anxiety related to the possibility of not being able to have children" and "pressure from others to have children." Multiple regression analysis was performed to examine the association between these factors and demographic characteristics. The analysis revealed that being male and having a partner were significant predictors for both factors for views on fertility issues. Additionally, younger age at the time of diagnosis was a significant predictor for the first factor. Conclusions: Greater fertility issues among unmarried cancer survivors were associated with younger age at diagnosis, having a partner, and being male. Surprisingly, contrary to previous findings, male cancer survivors experienced more significant fertility problems than women. This result may be attributed to the well-established gender roles in Japan, where men are predominantly considered the heirs and inheritors of the family.
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Affiliation(s)
- Kanako Yoshida
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yutaka Matsui
- Institute of Human Sciences, University of Tsukuba, Tokyo, Japan
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Kipling LM, Shandley LM, Mertens AC, Spencer JB, Howards PP. The use of fertility treatments among reproductive-aged women after cancer. Fertil Steril 2023:S0015-0282(23)02079-4. [PMID: 38103881 DOI: 10.1016/j.fertnstert.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine whether female cancer survivors are more likely to pursue care for infertility after cancer than women without cancer. DESIGN Population-based cohort study involving detailed interviews regarding reproductive history. SETTING Not applicable. PATIENTS Female cancer survivors aged 22-45 years, who were at least 2 years after a cancer diagnosis between the ages of 20 and 35 years (n = 1,036), and age-matched comparison women with no cancer history (n = 1,026). EXPOSURE History of cancer vs. no history of cancer. MAIN OUTCOME MEASURE(S) Each cancer survivor was randomly matched to a comparison woman, who was assigned an artificial age at cancer diagnosis equal to that of her match. Matching was repeated 1,000 times. Outcomes of visiting a doctor for help becoming pregnant or undergoing fertility treatment were modeled using Cox proportional hazards regression, comparing survivors after a cancer diagnosis to age-matched comparison women, adjusted for race, income, residence, education, and parity. RESULTS Only 25.5% of cancer survivors reported meeting their desired family size before a cancer diagnosis. The median time from diagnosis to interview among survivors was 7 (interquartile range 5-11) years. Cancer survivors were more likely to report having no children (32.6%) at the interview compared with women with no cancer history (19.5%). Survivors were not more likely to visit a doctor for help becoming pregnant compared with women without a cancer history, matched on birth year and followed by the age at which cancer survivors received their diagnosis (hazard ratio [HR] 1.16, 95% simulation interval [SI] 0.78-1.74). Compared with cancer-free women, cancer survivors had similar probabilities of pursuing any treatment (adjusted HR [aHR] 0.88, 95% SI 0.46-1.56), using hormones or medications (aHR 0.86, 95% SI 0.46-1.63), or undergoing intrauterine insemination (aHR 1.26, 95% SI 0.40-5.88) to conceive. Cancer survivors were slightly more likely to pursue surgical interventions to become pregnant (HR 1.55, 95% SI 0.67-3.71). Of those who visited a doctor but declined to pursue fertility treatment, one-quarter of women reported declining treatment due to cost. CONCLUSION Cancer survivors did not use fertility treatments at higher rates than the general population. Further counseling and education surrounding fertility options are recommended for young adult female cancer patients after treatment is completed.
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Affiliation(s)
- Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Ann C Mertens
- Department of Pediatrics, Aflac Cancer Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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10
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Albamonte MI, Vitullo AD. Preservation of fertility in female and male prepubertal patients diagnosed with cancer. J Assist Reprod Genet 2023; 40:2755-2767. [PMID: 37770817 PMCID: PMC10656407 DOI: 10.1007/s10815-023-02945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
Over the past two decades, the importance of fertility preservation has grown not only in the realm of medical and clinical patient care, but also in the field of basic and applied research in human reproduction. With advancements in cancer treatments resulting in higher rates of patient survival, it is crucial to consider the quality of life post-cure. Therefore, fertility preservation must be taken into account prior to antitumor treatments, as it can significantly impact a patient's future fertility. For postpubertal patients, gamete cryopreservation is the most commonly employed preservation strategy. However, for prepubertal patients, the situation is more intricate. Presently, ovarian tissue cryopreservation is the standard practice for prepubertal girls, but further scientific evidence is required in several aspects. Testicular tissue cryopreservation, on the other hand, is still experimental for prepubertal boys. The primary aim of this review is to address the strategies available for possible fertility preservation in prepubertal girls and boys, such as ovarian cryopreservation/transplantation, in vitro follicle culture and meiotic maturation, artificial ovary, transplantation of cryopreserved spermatogonia, and cryopreservation/grafting of immature testicular tissue and testicular organoids.
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Affiliation(s)
- María Itatí Albamonte
- Centro de Estudios Biomédicos Básicos, Aplicados y Desarrollo (CEBBAD), Universidad Maimónides, Hidalgo 775, C1405BCK, Buenos Aires, Argentina
| | - Alfredo D Vitullo
- Centro de Estudios Biomédicos Básicos, Aplicados y Desarrollo (CEBBAD), Universidad Maimónides, Hidalgo 775, C1405BCK, Buenos Aires, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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11
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Arup G, Shravan N. Cancer and Pregnancy in the Post-Roe v. Wade Era: A Comprehensive Review. Curr Oncol 2023; 30:9448-9457. [PMID: 37999104 PMCID: PMC10669942 DOI: 10.3390/curroncol30110684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Cancer during pregnancy, affecting 1 in 1000 pregnancies, is rising in incidence due to delayed childbearing and improved detection. Common types include breast cancer, melanoma and cervical cancer and Hodgkin's Lymphoma. There are several physiological changes that occur during pregnancy that make its management a challenge to clinicians. Managing it requires multidisciplinary approaches and cautious test interpretation due to overlapping symptoms. To minimize fetal radiation exposure, non-ionizing imaging is preferred, and the interpretation of tumor markers is challenging due to inflammation and pregnancy effects. In terms of treatment, chemotherapy is avoided in the first trimester but may be considered later. Immunotherapy's safety is under investigation, and surgery depends on gestational age and cancer type. Ethical and legal concerns are growing, especially with changes in U.S. abortion laws. Access to abortion for medical reasons is vital for pregnant cancer patients needing urgent treatment. Maternal outcomes may depend on the type of cancer as well as chemotherapy received but, in general, they are similar to the non-pregnant population. Fetal outcomes are usually the same as the general population with treatment exposure from the second trimester onwards. Fertility preservation may be an important component of the treatment discussion depending on the patient's wishes, age and type of treatment. This article addresses the complicated nature of a diagnosis of cancer in pregnancy, touching upon the known medical literature as well as the ethical-legal implications of such a diagnosis, whose importance has increased in the light of recent judicial developments.
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Affiliation(s)
- Ganguly Arup
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Narmala Shravan
- Department of Hematology and Oncology, DHR Health Oncology Institute, Edinburg, TX 78539, USA;
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12
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Bateni SB, Sutradhar R, Everett K, Wright FC, Hong NJL. The Association Between Pregnancy Timing and Cumulative Exposure on Survival in Melanoma. Ann Surg Oncol 2023; 30:6332-6338. [PMID: 37386307 DOI: 10.1245/s10434-023-13819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND As melanoma is common among young women, the impact of pregnancy on melanoma prognosis is of interest. OBJECTIVE The purpose of this study was to examine the association between pregnancy and survival in female melanoma patients of childbearing age. METHODS We performed a population-level, retrospective cohort study of women of childbearing age (18-45 years) diagnosed with melanoma from 2007 to 2017 using administrative data from Ontario, Canada. Patients were categorized according to pregnancy status (i.e. pregnancy before [conception from 60 to 13 months prior to melanoma], pregnancy-associated [conception 12 months prior to and after], and pregnancy after [conception 12 months after] melanoma). Cox models were used to examine melanoma-specific survival (MSS) and overall survival (OS) associated with pregnancy status. RESULTS Of 1312 women with melanoma, most did not experience pregnancy (84.1%), with 7.6% experiencing a pregnancy-associated melanoma and 8.2% experiencing a pregnancy after melanoma. Pregnancy before melanoma occurred in 18.1% of patients. Pregnancy before (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.35-1.28), associated (HR 1.15, 95% CI 0.45-2.97), and after melanoma (HR 0.39, 95% CI 0.13-1.11) was not associated with a difference in MSS compared with those who did not experience a pregnancy during these time periods. Pregnancy status was also not associated with a difference in OS (p > 0.05). Cumulative weeks pregnant were not associated with a difference in MSS (4-week HR 0.99, 95% CI 0.92-1.07) or OS (4-week HR 1.00, 95% CI 0.94-1.06). CONCLUSIONS In this population-level analysis of female melanoma patients of childbearing age, pregnancy was not associated with a difference in survival, suggesting that pregnancy is not associated with a worse melanoma prognosis.
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Affiliation(s)
- Sarah B Bateni
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Division of Surgical Oncology, Department of General Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rinku Sutradhar
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Frances C Wright
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Division of General Surgery, University of Toronto, Toronto, ON, Canada.
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Hong YH, Park C, Paik H, Lee KH, Lee JR, Han W, Park S, Chung S, Kim HJ. Fertility Preservation in Young Women With Breast Cancer: A Review. J Breast Cancer 2023; 26:221-242. [PMID: 37387349 DOI: 10.4048/jbc.2023.26.e28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Fertility preservation is a major concern in young patients diagnosed with breast cancer and planning to receive multimodality treatment, including gonadotoxic chemotherapy with or without age-related decline through long-term endocrine therapy. Most breast cancer patients undergo multimodality treatments; many short-term and long-term side effects arise during these therapies. One of the most detrimental side effects is reduced fertility due to gonadotoxic treatments with resultant psychosocial stress. Cryopreservation of oocytes, embryos, and ovarian tissue are currently available fertility preservation methods for these patients. As an adjunct to these methods, in vitro maturation or gonadotropin-releasing hormone agonist could also be considered. It is also essential to communicate well with patients in the decision-making process on fertility preservation. It is essential to refer patients diagnosed with breast cancer on time to fertility specialists for individualized treatment, which may lead to desirable outcomes. To do so, a multimodal team-based approach and in-depth discussion on the treatment of breast cancer and fertility preservation is crucial. This review aims to summarize infertility risk related to currently available breast cancer treatment, options for fertility preservation and its details, barriers to oncofertility counseling, and psychosocial issues.
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Affiliation(s)
- Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Changhee Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Han E, Seifer DB. Oocyte Cryopreservation for Medical and Planned Indications: A Practical Guide and Overview. J Clin Med 2023; 12:jcm12103542. [PMID: 37240648 DOI: 10.3390/jcm12103542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Oocyte cryopreservation (OC) is the process in which ovarian follicles are stimulated, the follicular fluid is retrieved, and mature oocytes are isolated and vitrified. Since the first successful pregnancy utilizing previously cryopreserved oocytes in 1986, OC has become increasingly utilized as an option for future biologic children in patients facing gonadotoxic therapies, such as for the treatment of cancer. Planned OC, also termed elective OC, is growing in popularity as a means to circumvent age-related fertility decline. In this narrative review, we describe both medically indicated and planned OC, focusing on the physiology of ovarian follicular loss, OC technique and risks, timing of when OC should be performed, associated financial considerations, and outcomes.
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Affiliation(s)
- Eric Han
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
| | - David B Seifer
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
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15
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Reynolds AC, McKenzie LJ. Cancer Treatment-Related Ovarian Dysfunction in Women of Childbearing Potential: Management and Fertility Preservation Options. J Clin Oncol 2023; 41:2281-2292. [PMID: 36888938 PMCID: PMC10115556 DOI: 10.1200/jco.22.01885] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE To review the complex concerns of oncofertility created through increased cancer survivorship and the long-term effects of cancer treatment in young adults. DESIGN Review chemotherapy-induced ovarian dysfunction, outline how fertility may be addressed before treatment initiation, and discuss barriers to oncofertility treatment and guidelines for oncologists to provide this care to their patients. CONCLUSION In women of childbearing potential, ovarian dysfunction resulting from cancer therapy has profound short- and long-term implications. Ovarian dysfunction can manifest as menstrual abnormalities, hot flashes, night sweats, impaired fertility, and in the long term, increased cardiovascular risk, bone mineral density loss, and cognitive deficits. The risk of ovarian dysfunction varies between drug classes, number of received lines of therapy, chemotherapy dosage, patient age, and baseline fertility status. Currently, there is no standard clinical practice to evaluate patients for their risk of developing ovarian dysfunction with systemic therapy or means to address hormonal fluctuations during treatment. This review provides a clinical guide to obtain a baseline fertility assessment and facilitate fertility preservation discussions.
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Affiliation(s)
| | - Laurie J. McKenzie
- Baylor College of Medicine Houston, Houston, TX
- The University of Texas MD Anderson Cancer Center, Houston, TX
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16
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Yumura Y, Takeshima T, Komeya M, Karibe J, Kuroda S, Saito T. Long-Term Fertility Function Sequelae in Young Male Cancer Survivors. World J Mens Health 2023; 41:255-271. [PMID: 36593712 PMCID: PMC10042651 DOI: 10.5534/wjmh.220102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023] Open
Abstract
With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.
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Affiliation(s)
- Yasushi Yumura
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
| | - Teppei Takeshima
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Mitsuru Komeya
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Jurii Karibe
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shinnosuke Kuroda
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tomoki Saito
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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17
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Pesce C. Donor Egg, Surrogacy, and Adoption for Breast Cancer Survivors. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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18
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Krouwel EM, Birkhoff EML, Nicolai MPJ, Osanto S, Putter H, Pelger RCM, Elzevier HW. An Educational Need Regarding Treatment-Related Infertility and Fertility Preservation: a National Survey Among Members of the Dutch Society for Medical Oncologists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:106-114. [PMID: 34623602 PMCID: PMC9852179 DOI: 10.1007/s13187-021-02084-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
Cancer diagnosis and treatment may influence reproductive planning and impact fertility in patients of reproductive age. Although guidelines have been established in the past decade, education, practice, and attitudes of medical oncologists regarding fertility preservation remain undecided. A nationwide survey was performed among members of the Dutch Society for Medical Oncology. Demographics, practice, knowledge, and barriers were measured regarding information provision of fertility preservation towards cancer patients of childbearing age. From 392 members, 120 oncologists completed the questionnaire (30.6%). Majority of oncologists was convinced it is their responsibility to discuss impact of cancer treatment to fertility (93.2%), yet 68.3% discussed the subject often or always (n = 82). Oncologists employed in district general hospitals were less likely to discuss fertility (p = 0.033). On average, 44.6% of reproductive men and 28.9% of reproductive women is referred to fertility specialists. Half of the respondents declared to possess sufficient knowledge regarding fertility preservation (n = 57, 47.5%). Poor prognosis (53%), unlikely survival (43.1%), and high chances on fertility recovery (28.7%) were identified as barriers to discussing fertility preservation. Among oncologists, impact of cancer treatment on fertility is a well-accepted responsibility to counsel. Despite, self-reported knowledge regarding fertility preservation is strongly varying. In practice, fertility is discussed to some extent, influenced by several barriers and depending on prognosis and type of hospital. Patients benefit from knowledge improvement among oncology care providers concerning fertility effects of cancer treatment. Education during medical school, residency, and among practicing oncologists may raise awareness, together with enhancement of referral possibilities.
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Affiliation(s)
- E. M. Krouwel
- Department of Urology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - E. M. L. Birkhoff
- Department of Urology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - M. P. J. Nicolai
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - S. Osanto
- Department of Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - H. Putter
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands
| | - R. C. M. Pelger
- Department of Urology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - H. W. Elzevier
- Department of Urology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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19
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Ida H, Alicia GK, Anna F, Irene L, Anna N, Helena M, Maria E, Emir H, Hannah N. Quality of life among female childhood cancer survivors with and without premature ovarian insufficiency. J Cancer Surviv 2023; 17:101-109. [PMID: 33469826 PMCID: PMC9971100 DOI: 10.1007/s11764-021-00987-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/02/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Due to an increase in survival, a growing population of childhood cancer survivors (CCS) is present. However, female CCS are at risk of developing premature ovarian insufficiency (POI) after cancer treatment. POI involves a decreased chance of conceiving and the increased infertility state has a large impact on affected individuals' health and mental life. The objective of this study was to investigate health state and well-being among female CCS with and without POI and healthy controls (HC). METHODS Female CCS treated in southern Sweden between 1964 and 2008 were included. Each patient was matched with a HC. The final study population included 167 female CCS and 164 HC that were examined between October 2010 and January 2015 at the Reproductive Medicine Centre at Skåne University Hospital in Malmö, Sweden. All participants, except for two HCs, answered an EQ-5D-3L questionnaire for measuring health state including a visual analogue scale (VAS) for estimating well-being. RESULTS There were 22 CCS with POI, none of the HC had POI. The mean health state differed among groups (unadjusted: P = 0.002; adjusted: P = 0.007). A difference in mean experienced well-being among groups was noted (unadjusted: P = 0.003; adjusted: P = 0.012). Lowest well-being was found in the CCS group with POI (P = 0.024). CONCLUSIONS Female CCS have a significantly decreased health state and well-being. Female CCS with POI additionally have the lowest self-estimated well-being. IMPLICATIONS FOR CANCER SURVIVORS Female CCS with POI should be identified early in order to give them adequate information and support.
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Affiliation(s)
- Hjelmér Ida
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Malmo, Sweden
| | - Gustafsson Kylberg Alicia
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Malmo, Sweden
| | - Fridenborg Anna
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Malmo, Sweden
| | - Leijonhufvud Irene
- Department of Translational Medicine, Reproductive Medicine Centre, Skåne University Hospital, Lund University, Malmo, Sweden
| | - Nyström Anna
- Department of Pediatrics, Pediatric Endocrinology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mörse Helena
- Department of Pediatrics, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Elfving Maria
- Department of Pediatrics, Pediatric Endocrinology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Henic Emir
- Department of Translational Medicine, Reproductive Medicine Centre, Skåne University Hospital, Lund University, Malmo, Sweden
| | - Nenonen Hannah
- Department of Translational Medicine, Molecular Genetic Reproductive Medicine, Clinical Research Centre, Lund University, Malmo, Sweden.
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20
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ADC and kinetic parameter of primary tumor: Surrogate imaging markers for fertility-sparing vaginal radical trachelectomy in patients with stage IB cervical cancer. Eur J Radiol 2022; 155:110467. [PMID: 35970120 DOI: 10.1016/j.ejrad.2022.110467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/23/2022] [Accepted: 08/07/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the role of ADC and kinetic parameters derived from DCE-MRI in selecting eligible candidates for fertility-sparing vaginal radical trachelectomy (VRT). METHOD Female patients with FIGO stage IB cervical cancers between March 2019 and January 2022 were retrospectively included. All patients underwent hysterectomy and bilateral lymphadenectomy. According to the surgical pathology, the study population was divided into VRT-eligible group and VRT-ineligible group. ADC, semi-quantitative and quantitative kinetic parameters of the primary tumor were compared between the two groups. Logistic regression analysis was used to determine the independent predictors for VRT eligibility and ROC curve was used to evaluate the predictive performance. RESULTS 19 patients were deemed eligible for VRT and 50 were ineligible. Compared with VRT-eligible group, time to peak and ADC were significantly lower in VRT-ineligible group (P = 0.004 and 0.001, respectively) while volume fraction of plasma (Vp) was higher in VRT ineligible group (P = 0.001). ADC and Vp were independent predictors for VRT eligibility. Combining Vp and ADC yielded the highest area under the ROC curve of 0.853 compared with that of 0.766 for Vp and 0.764 for ADC, though marginal differences were found (P = 0.109 and 0.078, respectively). CONCLUSIONS ADC and the kinetic DCE-MRI parameter Vp can be used as surrogate markers to select eligible candidates for fertility-sparing VRT.
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21
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Gaughran J, Rosen O'Sullivan H, Lyne T, Abdelbar A, Abdalla M, Sayasneh A. Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London. J Clin Med 2022; 11:jcm11113195. [PMID: 35683582 PMCID: PMC9181136 DOI: 10.3390/jcm11113195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/30/2022] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
Fertility Sparing Surgery (FSS) appears to be a safe means of treating early-stage ovarian cancer based on relatively limited evidence. However, there is currently insufficient evidence to aid women in counselling about their potential fertility outcomes. The aim of this study was to assess the reproductive outcomes and prognosis of women who have undergone FSS for ovarian malignancy. Between 1 June 2008 and 1 June 2018, a retrospective review of a clinical database was conducted to identify all consecutive patients who underwent FSS in a central London gynaecological oncology centre. All patients with a histological diagnosis of ovarian malignancy (excluding borderline ovarian tumours) were eligible. All identified patients were then prospectively called into a follow up and asked to complete a questionnaire about their fertility outcomes. A total of 47 women underwent FSS; 36 were included in this study. The mean age was 30.3 years (95% Confidence Interval [CI]: 27.6 to 33.0 years). During the study period, 17/36 (47.2%) of the women had attempted to conceive following surgery, with a successful live birth rate of 52.9% (9/17). The mean time of recurrence was 125.3 months (95% CI: 106.5−144.1 months). The mean time to death was 139.5 months (95% CI: 124.3−154.8). The cancer grade, tumour stage and use of Assisted Reproductive Technology (ART) were the main factors significantly associated with the risk of recurrence and death. In conclusion, this study suggests that a large proportion of women will not attempt to conceive following FSS. For those who do attempt to conceive, the likelihood of achieving a live birth is high. However, careful counselling about the higher risk of recurrence and worse survival for women with high grade cancer, disease Stage > IA and potentially those who undergo ART is essential before contemplating FFS.
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Affiliation(s)
- Jonathan Gaughran
- Women's Health, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Hannah Rosen O'Sullivan
- Women's Health, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Tom Lyne
- Faculty of Life Sciences & Medicine at Guy's, The School of Life Course Sciences, King's College London, London WC2R 2LS, UK
| | - Ahmed Abdelbar
- Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Mostafa Abdalla
- Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Ahmad Sayasneh
- Faculty of Life Sciences & Medicine at Guy's, The School of Life Course Sciences, King's College London, London WC2R 2LS, UK
- Department of Gynaecological Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
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22
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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] [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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23
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Reproductive Issues in Long-Term Surviving Patients following Therapy for Hodgkin’s Disease in the Republic of North Macedonia: Risks of Infertility According to First-Line Treatment Regimens. Hematol Rep 2022; 14:85-94. [PMID: 35466177 PMCID: PMC9036275 DOI: 10.3390/hematolrep14020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/03/2022] Open
Abstract
Infertility as a consequence of therapy presents a high psychosocial burden for HL patients. In the cohort of our analyzed patients, within the post-ABVD surviving patients, alterations of the spermogram were documented in a total of 6.1% of the male patients and 5.4% of the female patients developed amenorrhea. On the other hand, within the subgroup of surviving patients following BEACOPP chemotherapy, 60% of the male patients manifested defects in their spermogram, and as high as 28.6% of the female survivors reported loss of their monthly cycle. It has been reported on several occasions that even prior to treatment, the sperm of HL patients manifests poorer quality characteristics when analyzed against control specimens from healthy male donors. The analyzed results in ABVD-treated male HL patients confirm ABVD to be a safe regimen for males of all age categories, as well as for female patients under the age of thirty. In women above the age of 30, the infertility risk rate is relatively low (14%), which leaves the decision of preserving fertility to themselves. For all BEACOPP-treated female, as well as male patients, a consult with a reproductive medicine specialist is warranted prior to therapy, due to the high infertility risk, and the final decision should be made on an individual basis.
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Psychological State and Decision Perceptions of Male and Female Cancer Patients on Fertility Preservation. Support Care Cancer 2022; 30:5723-5728. [PMID: 35322275 DOI: 10.1007/s00520-022-06973-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
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.
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Xie J, Sun Q, Duan Y, Cheng Q, Luo X, Zhou Y, Liu X, Xiao P, Cheng ASK. Reproductive concerns among adolescent and young adult cancer survivors: A scoping review of current research situations. Cancer Med 2022; 11:3508-3517. [PMID: 35332694 PMCID: PMC9487873 DOI: 10.1002/cam4.4708] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Fertility is a significant concern among adolescent and young adult (AYA) cancer survivors and their caregivers, especially after their completion of cancer treatment programs. Concerns about fertility affect not only cancer patients' psychological well‐being, but also all aspects of their medical treatments, including treatment protocol, decision‐making, and treatment adherence. In this scoping review, the PubMed, CINAHL, Web of Science, Embase, CNKI, and Wanfang electronic databases were searched according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Extension for Scoping Reviews. The searches identified 669 articles, 54 of which met the inclusion criteria. Reviewers extracted the data on the study characteristics, measurements, positive factors, negative factors, and additional themes. This scoping review included studies from 10 countries. Most studies were quantitative using a cross‐sectional design. The prevalence of reproductive concerns among AYA cancer survivors ranged from 44% to 86%, and 28% to 44% of the survivors experienced moderate to severe concerns. The specific implementation of fertility consultation, including timing, consult frequency, and content, deserves ongoing exploration.
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Affiliation(s)
- Jianfei Xie
- Department of Rehabilitation, Third Xiangya Hospital of Central South University, Changsha, China
| | - Qian Sun
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Yinglong Duan
- Department of Emergency, Third Xiangya Hospital of Central South University, Changsha, China
| | - Qinqin Cheng
- Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, China
| | - Xiaofei Luo
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yi Zhou
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xiangyu Liu
- Health Management Center of Hunan Cancer Hospital, Changsha, China
| | - Panpan Xiao
- Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, China
| | - Andy S K Cheng
- Department of Rehabilitation, Hong Kong Polytechnic University, Kowloon, China
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Zaami S, Melcarne R, Patrone R, Gullo G, Negro F, Napoletano G, Monti M, Aceti V, Panarese A, Borcea MC, Scorziello C, Ventrone L, Mamedov SN, Meggiorini ML, Vergine M, Giacomelli L. Oncofertility and Reproductive Counseling in Patients with Breast Cancer: A Retrospective Study. J Clin Med 2022; 11:jcm11051311. [PMID: 35268402 PMCID: PMC8911138 DOI: 10.3390/jcm11051311] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
- Correspondence:
| | - Rossella Melcarne
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Renato Patrone
- ICTUS, University of Naples Federico II, 80131 Naples, Italy;
| | - Giuseppe Gullo
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy;
| | - Francesca Negro
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
| | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (M.M.); (M.L.M.)
| | - Valerio Aceti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Alessandra Panarese
- General and Transplant Surgery Department, Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB), University of L’Aquila, 67100 L’Aquila, Italy;
| | - Maria Carola Borcea
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Chiara Scorziello
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Luca Ventrone
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Samira Nicole Mamedov
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Maria Letizia Meggiorini
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (M.M.); (M.L.M.)
| | - Massimo Vergine
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Laura Giacomelli
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
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Valsamakis G, Valtetsiotis K, Charmandari E, Lambrinoudaki I, Vlahos NF. GnRH Analogues as a Co-Treatment to Therapy in Women of Reproductive Age with Cancer and Fertility Preservation. Int J Mol Sci 2022; 23:2287. [PMID: 35216409 PMCID: PMC8875398 DOI: 10.3390/ijms23042287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
In this review, we analyzed existing literature regarding the use of Gonadotropin-releasing Hormone (GnRH) analogues (agonists, antagonists) as a co-treatment to chemotherapy and radiotherapy. There is a growing interest in their application as a prophylaxis to gonadotoxicity caused by chemotherapy and/or radiotherapy due to their ovarian suppressive effects, making them a potential option to treat infertility caused by such chemotherapy and/or radiotherapy. They could be used in conjunction with other fertility preservation options to synergistically maximize their effects. GnRH analogues may be a valuable prophylactic agent against chemotherapeutic infertility by inhibiting rapid cellular turnover on growing follicles that contain types of cells unintentionally targeted during anti-cancer treatments. These could create a prepubertal-like effect in adult women, limiting the gonadotoxicity to the lower levels that young girls have. The use of GnRH agonists was found to be effective in hematological and breast cancer treatment whereas for ovarian endometrial and cervical cancers the evidence is still limited. Studies on GnRH antagonists, as well as the combination of both agonists and antagonists, were limited. GnRH antagonists have a similar protective effect to that of agonists as they preserve or at least alleviate the follicle degradation during chemo-radiation treatment. Their use may be preferred in cases where treatment is imminent (as their effects are almost immediate) and whenever the GnRH agonist-induced flare-up effect may be contra-indicated. The combination treatment of agonists and antagonists has primarily been studied in animal models so far, especially rats. Factors that may play a role in determining their efficacy as a chemoprotective agent that limits gonadal damage, include the type and stage of cancer, the use of alkylating agents, age of patient and prior ovarian reserve. The data for the use of GnRH antagonist alone or in combination with GnRH agonist is still very limited. Moreover, studies evaluating the impact of this treatment on the ovarian reserve as measured by Anti-Müllerian Hormone (AMH) levels are still sparse. Further studies with strict criteria regarding ovarian reserve and fertility outcomes are needed to confirm or reject their role as a gonadal protecting agent during chemo-radiation treatments.
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Affiliation(s)
- Georgios Valsamakis
- Second University Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Ethnikon and Kapodistriakon University of Athens, 115 28 Athens, Greece; (K.V.); (I.L.); (N.F.V.)
| | - Konstantinos Valtetsiotis
- Second University Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Ethnikon and Kapodistriakon University of Athens, 115 28 Athens, Greece; (K.V.); (I.L.); (N.F.V.)
| | - Evangelia Charmandari
- First University Department of Paediatrics, Aghia Sophia Childrens Hospital, Athens Medical School, Ethnikon and Kapodistriakon University of Athens, 152 33 Athens, Greece;
| | - Irene Lambrinoudaki
- Second University Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Ethnikon and Kapodistriakon University of Athens, 115 28 Athens, Greece; (K.V.); (I.L.); (N.F.V.)
| | - Nikolaos F. Vlahos
- Second University Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Ethnikon and Kapodistriakon University of Athens, 115 28 Athens, Greece; (K.V.); (I.L.); (N.F.V.)
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Abstract
PURPOSE OF REVIEW The issue of fertility preservation has become increasingly relevant as survival rates of children with cancer exceeds 80% at 5 years. Fertility preservation options are being utilized alongside less gonadotoxic therapeutic regimens in the treatment of these patients. The purpose of this review is to summarize the recent advances in fertility preservation in the pediatric, adolescent, and young adult population. RECENT FINDINGS Education research involves both patient and provider; to increase understanding on both sides for improved adoption of techniques and higher rates of posttreatment fertility. Basic science research, specific to the pediatric population, has worked to further understanding of protective techniques and cryopreserved tissue transfer. Research on the techniques of preservation confirms the safety of surgical gonadal (ovarian and testicular) tissue retrieval for cryopreservation but a viable pathway for testicular tissue utilization, as it has for ovarian, has yet to be realized. Outcomes may be improving but it is apparent that robust registries are necessary to track patients long-term. Possibly the largest advancement in the recent past are group efforts, such as by PanCareLIFE, to create guidelines for these issues using larger cohorts and registries than were available. SUMMARY Current research implies the need for the development of a national strategy to ensure that pediatric patients undergoing gonadotoxic regimens are educated, alongside their family, about fertility options and outcomes thereafter.
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Affiliation(s)
| | | | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Cao Q, Zhu H, Zhang J, Li Y, Huang W. Pregnancy Outcomes in Thyroid Cancer Survivors: A Propensity Score-Matched Cohort Study. Front Endocrinol (Lausanne) 2022; 13:816132. [PMID: 35250872 PMCID: PMC8893319 DOI: 10.3389/fendo.2022.816132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some female thyroid cancer survivors wish to become pregnant following their cancer treatment. Current studies have shown inconsistent results on pregnancy outcomes in these survivors; however, detailed information on the pathological type, treatment, and gestational thyroid function of these patients are not yet well documented, making the refined assessment of the influence of a history of thyroid cancer and related treatments on pregnancy outcomes challenging. OBJECTIVE To investigate the risk of adverse pregnancy outcomes in thyroid cancer survivors. METHODS This was a retrospective cohort study. We included all women aged between 19 and 45 years old who delivered between January 2019 and June 2020 in West China Second University Hospital of Sichuan University. Women with tumors other than thyroid cancer or other thyroid diseases were excluded. The included women were divided into survivors of thyroid cancer (survivors) and women without any history of thyroid disease (controls). Propensity score matching and logistic regression were used to control confounding variables. RESULTS All 18,332 women who met the inclusion criteria were included in the study (96 survivors of papillary thyroid cancer and 18,236 controls). After propensity score matching, 96 survivors and 192 controls were included. The survivors had higher levels of free thyroxine (15.47 [13.61-17.67] vs. 14.38 [13.20-15.81] pmol/mL; P<0.001) and higher levels of thyroid peroxidase antibodies (TPOAb) (43.55 [31.43-71.43] vs. 35.95 [28.00-48.03] U/mL; P=0.008) but similar levels of thyroid stimulating hormone (1.46 [0.56-3.15] vs. 1.36 [0.81-1.92] mIU/mL; P=0.142) than the controls. There were no significant differences in adverse pregnancy outcomes between survivors and controls. Fetal macrosomia was lower among survivors (OR: 0.077, 95% CI: 0.009-0.668. P=0.020) than controls. Additionally, survivors had reduced weight gain during pregnancy (13.0 [10.0-15.0] vs. 14.00 [11.00-16.00] kg, P=0.005) and reduced placental weight (563.0 [514.5-620.0] vs. 572.0 [520.0-650.0] g, P=0.019), albeit with small absolute differences. Thyroidectomy or radioiodine therapy did not adversely affect pregnancy outcomes. CONCLUSION A history of treated papillary thyroid cancer was not associated with adverse pregnancy outcomes.
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Affiliation(s)
- Qi Cao
- Department of Obstetrics and Gynaecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Huili Zhu
- Department of Obstetrics and Gynaecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Jiani Zhang
- Department of Obstetrics and Gynaecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Yujing Li
- Department of Obstetrics and Gynaecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Wei Huang
- Department of Obstetrics and Gynaecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Chronobiology (Sichuan University), National Health Commission (NHC), West China Second University Hospital of Sichuan University, Chengdu, China
- *Correspondence: Wei Huang,
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Coker Appiah L, Fei YF, Olsen M, Lindheim SR, Puccetti DM. Disparities in Female Pediatric, Adolescent and Young Adult Oncofertility: A Needs Assessment. Cancers (Basel) 2021; 13:5419. [PMID: 34771582 PMCID: PMC8582476 DOI: 10.3390/cancers13215419] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Advancements in cancer screening and implementation of targeted treatments have significantly improved survival rates to 85% for pediatric and AYA survivors. Greater than 75% of survivors will live to experience the long-term adverse outcomes of cancer therapies, termed late effects (LE), that disrupt quality of life (QoL). Infertility and poor reproductive outcomes are significant disruptors of QoL in survivorship, affecting 12-88% of survivors who receive at-risk therapies. To mitigate risk, fertility preservation (FP) counseling is recommended as standard of care prior to gonadotoxic therapy. However, disparities in FP counseling, implementation of FP interventions, and screening for gynecologic late effects in survivorship persist. Barriers to care include a lack of provider and patient knowledge of the safety and breadth of current FP options, misconceptions about the duration of time required to implement FP therapies, cost, and health care team bias. Developing strategies to address barriers and implement established guidelines are necessary to ensure equity and improve quality of care across populations.
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Affiliation(s)
- Leslie Coker Appiah
- Division of Academic Specialists in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Denver, CO 80045, USA
- Pediatric and Adolescent Gynecology, Children’s Hospital Colorado, Denver, CO 80045, USA
| | - Yueyang Frances Fei
- Pediatric and Adolescent Gynecology, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Mallery Olsen
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
| | - Steven R. Lindheim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wright State University, Dayton, OH 45409, USA;
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Diane M. Puccetti
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
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Wan Q, Han L, Liu J, Li H, Li Y, Long QM, Tan L, Li JJ. Fertility preservation among young breast cancer patients: A single-center experience in China. Taiwan J Obstet Gynecol 2021; 60:827-830. [PMID: 34507656 DOI: 10.1016/j.tjog.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aims to investigate the status of fertility preservation (FP) in young breast cancer patients. MATERIALS AND METHODS A clinical database of six women with breast cancer who wished to undergo FP before starting chemotherapy were analyzed between January 2018 and December 2019 in our hospital. Among the six women, three were unmarried and three were married. RESULTS Three patients chose oocyte preservation and obtained 23, 7, and 17 MII oocytes, respectively. One patient chose embryo freezing, and three embryos were frozen. Fertility preservation failed for two patients, one of whom had premature ovulation, while the other patient abandoned egg retrieval on the human chorionic gonadotropin (HCG) day. CONCLUSION The present results indicate that oocyte and embryo cryopreservation are effective optional methods for young breast cancer patients. However, a lack of knowledge, the urgency of cancer treatment, and financial constraints are causes for a low access rate regarding this process.
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Affiliation(s)
- Qi Wan
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China; Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ling Han
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Liu
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Ya Li
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Qi-Ming Long
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Li Tan
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Jun-Jie Li
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China.
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Schwab R, Anic K, Hasenburg A. Cancer and Pregnancy: A Comprehensive Review. Cancers (Basel) 2021; 13:3048. [PMID: 34207252 PMCID: PMC8234287 DOI: 10.3390/cancers13123048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/11/2023] Open
Abstract
Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.
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Affiliation(s)
- Roxana Schwab
- Department of Obstetrics and Women’s Health, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.A.); (A.H.)
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Kanbar M, de Michele F, Giudice MG, Desmet L, Poels J, Wyns C. Long-term follow-up of boys who have undergone a testicular biopsy for fertility preservation. Hum Reprod 2021; 36:26-39. [PMID: 33259629 DOI: 10.1093/humrep/deaa281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION What is the long-term reproductive health outcome of patients who have undergone testicular sampling for fertility preservation (FP) before and during the pubertal transition period? SUMMARY ANSWER In long-term follow-up after testicular sampling for FP, hormonal data showed that 33% of patients had primary seminiferous tubule insufficiency (high FSH) while semen analyses showed 52% of patients having a severe reduction in total sperm counts or complete absence of ejaculated sperm. WHAT IS KNOWN ALREADY During childhood and adolescence, both treatments for cancer and benign haematological diseases that require a bone marrow transplantation, can be detrimental to spermatogenesis by depleting the spermatogonial stem cell population. A testicular biopsy prior to chemotherapy or radiotherapy, even though still an experimental procedure, is now recommended for FP by European and USA oncofertility societies if performed within an institutional research setting. While short-term follow-up studies showed little to no post-operative complications and a normal testicular development after 1 year, data regarding the long-term follow-up of boys who have undergone this procedure are still lacking. STUDY DESIGN, SIZE, DURATION This is a longitudinal retrospective cohort study that reports on the long-term follow-up of pre- and peri-pubertal boys who have undergone a testicular biopsy for FP between May 2005 and May 2020. All the patients included in this study were referred to our programme by haematologists-oncologists who are part of a regional multi-centric collaborative care pathway. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 151 boys referred to our FP programme, 139 parents/legal guardians accepted that their child undergo a testicular biopsy. Patient characteristics (i.e. age at biopsy, urogenital history, pubertal status at diagnosis), indications (disease type and dosage of gonadotoxic treatments), operative and post-operative data (biopsy volume, surgical complications), anatomopathological analyses (presence/absence of spermatogonia, Johnsen score) and reproductive data (semen analyses, FSH, LH, testosterone levels) were collected from the institutions' FP database and medical records or from the 'Brussels Health Network'. Cumulative alkylating agent treatment was quantified using the cyclophosphamide equivalent dose (CED). Patients who were 14 years or older at the time of the follow-up and in whom the testicular tissue was shown to contain spermatogonia were included in the reproductive outcome analysis. Comparison of the sperm count findings (absence/presence of spermatozoa) and FSH levels (high (≥10 IU/l)/normal) between patients who were either pre- (Tanner 1) or peri-pubertal (Tanner >1) at the time of the biopsy was done using the Mann-Whitney U or Fisher's tests. A multiple logistic regression was used to study the relationship between the hormone reproductive outcome (high versus normal FSH), as a proxy marker for fertility, and both the pubertal status (Tanner 1 versus Tanner >1) and Johnsen score at the time of the biopsy, while adjusting for CED. MAIN RESULTS AND THE ROLE OF CHANCE A testicular biopsy was performed in 139 patients either before (129/139) or after (10/139) the start of a gonadotoxic treatment. Post-operative complications occurred in 2.1% (3/139). At the time of the procedure, 88% (122/139) of patients were pre-pubertal and 12% (17/139) were peri-pubertal. The presence of spermatogonia was documented in 92% (128/139) of cases. Follow-up data were available for 114 patients after excluding 23 deceased and two patients lost to follow-up. A paediatric endocrinologist's follow-up including clinical examination and data on reproductive hormones was available for 57 patients (age ≥14) and 19 (33%) of these were found to have high FSH levels (20 ± 8.8 IU/l). There were 37 patients who had returned to the reproductive specialist's consultation for post-treatment fertility counselling and results on semen analysis were available in 27 of these cases; 14/27 (52%) had severely impaired semen parameters including 8 who were azoospermic. Among patients who received an alkylating agent-based treatment (n = 42), a peri-pubertal status (Tanner >1) at the time of diagnosis/biopsy was found to be associated with a higher risk of having primary testicular failure (defined by an FSH ≥ 10 IU/l) after treatment completion with an OR of 6.4 (95% CI 1.22-33.9; P = 0.03). Of all the patients, 2.6% had already fulfilled their wish to build a family or were actively seeking parenthood. LIMITATIONS, REASONS FOR CAUTION Although this is the largest cohort with follow-up data providing proxy markers of the reproductive potential of boys in whom a testicular biopsy for FP was performed before puberty or during the pubertal transition period, the amount of data provided is limited, and originating from a single programme. Further data collection to confirm the observations in other settings is therefore awaited. WIDER IMPLICATIONS OF THE FINDINGS Testicular sampling for FP should be offered to boys at risk of losing their fertility (and is recommended for those at high risk) as part of ethically approved research programmes. Long-term follow-up data on increasing numbers of boys who have undergone an FP procedure will help improve patient care in the future as patient-specific factors (e.g. urogenital history, age at gonadotoxic therapy) appear to influence their reproductive potential after gonadotoxic therapies. STUDY FUNDING/COMPETING INTEREST(S) FNRS-Télévie, the Salus Sanguinis Foundation and the Belgian Foundation against Cancer supported the studies required to launch the FP programme. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Kanbar
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - F de Michele
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - M G Giudice
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - L Desmet
- Louvain Institute of Data Analysis and Modeling in economics and statistics (LIDAM), Louvain-la-Neuve 1348, Belgium
| | - J Poels
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - C Wyns
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
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Ketterl TG. Closing the Gaps: Progress in the Care of Adolescents and Young Adults With Cancer. JCO Oncol Pract 2021; 17:302-304. [PMID: 34010020 DOI: 10.1200/op.21.00223] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Himelhoch AC, Datillo TM, Tuinman MA, Gerhardt CA, Lehmann V. Attitudes and Perceptions of Parenthood Among Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2021; 11:138-145. [PMID: 33999693 DOI: 10.1089/jayao.2020.0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Increasing numbers of childhood cancer survivors enter adulthood and encounter decisions surrounding parenthood. However, limited research has systematically examined how childhood cancer may influence parenthood attitudes among survivors. Methods: Adult survivors of childhood cancer, who had or wanted to have children (N = 77; Mage = 30.2 years, range: 22-43; 91% White), rated their perceived impact of cancer at enrollment and parenthood attitudes using the "Attitudes to Parenthood After Cancer Scale" 2 years later. First, internal consistencies for the parenthood measure were examined, and modified subscales were proposed. Second, hierarchical stepwise regressions analyzed the contribution of background factors and cancer's impact on parenthood attitudes. Results: Reevaluation of parenthood items yielded four subscales with improved internal consistency (α's > .78): improved parenting due to cancer, no children due to cancer, concerns about a (potential) child's health, and parenthood desire irrespective of own health concerns. Already having children (n = 38) was related to more favorable ratings on most subscales. Older age was associated with perceiving improved parenting due to cancer (r = .24) and shorter time since diagnosis was related to considering having no children due to cancer (r = -.23). Hierarchical stepwise regressions reconfirmed parenthood status as related to more favorable parenting attitudes. Cancer preoccupation and perceiving cancer as a most difficult life experience predicted more concerns toward parenthood (R2 = .044-.216). Conclusions: Parenthood attitudes were more favorable among survivors with children, who were older, and/or further into survivorship. Survivors burdened by their cancer experience reported more concerns about parenthood. Childhood cancer may shape parenthood perceptions positively and negatively, warranting further research to inform interventions.
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Affiliation(s)
- Alexandra C Himelhoch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Taylor M Datillo
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Marrit A Tuinman
- Health Psychology Research Section, University Medical Center Groningen, Groningen, The Netherlands
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics and The Ohio State University, Columbus, Ohio, USA.,Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Michalczyk K, Cymbaluk-Płoska A. Fertility Preservation and Long-Term Monitoring of Gonadotoxicity in Girls, Adolescents and Young Adults Undergoing Cancer Treatment. Cancers (Basel) 2021; 13:E202. [PMID: 33429908 PMCID: PMC7827074 DOI: 10.3390/cancers13020202] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/03/2021] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Chemo- and radio-therapy can often affect reproductive organs impairing hormonal regulation, fertility, and sexual function. As cancer treatments become more effective and many patients have long term survival, concerns related to patient's quality of life and reproductive health become relevant. It is especially important for girls and young females facing cancer therapy who have not yet started family planning. Chemotherapy protocols using alkylating agents and abdominal radiotherapy, which are frequently used in the treatment of childhood and adolescent cancer, can cause gonadal injury. The most common clinical manifests are ovarian hormone insufficiency, premature ovarian insufficiency, early menopause and infertility. In this review we assess current literature and summarize current recommendations on the reproductive function of girls and young females undergoing cancer treatment and their follow-up. Fertility preservation methods are discussed, including psychological and ethical considerations and barriers. Improvement of reproductive health and quality of life of adolescents and young adults (AYA) undergoing cancer treatment is an important issue. Further research should be continued to develop efficient and accessible methods for fertility preservation in young patients. An expert panel including oncologists, radiation oncologists, endocrinologists and gynecologists should always consider fertility preservation in pediatric, adolescent and AYA cancer patients, minding patients' medical condition, cancer staging and potential risk of treatment-related gonadotoxicity.
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Affiliation(s)
- Kaja Michalczyk
- Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
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Wyns C, Kanbar M, Giudice MG, Poels J. Fertility preservation for prepubertal boys: lessons learned from the past and update on remaining challenges towards clinical translation. Hum Reprod Update 2020; 27:433-459. [PMID: 33326572 DOI: 10.1093/humupd/dmaa050] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/25/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Childhood cancer incidence and survivorship are both on the rise. However, many lifesaving treatments threaten the prepubertal testis. Cryopreservation of immature testicular tissue (ITT), containing spermatogonial stem cells (SSCs), as a fertility preservation (FP) option for this population is increasingly proposed worldwide. Recent achievements notably the birth of non-human primate (NHP) progeny using sperm developed in frozen-thawed ITT autografts has given proof of principle of the reproductive potential of banked ITT. Outlining the current state of the art on FP for prepubertal boys is crucial as some of the boys who have cryopreserved ITT since the early 2000s are now in their reproductive age and are already seeking answers with regards to their fertility. OBJECTIVE AND RATIONALE In the light of past decade achievements and observations, this review aims to provide insight into relevant questions for clinicians involved in FP programmes. Have the indications for FP for prepubertal boys changed over time? What is key for patient counselling and ITT sampling based on the latest achievements in animals and research performed with human ITT? How far are we from clinical application of methods to restore reproductive capacity with cryostored ITT? SEARCH METHODS An extensive search for articles published in English or French since January 2010 to June 2020 using keywords relevant to the topic of FP for prepubertal boys was made in the MEDLINE database through PubMed. Original articles on fertility preservation with emphasis on those involving prepubertal testicular tissue, as well as comprehensive and systematic reviews were included. Papers with redundancy of information or with an absence of a relevant link for future clinical application were excluded. Papers on alternative sources of stem cells besides SSCs were excluded. OUTCOMES Preliminary follow-up data indicate that around 27% of boys who have undergone testicular sampling as an FP measure have proved azoospermic and must therefore solely rely on their cryostored ITT to ensure biologic parenthood. Auto-transplantation of ITT appears to be the first technique that could enter pilot clinical trials but should be restricted to tissue free of malignant cells. While in vitro spermatogenesis circumvents the risk linked to cancer cell contamination and has led to offspring in mice, complete spermatogenesis has not been achieved with human ITT. However, generation of haploid germ cells paves the way to further studies aimed at completing the final maturation of germ cells and increasing the efficiency of the processes. WIDER IMPLICATIONS Despite all the research done to date, FP for prepubertal boys remains a relatively young field and is often challenging to healthcare providers, patients and parents. As cryopreservation of ITT is now likely to expand further, it is important not only to acknowledge some of the research questions raised on the topic, e.g. the epigenetic and genetic integrity of gametes derived from strategies to restore fertility with banked ITT but also to provide healthcare professionals worldwide with updated knowledge to launch proper multicollaborative care pathways in the field and address clinical issues that will come-up when aiming for the child's best interest.
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Affiliation(s)
- Christine Wyns
- Andrology lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marc Kanbar
- Andrology lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maria Grazia Giudice
- Andrology lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jonathan Poels
- Andrology lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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38
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Nejatisafa AA, Faccio F, Nalini R. Psychological Aspects of Pregnancy and Lactation in Patients with Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:199-207. [PMID: 32816283 DOI: 10.1007/978-3-030-41596-9_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Young breast cancer patients face numerous challenges during the cancer trajectory. As in the last decade, women tend to delay pregnancies to a later time in life, and clinicians are often faced with young breast cancer patients who want to start a family or complete it. Becoming a mother is a delicate developmental process in which the woman redefines and restructures her identity as she gets prepared for her new role and responsibilities. When there is a history of cancer or cancer diagnosis is communicated during the pregnancy, fears, worries, and concerns emerge and specific support may be necessary. Follow-ups during the post-partum period are also recommended as lactation issues should not be overlooked. In this chapter, we analyze the psychological aspects of cancer survivors and women with pregnancy-associated breast cancer, and the management of these issues.
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Affiliation(s)
- Ali-Akbar Nejatisafa
- Department of Psychiatry, Division of Psychosomatic Medicine, Psychosomatic Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Flavia Faccio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Ronak Nalini
- Department of Internal Medicine, Division of Hematology-Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Abstract
Safety of pregnancy occurring after breast cancer treatment has been studied largely, but it is still debatable. These studies have generally showed that overall and disease-free survival in breast cancer survivors with subsequent pregnancy is not less than those without future pregnancy . Also, breast cancer survivors treated with chemotherapy , radiation therapy, or both had no increased risk of congenital anomalies, single gene disorders, or chromosomal syndromes in their offspring. However, it appears that the incidence of preterm labor, low birth weight, and fetal anomalies is higher in these cases.These issues as well as safe time interval from breast cancer treatment to pregnancy , safe contraceptive method after breast cancer, counseling about pregnancy in survivors, and how to follow up the patient for breast cancer recurrence during pregnancy are discussed in this chapter.
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40
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Poirot C, Fortin A, Lacorte JM, Akakpo JP, Genestie C, Vernant JP, Brice P, Morice P, Leblanc T, Gabarre J, Delmer A, Badachi Y, Drouineaud V, Gouy S, Chalas C, Egels S, Dhédin N, Touraine P, Dommergues M, Lebègue G, Wolf JP, Capron F, Lefebvre G, Boissel N. Impact of cancer chemotherapy before ovarian cortex cryopreservation on ovarian tissue transplantation. Hum Reprod 2020; 34:1083-1094. [PMID: 31116405 DOI: 10.1093/humrep/dez047] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION How efficacious is transplantation of ovarian cortex previously exposed to chemotherapy? SUMMARY ANSWER Prior exposure to chemotherapy did not disrupt the function of cryopreserved ovarian tissue after transplantation. WHAT IS KNOWN ALREADY Ovarian tissue cryopreservation (OTC) followed by ovarian tissue transplantation (OTT) is an efficacious technique for restoration of female fertility. At least 130 children have been born following this procedure. To date, little is known about the efficacy of OTT in patients exposed to cancer chemotherapy prior to OTC. STUDY DESIGN, SIZE, DURATION This study evaluates the recovery of ovarian function and fertility in 31 consecutive patients who had received OTT, between 2005 and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Thirty one patients, wanting children, were transplanted with autologous ovarian cortex, among which 22 patients (71%) had been exposed to chemotherapy before OTC. Recovery of ovarian function was considered total once menstruation occurred. Ovarian function recovery (OFR), ovarian graft survival, and incidence of pregnancy were related to previous chemotherapy exposure, type of chemotherapy and graft characteristics (number of grafted fragments and follicular density). MAIN RESULTS AND ROLE OF CHANCE The amount of ovarian tissue collected was the only parameter to show any significant change between patients with versus without previous chemotherapy. At 1 year after OTT, the cumulative incidence of OFR was 83% (93% in patients exposed to chemotherapy and 67% in others (P = 0.14)). A low follicular density (<0.3 foll/mm2) in the transplant and a low number of grafted fragments (<16) were significantly associated with a delayed OFR. Graft survival at 2 years after OTT was 77%. It was significantly lower in patients exposed to bifunctional alkylating agents before ovarian cryopreservation and in patients with a low follicular density. The proportion of women who succeeded in having at least one live birth was 23% in the total population, 0% (0/9) in the group 'no previous chemotherapy', and 32% (7/22) in the group 'previous chemotherapy'. The cumulative incidence of pregnancy (Kaplan-Meier) at 3 years after OTT was 36% overall and 49% in case of previous chemotherapy, with no difference related to previous chemotherapy exposure. In total there were 13 pregnancies and 8 births in 7 patients. LIMITATIONS, REASONS FOR CAUTION The pathology in the two groups of patients was not comparable. In the group of patients who had chemotherapy before OTC, there were 95% of hematological malignancies. In the group of patients who did not have chemotherapy before OTC only 1 out of 9 patients had a malignant hematological disease while 44% had some pathology affecting the ovaries. Few women are available for study and only large changes are likely to have statistical significance. WIDER IMPLICATIONS OF THE FINDINGS These results suggest that prior cancer chemotherapy should no longer be considered a limitation to cryopreservation of ovarian tissue and current recommendations in this regard should be revised. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Agence de la Biomédecine (France's biomedical office). There are no competing interests to report. TRIAL REGISTRATION NUMBER NCT02184806.
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Affiliation(s)
- C Poirot
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP) Saint Louis Hospital, Paris, France.,Médecine Sorbonne Université, Paris, France
| | - A Fortin
- Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - J M Lacorte
- Médecine Sorbonne Université, Paris, France.,Department of Hormonal Biochemistry, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - J P Akakpo
- Department of Radiology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - C Genestie
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - J P Vernant
- Médecine Sorbonne Université, Paris, France.,Department of Hematology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - P Brice
- Department of Hematology/Oncology, AP-HP Saint Louis Hospital, Paris, France
| | - P Morice
- Department of Oncological Surgery, Gustave Roussy Institute, Villejuif, France.,Paris-Sud XI University, Le Kremlin-Bicêtre, France
| | - T Leblanc
- Department of Pediatric Hematology, AP-HP Robert Debré University Hospital, Paris, France
| | - J Gabarre
- Department of Hematology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - A Delmer
- Department of Clinical Hematology, Robert Debré Hospital, Reims, France.,Reims Champagne-Ardenne University, Reims, France
| | - Y Badachi
- Department of Radiology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - V Drouineaud
- Department of Reproductive Biology, AP-HP Cochin Hospital, Paris, France
| | - S Gouy
- Department of Oncological Surgery, Gustave Roussy Institute, Villejuif, France
| | - C Chalas
- Department of Reproductive Biology, AP-HP Cochin Hospital, Paris, France
| | - S Egels
- Department of Radiology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - N Dhédin
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP) Saint Louis Hospital, Paris, France
| | - P Touraine
- Médecine Sorbonne Université, Paris, France.,Department of Endocrinology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - M Dommergues
- Médecine Sorbonne Université, Paris, France.,Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - G Lebègue
- Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - J P Wolf
- Department of Reproductive Biology, AP-HP Cochin Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - F Capron
- Médecine Sorbonne Université, Paris, France.,Department of Pathology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - G Lefebvre
- Department of Obstetrics Gynecology, AP-HP Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France
| | - N Boissel
- Department of Hematology, Adolescents and Young Adults Unit, Fertility Preservation, Assistance Publique-Hôpitaux de Paris (AP-HP) Saint Louis Hospital, Paris, France.,Paris Diderot University, Paris, France
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Rodriguez-Wallberg KA, Anastacio A, Vonheim E, Deen S, Malmros J, Borgström B. Fertility preservation for young adults, adolescents, and children with cancer. Ups J Med Sci 2020; 125:112-120. [PMID: 32356507 PMCID: PMC7721046 DOI: 10.1080/03009734.2020.1737601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Options for fertility preservation (FP) through cryopreservation methods are currently available for young adults, adolescents, and children. Guidelines for FP have been provided by international clinical societies, and emergency procedures aimed at FP have been implemented into clinical practice worldwide. In this article, we review the current data on clinical standards of emergency FP in patients who are facing gonadotoxic effects of cancer treatment, and we also describe the methods that are still under development, usually denoted as experimental. In Sweden, programmes for FP have been established at large university hospitals, thus covering the whole country. The Swedish publicly financed health care covers both assisted reproduction for treatment of infertility and the cryopreservation of gametes or gonadal tissue when there is a medical indication, such as the risk to become infertile due to oncologic treatment; hence the access to FP is ensured for the whole population. At our centre at Karolinska University Hospital in Stockholm, methods for FP have been offered since 1988. In this article, we also review the oncologic indications for FP in our patient cohort of >3000 individuals during the period 1988-2018.
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Affiliation(s)
- Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- CONTACT Kenny A. Rodriguez-Wallberg Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital Huddinge, StockholmSE-141 86, Sweden
| | - Amandine Anastacio
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Vonheim
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Deen
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Malmros
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Birgit Borgström
- Department of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
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van Dijk M, van Leeuwen FE, Overbeek A, Lambalk CB, van den Heuvel-Eibrink MM, van Dorp W, Tissing WJ, Kremer LC, Loonen JJ, Versluys B, Bresters D, Ronckers CM, van der Pal HJ, Beerendonk CCM, Kaspers GJL, van Dulmen-den Broeder E, van den Berg MH. Pregnancy, time to pregnancy and obstetric outcomes among female childhood cancer survivors: results of the DCOG LATER-VEVO study. J Cancer Res Clin Oncol 2020; 146:1451-1462. [PMID: 32221745 PMCID: PMC7230041 DOI: 10.1007/s00432-020-03193-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/20/2020] [Indexed: 12/02/2022]
Abstract
Purpose To evaluate pregnancy rates, time to pregnancy (TTP) and obstetric outcomes in female childhood cancer survivors (CCSs) and to identify specific diagnosis- and treatment-related factors associated with these outcomes. Methods The study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating fertility among long-term Dutch female CCSs. Data were collected by questionnaire. The current study included 1095 CCSs and 812 controls, consisting of sisters of CCSs and a random sample of women from the general population. Results Among the subgroup of women who ever had the desire to become pregnant, the chance of becoming pregnant was significantly lower for CCSs than controls (OR 0.5, 95%CI 0.4–0.8). Moreover, TTP was 1.1 times longer for CCSs compared to controls (p = 0.09) and was significantly longer in survivors of CNS and renal tumours. Overall, no differences were found between CCSs and controls regarding the probability of ever having had a miscarriage, still birth, or induced abortion. However, CCSs had a significantly increased risk of delivering preterm (OR 2.2, 95%CI 1.3–3.7) and delivering via caesarean section (OR 1.8, 95%CI 1.2–2.6). Treatment with lower abdominal/pelvic radiotherapy was strongly associated with several adverse obstetric outcomes. Conclusion CCSs are less likely to have ever been pregnant. Among those who do become pregnant, certain subgroups of CCSs are at increased risk of longer TTP. Moreover, as pregnant CCSs, especially those treated with lower abdominal/pelvic radiotherapy, are more likely to develop various adverse obstetric outcomes, appropriate obstetric care is highly advocated. Electronic supplementary material The online version of this article (10.1007/s00432-020-03193-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M van Dijk
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Overbeek
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - W van Dorp
- Department of Gynaecology and Obstetrics, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - W J Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J J Loonen
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - D Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H J van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J L Kaspers
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E van Dulmen-den Broeder
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M H van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Schmitz C, Baum J, Lax H, Lehmann N, Gromke T, Beelen DW, Jöckel KH, Dührsen U. Fertility preservation and fulfillment of parenthood after treatment of hematological malignancies: results from the 'Aftercare in Blood Cancer Survivors' (ABC) study. Int J Clin Oncol 2020; 25:1187-1194. [PMID: 32140954 PMCID: PMC7261262 DOI: 10.1007/s10147-020-01639-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
Purpose Treatment of hematological malignancies carries the risk of lasting sterility. We aimed to identify fertility-related unmet needs. Methods The ‘Aftercare in Blood Cancer Survivors’ study is a cohort study of hematological patients who were in treatment-free remission for ≥ 3 years or stable under continuous oral medication. Female patients age 18–45 years and male patients age 18–65 years without a history of pre-treatment infertility were asked to answer a structured questionnaire including questions addressing fertility issues. Multivariable analyses were performed to detect risk factors. Results Of 1562 study participants, 1031 met the inclusion criteria for the fertility sub-study. A high proportion of patients (72.4%) received information about the risk of losing fertility, but only a minority (15%) took steps to preserve it. Female and older patients were less likely to be informed. A post-treatment wish for parenthood was expressed by 19.3% of patients. It was strongly associated with childlessness at time of diagnosis and could be fulfilled by 29.4%. Fulfillment of desired parenthood increased with increasing time from diagnosis and was low after allogeneic transplantation. Conclusions Female and older hematological patients are less likely to be informed about fertility-related issues than other patients. With societal changes towards first parenthood at higher age, the proportion of patients desiring a child after treatment is likely to increase. Fulfillment of desired parenthood remains challenging, especially after allogeneic transplantation. Implications for cancer survivors In patients likely to express a wish for post-treatment parenthood, fertility-related issues should routinely be addressed before gonadotoxic treatment is started. Electronic supplementary material The online version of this article (10.1007/s10147-020-01639-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine Schmitz
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Julia Baum
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Hildegard Lax
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tanja Gromke
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - K-H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Dührsen
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
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Hershlag A, Mullin C, Bristow SL. Is Fertility Preservation Feasible and Safe With Neoadjuvant Therapy for Breast Cancer? JCO Glob Oncol 2020; 6:356-359. [PMID: 35275744 PMCID: PMC9812502 DOI: 10.1200/go.22.00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Avner Hershlag
- Northwell Health, Manhasset, New Hyde, NY
- Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
| | - Christine Mullin
- Northwell Health, Manhasset, New Hyde, NY
- Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
| | - Sara L. Bristow
- Northwell Health, Manhasset, New Hyde, NY
- Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
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45
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Halpern JA, Das A, Faw CA, Brannigan RE. Oncofertility in adult and pediatric populations: options and barriers. Transl Androl Urol 2020; 9:S227-S238. [PMID: 32257863 PMCID: PMC7108982 DOI: 10.21037/tau.2019.09.27] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cancer and its treatments can affect fertility in a variety of ways, and recent advances in cancer detection and treatment have led to an increasing number of cancer survivors for whom future fertility is a primary concern. Oncofertility is the study of interactions between cancer, anti-cancer therapy, fertility, and reproductive health. Fertility preservation aims to optimize fertility potential before initiation of gonadotoxic therapies. Sperm cryopreservation from an ejaculated sample is the gold standard for adults and post-pubertal adolescents, though added maneuvers such as medical therapy, penile vibratory stimulation, and electroejaculation can be employed when appropriate. When all these approaches fail, testicular sperm extraction can be used to obtain and cryopreserve testicular sperm from the azoospermic patient. Fertility preservation in the pre-pubertal pediatric patient is still experimental, but recent scientific breakthroughs with use of spermatogonial stem cells and testicular tissue transplantation offer great promise for the future. While there may be several practical, cultural, religious, and other barriers to fertility preservation, the establishment of a dedicated fertility preservation team can help to overcome these obstacles and optimize the utilization of fertility preservation in cancer patients of all ages.
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Affiliation(s)
- Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arighno Das
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cory A Faw
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Klipstein S, Fallat ME, Savelli S. Fertility Preservation for Pediatric and Adolescent Patients With Cancer: Medical and Ethical Considerations. Pediatrics 2020; 145:peds.2019-3994. [PMID: 32071259 DOI: 10.1542/peds.2019-3994] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Many cancers presenting in children and adolescents are curable with surgery, chemotherapy, and/or radiotherapy. Potential adverse consequences of treatment include sterility, infertility, or subfertility as a result of gonad removal, damage to germ cells as a result of adjuvant therapy, or damage to the pituitary and hypothalamus or uterus as a result of irradiation. In recent years, treatment of solid tumors and hematologic malignancies has been modified in an attempt to reduce damage to the gonadal axis. Simultaneously, advances in assisted reproductive technology have led to new possibilities for the prevention and treatment of infertility. This clinical report reviews the medical aspects and ethical considerations that arise when considering fertility preservation in pediatric and adolescent patients with cancer.
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Affiliation(s)
- Sigal Klipstein
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; .,InVia Fertility Specialists, Chicago, Illinois
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, Louisville, Kentucky; and
| | - Stephanie Savelli
- Division of Pediatric Hematology/Oncology, Akron Children's Hospital, Akron, Ohio
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Kemal Harzif A, Maidarti M, Silvia M, Mariana A, Dewi Mutia H, Wiweko B. Knowledge, attitude, intention, and religion aspect toward fertility preservation among obstetrics and gynecology residents in Indonesia: A cross-sectional study. Int J Reprod Biomed 2020; 18:47-56. [PMID: 32043071 PMCID: PMC6996126 DOI: 10.18502/ijrm.v18i1.6199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/15/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background The lack of knowledge from healthcare providers regarding fertility preservation will certainly affect the patient's knowledge, attitude, behavior, and also perspective. Obstetrics and Gynecology (OB/GYN) residents may most likely be the first line professionals to integrate fertility preservation technologies into their practice which plays an important task in giving an understanding of the relationship between age and fertility for patients. Objective This study aims to assess OB/GYN resident knowledge and beliefs regarding age-related fertility decline, intentions, and religion aspect toward fertility preservation. Materials and Methods A cross-sectional study was conducted on 92 Indonesian OB/GYN residents at the Cipto Mangunkusomo Hospital between November and December 2017. Data were collected using a questionnaire which had four sections, knowledge, attitude, intention, and religion aspect toward fertility preservation. Results The majority of participants believed that an OB/GYN should encourage discussions about potential childbearing desires (96.74%) and age-related fertility decline (94.57%) with patients, of which 79.34% believed that these discussions should be part of a woman's annual health examination. Cancer patients are likely to undergo oocyte cryopreservation than people who choose career as priority. From the religion aspect, fertility preservation options such as sperm, oocyte, embryo, and ovarian cortex cryopreservation were accepted by most residents with varied religions, while oocyte and sperm donor methods were unacceptable (48% and 57%, respectively) because of the belief that oocyte/sperm should only be given to legitimate partners, but many still do not know that oocyte and sperm donor were prohibited by all religions. Conclusion Age-related fertility decline and frozen egg storage should be discussed during annual woman wellness examinations by OB/GYN specialists.
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Affiliation(s)
- Achmad Kemal Harzif
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Mila Maidarti
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Melisa Silvia
- Indonesian Reproductive Medicine Research and Training Center (INA- REPROMED) Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Ana Mariana
- Indonesian Reproductive Medicine Research and Training Center (INA- REPROMED) Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Heidi Dewi Mutia
- Indonesian Reproductive Medicine Research and Training Center (INA- REPROMED) Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Budi Wiweko
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia
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Ernst M, Brähler E, Wild PS, Faber J, Merzenich H, Beutel ME. The desire for children among adult survivors of childhood cancer: Psychometric evaluation of a cancer-specific questionnaire and relations with sociodemographic and psychological characteristics. Psychooncology 2019; 29:485-492. [PMID: 31713915 DOI: 10.1002/pon.5285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Long-term childhood cancer survivors (CCS) are less likely to become parents than their peers of the same age. Previous research has suggested that besides fertility, this outcome is shaped by psychosocial factors such as emotional motives toward having a child. Drawing from a sample of CCS with survival times >25 years, we present the validation of a questionnaire assessing cancer-specific reproductive motives and concerns. METHODS We evaluated the cancer-specific version of the Leipzig Questionnaire of Motives to have a Child (LKM-C) in a register-based sample of adult CCS (N = 632, 31% had children, 44.5% women). We conducted a confirmatory factor analysis and tested associations with sociodemographic characteristics and psychological symptoms (PHQ-9, GAD-2). RESULTS The questionnaire showed good item discrimination parameters and reliability (α = 0.86). The two-factorial structure was confirmed with the independent scales "return to normalcy" and "illness-related worries (child's/own health)." On average, CCS reported more motives in favor of a child than worries (P < .001; d = 1.12). Favorable attitudes were associated with the presence of a partnership and children, stronger current desire for a child, and fewer depressive symptoms. Worries were associated with an unfulfilled desire to have a child and elevated levels of depression and anxiety symptoms. CONCLUSIONS The LKM-C offers a brief measure of parenthood motivations in long-term CCS. Having a child signifies return to normalcy, health, fulfillment of life perspectives, and enrichment of the partnership. Less intense worries included illnesses of the child and concerns regarding one's own health. The questionnaire could inform follow-up care, psychotherapy, and fertility treatments.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine-Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hiltrud Merzenich
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Valipour A, Osowski S, Rey J, Ochsendorf F, Weberschock T. Semen cryopreservation in adolescent and adult men undergoing fertility compromising cancer treatment: A systematic review. Andrologia 2019; 51:e13392. [DOI: 10.1111/and.13392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Arash Valipour
- Department of Dermatology, Venereology and Allergology Goethe University Hospital Frankfurt/Main Germany
- Working Group Evidence‐based Medicine Frankfurt Institute for General Practice Goethe University Hospital Frankfurt/Main Germany
| | - Sebastian Osowski
- Department of Dermatology, Venereology and Allergology Goethe University Hospital Frankfurt/Main Germany
- Working Group Evidence‐based Medicine Frankfurt Institute for General Practice Goethe University Hospital Frankfurt/Main Germany
| | - Julia Rey
- Institute of Biostatistics and Mathematical Modelling Goethe University Hospital Frankfurt/Main Germany
| | - Falk Ochsendorf
- Department of Dermatology, Venereology and Allergology Goethe University Hospital Frankfurt/Main Germany
| | - Tobias Weberschock
- Department of Dermatology, Venereology and Allergology Goethe University Hospital Frankfurt/Main Germany
- Working Group Evidence‐based Medicine Frankfurt Institute for General Practice Goethe University Hospital Frankfurt/Main Germany
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50
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Selter J, Huang Y, Grossman Becht LC, Palmerola KL, Williams SZ, Forman E, Ananth CV, Hur C, Neugut AI, Hershman DL, Wright JD. Use of fertility preservation services in female reproductive-aged cancer patients. Am J Obstet Gynecol 2019; 221:328.e1-328.e16. [PMID: 31108063 DOI: 10.1016/j.ajog.2019.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine the rates and predictors of fertility preservation services among reproductive-aged women with common cancers in the United States. STUDY DESIGN We used the MarketScan database to identify women 18-45 years of age with lung, breast, colorectal, or cervical cancer who underwent surgery and chemotherapy from 2009 through 2016. Services from 3 months before to 3 months after chemotherapy for evaluation for fertility preservation, laboratory testing for fertility evaluation, and fertility-preserving procedures were captured. Multivariable models were used to assess the factors associated with the use of fertility-preservation services. RESULTS A total of 18,781 women, including 386 cervical, 1372 colorectal, 246 lung, and 16,777 with breast cancer, were identified. In women 18-35 years old, 11.7% underwent evaluation for fertility preservation, 13.7% underwent laboratory testing, and 6.3% pursued fertility-preserving procedures. The rates of office evaluation, laboratory testing, and performance of procedure were 3.3%, 7.5%, and 1.9 % in women aged 36-40 years and 0.5%, 7.2%, and 0.3% in those aged 41-45 years, respectively. The rate of fertility preservation evaluation rose from 1.0% in 2009 to 5.5% in 2016 (risk ratio, 4.66, 95% confidence interval, 2.38-9.11) while use of fertility-preserving procedures increased from 1.0% to 4.6% (risk ratio, 3.84, 95% confidence interval, 1.94-7.59) during the same time period. In a multivariable model, use of any fertility-preserving interventions were more common in patients with breast cancer (adjusted risk ratio, 2.30, 95% confidence interval, 1.30-4.06), those in the Northeast (adjusted risk ratio, 1.24, 95% confidence interval, 1.10-1.40), and in younger women (18-35 years) (adjusted risk ratio, 2.59, 95% confidence interval, 2.32-2.89). CONCLUSION Although limited by lack of information regarding cancer stage and desire for future fertility, only a small fraction of reproductive-aged female cancer patients receiving chemotherapy are evaluated in a nationwide sample for fertility preservation or undergo fertility-preserving procedures.
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Affiliation(s)
- Jessica Selter
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lisa C Grossman Becht
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Katherine L Palmerola
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - S Zev Williams
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Eric Forman
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Cande V Ananth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Chin Hur
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
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