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Baek SY, Kim HK, Park S, Yu JH, Lee MH, Youn HJ, Kim HA, Han JH, Choi JE, Lee JR, Lee KH, Chung S, Chae HD, Kim S, Yoo S, Hahm SK, Kim HJ. Multidisciplinary Shared Decision Making for Fertility Preservation in Young Women With Breast Cancer. J Breast Cancer 2023; 26:582-592. [PMID: 37985382 PMCID: PMC10761754 DOI: 10.4048/jbc.2023.26.e44] [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: 06/08/2023] [Revised: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Fertility preservation (FP) is an important issue for young survivors of breast cancer. Although international guidelines recommend pre-treatment fertility counseling for women with breast cancer, there is no standardized protocol or referral system for FP in South Korea. There are also barriers to discussing FP that make patient-centered decision making difficult. This study aimed to develop a shared decision making program for FP and compare the rates of FP procedures between the usual care and shared decision making groups. We hypothesized that multidisciplinary shared decision making for FP would increase the rate of FP procedures and patient satisfaction. METHODS The multidisciplinary shared decision making for FP in young women with breast cancer (MYBC) is a multicenter, clustered, stepped-wedge, randomized trial. A total of 1100 patients with breast cancer, aged 19-40 years, from nine hospitals in South Korea, will be enrolled. They will be randomized at the institutional level and assigned to usual care and shared decision making groups. Four institutions, each of which can recruit more than 200 patients, will each become a cluster, whereas five institutions, each of which can recruit more than 50 patients, will become one cluster, for a total of five clusters. The shared decision making groups will receive multidisciplinary programs for FP developed by the investigator. The primary outcome is the rate of FP procedures; secondary outcomes include fertility results, satisfaction, and quality of life. Outcomes will be measured at enrollment, treatment initiation, and the 1-, 3-, and 5-year follow-ups after starting breast cancer treatment. DISCUSSION A multidisciplinary shared decision making program for FP is expected to increase fertility rates and satisfaction among young patients with breast cancer. This study will provide the evidence to implement a multidisciplinary system for patients with breast cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05139641. Registered on December 1, 2021.
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Affiliation(s)
- Soo Yeon Baek
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Kyu Kim
- 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
| | - Jong Han Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Jai Hong Han
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jung Eun Choi
- Division of Breast Surgical Oncology, Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 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
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Soyoung Yoo
- Human Research Protection Center, Asan Medical Center, Seoul, Korea
| | - Sang Keun Hahm
- Department of Family Medicine, Hanil General Hospital, 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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Zhu LX, Jin L, Jiang JH, Yang L, Fang ZS, Wang M, Xiao Y, Xi QS. Update Knowledge Assessment and Influencing Predictor of Female Fertility Preservation in Oncologists. Curr Med Sci 2022; 42:824-831. [PMID: 35583589 DOI: 10.1007/s11596-022-2592-6] [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: 07/06/2021] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to offer an update assessment of the knowledge of Chinese oncologists on female fertility preservation, and identify the determinants that influence the implementation of fertility preservation. METHODS A total of 713 Chinese oncologists with different specialties completed the online self-report questionnaire to assess their understanding of fertility risks in cancer treatment, knowledge on female fertility preservation, and perceptions on the barriers in referring patients for fertility preservation. RESULTS Although most oncologists were familiar with fertility risk in cancer treatment, half of them lacked the knowledge for reproduction and preservation methods. In the multivariable model, oncologists in a hospital with a specialized reproductive institution, positive precaution for fertility risk, and fertility preservation discussion with patients were significantly correlated with the possibility of fertility preservation referral. CONCLUSIONS The intervention targets based on the update evaluation and identified influencing determinants will be helpful for all the oncofertility researchers, oncologists and institutions in future efforts for well-established female fertility preservation services.
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Affiliation(s)
- Li-Xia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing-Hang Jiang
- Reproductive Medicine Center, Jingmen Second People's Hospital, Jingmen, 448000, China
| | - Liu Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zi-Shui Fang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ying Xiao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qing-Song Xi
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Omani-Samani R, Vesali S, Navid B, Mohajeri M, Rafsanjani KA, Aghamaleki SZN, Mohammadi M. Adult cancer patients and parents of younger cancer patients have little information about fertility preservation: a survey of knowledge and attitude. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Impaired fertility is one of the side effects of effective cancer therapy. Saving the potential or storing the material to enable people to have biological children after cancer treatment can be of high importance to many cancer survivors. Therefore, we designed a study to determine knowledge and attitudes to fertility preservation (FP) in adult cancer patients and the parents of patients with cancer. Participants who completed this survey were a convenience sample of 384 parents of cancer patients < 18 years and cancer patients ≥ 18 years from two large referral hospitals. A 25-item self-administered questionnaire measured knowledge and attitudes to FP. Responses were yes/no, or on a 4-point Likert scale (greatly, usually, rarely, never) scored from 1 for never to 4 for greatly.
Results
Most parents and most cancer patients were unaware of the FP methods of embryo cryopreservation (96.3% and 88.4%, respectively) and sperm cryopreservation (97.5% and 89.0%, respectively). Attitudes among cancer patients and parents to use of FP options, based on a 4-point Likert scale, were determined by financial cost, lack of access and information on FP options.
Conclusion
Of concern in this sample of Iranian adult cancer patients and their parents is that knowledge of the fertility risk associated with cancer therapy and knowledge of FP treatment options was generally poor, particularly among the parents. To enable cancer patients or their parents to make the best decisions about using FP services, oncologists and fertility specialists should discuss FP options during their consultation.
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Anguzu R, Cusatis R, Fergestrom N, Cooper A, Schoyer KD, Davis JB, Sandlow J, Flynn KE. Decisional conflict among couples seeking specialty treatment for infertility in the USA: a longitudinal exploratory study. Hum Reprod 2021; 35:573-582. [PMID: 32154565 DOI: 10.1093/humrep/dez292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/28/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are couples' decisional conflicts around family-building approaches before and after seeking a specialty consultation for infertility? SUMMARY ANSWER Decisional conflict is high among couples before an initial specialty consultation for infertility; on average, women resolved decisional conflict more quickly than men. WHAT IS KNOWN ALREADY Couples have multiple options for addressing infertility, and decisional conflict may arise due to lack of information, uncertainty about options and potential risks or challenges to personal values. STUDY DESIGN, SIZE, DURATION We conducted a total of 385 interviews and 405 surveys for this longitudinal, mixed-methods cohort study of 34 opposite-sex couples who sought a new reproductive specialty consultation (n = 68), who enrolled before the initial consultation and were followed over 12 months. PARTICIPANTS/MATERIALS, SETTING, METHODS The in-depth, semi-structured interviews included questions about information gathering, deliberation and decision-making, and self-administered surveys included the Decisional Conflict Scale (DCS), at six time points over 12 months. A DCS total score of 25 is associated with implementing a decision, and higher scores indicate more decisional conflict. A systematic content analysis of interview transcripts identified major themes. Paired t tests identified differences in DCS between women and men within couples. Linear mixed models predicted changes in DCS over time, adjusting for sociodemographic and fertility-related factors. MAIN RESULTS AND THE ROLE OF CHANCE The major qualitative themes were communication with partners, feeling supported and/or pressured in decision (s), changing decisions over time and ability to execute a desired decision. Average DCS scores were highest before the initial consultation. Within couples, men had significantly higher decisional conflict than women pre-consultation (48.9 versus 40.2, P = 0.037) and at 2 months (28.9 versus 22.1, P = 0.015), but differences at other time points were not significant. In adjusted models, predicted DCS scores declined over time, with women, on average, reaching the DCS threshold for implementing a decision at 2 months while for men it was not until 4 months. LIMITATIONS, REASONS FOR CAUTION This is a convenience sample from a single center, and generalizability may be limited. WIDER IMPLICATIONS OF THE FINDINGS Understanding how couples discuss and make decisions regarding family-building could improve the delivery of patient-centered infertility care. Our findings are the first to prospectively explore decisional conflict at multiple time points in both men and women; the observed gender differences underlie the importance of supporting both partners in clinical decision-making for infertility. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Institute of Child Health and Human Development under Grant [R21HD071332], the Research and Education Program Fund, of the Advancing a Healthier Wisconsin endowment at Medical College of Wisconsin, the National Research Service Award under Grant [T32 HP10030] and the use of REDCap for data collection from the National Center for Advancing Translational Sciences, National Institutes of Health under Grant through [8UL1TR000055]. The authors have no competing interests.
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Affiliation(s)
- R Anguzu
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - R Cusatis
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - N Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - A Cooper
- Social Science Research Institute, Duke University, Durham, NC 27708, USA
| | - K D Schoyer
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology and Infertility, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - J B Davis
- Cayman Fertility Centre, Barbados Fertility Centre Group, Grand Cayman, KY1, 1005, Cayman Islands
| | - J Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - K E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Jing X, Xu L, Qin W, Zhang J, Lu L, Wang Y, Xia Y, Jiao A, Li Y. The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010369. [PMID: 31935834 PMCID: PMC6981471 DOI: 10.3390/ijerph17010369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
Abstract
Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice.
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Affiliation(s)
- Xiang Jing
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
- Correspondence: ; Tel.: +86-0531-8838-2648
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Jiao Zhang
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Lu Lu
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yali Wang
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yu Xia
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - An’an Jiao
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yaozu Li
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
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Melo C, Moura-Ramos M, Canavarro MC, Almeida-Santos T. The time is now: An exploratory study regarding the predictors of female cancer patients' decision to undergo fertility preservation. Eur J Cancer Care (Engl) 2019; 28:e13025. [PMID: 30809894 DOI: 10.1111/ecc.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/07/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This cross-sectional exploratory study aimed to examine the female cancer patients' personal and health care-related variables mostly associated with their decision whether to preserve or not their fertility, in order to know more about the influence of attitudinal and health care-related variables on this decision where fertility preservation (FP) is fully covered by the National Health System. METHODS Childbearing attitudes, health care-related information, FP motivations and childbearing motivations were assessed, in a clinical setting, to female cancer patients in childbearing age, who were undergoing the FP decision-making process. RESULTS This study included 89 participants (82% response rate). Those who decided to undergo FP attributed more value to the reasons for FP and less value to the reasons against FP than those who decided not to undergo FP. Not having children, strongly valuing pregnancy after cancer and attributing low value to the implications of the postponement of cancer treatments were significant and independently associated with deciding to preserve fertility. CONCLUSION The decision to pursue FP is mainly influenced by three factors: the absence of children, attributing high value to trying to ensure future pregnancy and attributing low value to the possible postponement of cancer therapy in order to have time to preserve fertility.
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Affiliation(s)
- Cláudia Melo
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Portuguese Centre for Fertility Preservation, Reproductive Medicine Department, Coimbra Hospital and University Centre, Coimbra, Portugal
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Kim H, Kim H, Ku SY. Fertility preservation in pediatric and young adult female cancer patients. Ann Pediatr Endocrinol Metab 2018; 23:70-74. [PMID: 29969877 PMCID: PMC6057020 DOI: 10.6065/apem.2018.23.2.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 01/08/2023] Open
Abstract
As the 5-year survival rate increases up to 80% in pediatric cancer patients, the number of women patients with reduced gonadal function by chemotherapy and radiotherapy increases. The gonadal toxicity of pediatric patients varies highly according to the chemotherapeutic agent and the type of radiotherapy. Although American Society of Clinical Oncology published the guideline for fertility preservation, additional scientific and ethical concerns should be considered for clinical practice. In addition, only the experimental method can be applied for the prepubertal patients in contrast to the postpubertal patients. In this review, we will discuss some options for preserving fertility among women's quality of life issues.
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Affiliation(s)
| | | | - Seung-Yup Ku
- Address for correspondence: Seung-Yup Ku, MD, PhD Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2387 Fax: +82-2-762-3599 E-mail:
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8
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Raanani H, Dirnfeld M, Patrizio P. Medical egg freezing: How cost and lack of insurance cover impact women and their families. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2018; 5:82-92. [PMID: 30014045 PMCID: PMC6024226 DOI: 10.1016/j.rbms.2017.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/28/2017] [Accepted: 12/18/2017] [Indexed: 05/03/2023]
Abstract
Medical egg freezing (MEF) is being recommended increasingly for women at risk of losing their reproductive ability due to cancer chemotherapy or other fertility-threatening medical conditions. This first, binational, ethnographic study of women who had undergone MEF sought to explore women's experiences under two different funding systems: (i) the USA, where the cost of MEF is rarely covered by private or state health insurance; and (ii) Israel, where the cost of MEF is covered by national health insurance. Women were recruited from four American and two Israeli in-vitro fertilization clinics where MEF is offered. In-depth, semi-structured interviews were conducted with 45 women (33 Americans, 12 Israelis) who had completed at least one cycle of MEF. All of the Israeli women had cancer diagnoses, but were not faced with the additional burden of funding an MEF cycle. In marked contrast, the American women - 23 with cancer diagnoses and 10 with other fertility-threatening medical conditions - struggled, along with their families, to 'piece together' MEF funding, which added significant financial pressure to an already stressful situation. Given the high priority that both American and Israeli women in this study placed on survival and future motherhood, it is suggested that insurance funding for MEF should be mandated in the USA, as it is in Israel. This article concludes by describing new state legislative efforts in this regard.
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Affiliation(s)
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, Sunnyvale, CA, USA
| | | | | | - Dror Meirow
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Hila Raanani
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Martha Dirnfeld
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, Haifa, Israel
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Melo C, Fonseca A, Silva C, Almeida-Santos T, Canavarro MC. Portuguese oncologists' practices regarding female fertility preservation: Which barriers most relate to these practices? Eur J Cancer Care (Engl) 2018; 27:e12812. [PMID: 29314332 DOI: 10.1111/ecc.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 01/03/2023]
Abstract
This study aims to investigate the current practice patterns of Portuguese oncologists with different clinical specialties regarding female fertility preservation (FP) and to determine the relative endorsement of different barriers to these practices. A total of 111 doctors with different clinical specialties assisting female cancer patients of childbearing age at Portuguese clinical institutions completed a self-report questionnaire to assess their current practice patterns regarding female FP and their perceptions of the barriers to these practices. Although the majority of the oncologists reported discussing the reproductive future with their patients, 2.8% and 7.2% of these clinicians reported never informing about the risk of infertility and about FP, respectively, and 75.8% of the participants have referred fewer than ten patients to a reproductive medicine doctor. Time with patients was the strongest endorsed barrier to these practices. A stronger endorsement of the barriers "oncologists' communication skills" and "patient-related factors" was related to a lower frequency of informing about both the risk of cancer-related infertility and about FP. It is important to overcome the intrinsic barriers that emerged as being the most relevant to oncologists' FP practices and that can be modified, namely the lack of communication skills and the oncologists' perceptions of their patients' characteristics.
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Affiliation(s)
- Cláudia Melo
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Fonseca
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Cristina Silva
- Centre for Pharmaceutical Studies, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Portuguese Centre for Fertility Preservation, Reproductive Medicine Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
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10
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Raanani H, Dirnfeld M, Patrizio P. Medical egg freezing: the importance of a patient-centered approach to fertility preservation. J Assist Reprod Genet 2018; 35:49-59. [PMID: 29124460 PMCID: PMC5758476 DOI: 10.1007/s10815-017-1081-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses. METHODS Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions. RESULTS Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age < 30), unmarried, resource-constrained women, who are facing not only fertility loss but also the "double jeopardy" of cancer. Through in-depth, qualitative interviews, these women's MEF stories reveal 10 dimensions of care important to fertility preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF." CONCLUSIONS Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to mostly young, single women facing the daunting prospect of fertility loss and life-threatening medical diagnoses.
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Affiliation(s)
- Marcia C. Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520 USA
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, 1195 W. Fremont Ave., Sunnyvale, CA 94087 USA
| | - Joseph Doyle
- Shady Grove Fertility, 9600 Blackwell Road, Rockville, MD 20850 USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY 10021 USA
| | - Dror Meirow
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Hila Raanani
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Martha Dirnfeld
- Division Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Ruth and Bruce Faculty of Medicine, Technion, 3436212 Haifa, Israel
| | - Pasquale Patrizio
- Yale Fertility Center, Yale University, 150 Sargent Drive, New Haven, CT 06511 USA
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11
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Kim H, Kim SK, Lee JR, Hwang KJ, Suh CS, Kim SH. Fertility preservation for patients with breast cancer: The Korean Society for Fertility Preservation clinical guidelines. Clin Exp Reprod Med 2017; 44:181-186. [PMID: 29376014 PMCID: PMC5783914 DOI: 10.5653/cerm.2017.44.4.181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/20/2017] [Accepted: 07/05/2017] [Indexed: 01/25/2023] Open
Abstract
With advances in the methods of cancer treatment used in modern medicine, the number of breast cancer survivors has been consistently rising. As the number of women who wish to become pregnant after being diagnosed with breast cancer increases, it is necessary to consider fertility preservation in these patients. However, medical doctors may be unaware of the importance of fertility preservation among cancer patients because most patients do not share their concerns about fertility with their doctors. Considering the time spent choosing and undergoing treatment, an early referral to a reproductive specialist is the best way to prevent a delay in cancer treatment. Since it is not easy to make decisions on matters related to cancer diagnosis and fertility, patients should be provided with enough time for decision-making, and to allow for this, an early referral will provide patients with sufficient time to choose an appropriate method of fertility preservation. The currently available options of fertility preservation for patients with breast cancer include cryopreservation of embryos, oocytes, and ovarian tissue and gonadotropin-releasing hormone agonist treatment before and during chemotherapy. An appropriate method of fertility preservation must be selected through consultations between individual patients and health professionals and analyses of the pros and cons of different options.
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Affiliation(s)
- Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Joo Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
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12
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Inhorn MC, Birenbaum-Carmeli D, Patrizio P. Medical egg freezing and cancer patients’ hopes: Fertility preservation at the intersection of life and death. Soc Sci Med 2017; 195:25-33. [DOI: 10.1016/j.socscimed.2017.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 01/02/2023]
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13
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Algarroba GN, Sanfilippo JS, Valli-Pulaski H. Female fertility preservation in the pediatric and adolescent cancer patient population. Best Pract Res Clin Obstet Gynaecol 2017; 48:147-157. [PMID: 29221705 DOI: 10.1016/j.bpobgyn.2017.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/15/2017] [Indexed: 01/26/2023]
Abstract
The 5-year survival rate for childhood cancer is over 80%, thereby increasing the number of young women facing infertility in the future because of the gonadotoxic effects of chemotherapy and radiation. The gonadotoxic effects of childhood cancer treatment vary by the radiation regimen and the chemotherapeutic drugs utilized. Although the American Society of Clinical Oncology guidelines recommend fertility preservation for all patients, there are several barriers and ethical considerations to fertility preservation in the pediatric and adolescent female population. Additionally, the fertility preservation methods for pre- and postpubertal females differ, with only experimental methods available for prepubertal females. We will review the risk of chemotherapy and radiation on female fertility, the approach to fertility preservation in the pediatric and adolescent female population, methods of fertility preservation for both pre- and postpubertal females, barriers to fertility preservation, cost, and psychological and ethical considerations.
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Affiliation(s)
- Gabriela N Algarroba
- University of Pittsburgh School of Medicine, 3550 Terrace St., Pittsburgh, PA 15213, USA.
| | - Joseph S Sanfilippo
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket St., Suite 5150, Pittsburgh, PA 15213, USA.
| | - Hanna Valli-Pulaski
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, 204 Craft Ave, Pittsburgh, PA 15213, USA.
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14
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Fertility preservation training for obstetrics and gynecology fellows: a highly desired but non-standardized experience. FERTILITY RESEARCH AND PRACTICE 2017; 3:9. [PMID: 28690863 PMCID: PMC5496430 DOI: 10.1186/s40738-017-0036-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/15/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite a large body of data suggesting that delivery of fertility care to cancer patients is inconsistent and frequently insufficient, there is a paucity of literature examining training in fertility preservation for those physicians expected to discuss options or execute therapy. The study objective was to compare fertility preservation training between Reproductive Endocrinology & Infertility (REI) and Gynecologic Oncology (GYN ONC) fellows and assess the need for additional education in this field. METHODS A 38-item survey was administered to REI and GYN ONC fellows in the United states in April 2014. Survey items included: 1) Clinical exposure, perceived quality of training, and self-reported knowledge in fertility preservation; 2) an educational needs assessment of desire for additional training in fertility preservation. RESULTS Seventy-nine responses were received from 137 REI and 160 GYN ONC fellows (response rate 27%). REI fellows reported seeing significantly more fertility preservation patients and rated their training more favorably than GYN ONC fellows (48% of REI fellows versus 7% of GYN ONC fellows rated training as 'excellent', p < 0.001). A majority of all fellows felt discussing fertility preservation was 'very important' but fellows differed in self-reported ability to counsel patients, with 43% of REI fellows and only 4% of GYN ONC fellows able to counsel patients 'all the time' (p = 0.002). Seventy-six percent of all fellows felt more education in fertility preservation was required, and 91% felt it should be a required component of fellowship training. CONCLUSION Significant variability exists in fertility preservation training for REI and GYN ONC fellows, with the greatest gap seen for GYN ONC fellows, both in perceived quality of fertility preservation training and number of fertility preservation patients seen. A majority of fellows in both disciplines support the idea of a standardized multi-disciplinary curriculum in fertility preservation.
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15
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"My choice": breast cancer patients recollect doctors fertility preservation recommendations. Support Care Cancer 2017; 25:2421-2428. [PMID: 28238094 DOI: 10.1007/s00520-017-3648-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The increasing rates of early-onset breast cancer (BC) and of woman survival render fertility preservation (FP) a pressing issue. We probe women's experiences of FP counseling and decision making, aiming to identify emergent counseling patterns. METHODS Semi-structured interviews were conducted with 16 women, who had been diagnosed with BC at the ages of 24-38, 1 to 5 years prior to the interview. BC survivors were recruited through posts in online fora, consented to participate, and were invited to tell their FP stories. The transcribed interviews were analyzed thematically, using the phenomenological paradigm. FINDINGS Doctors' FP recommendations belong into three categories: (a) direct clinical rationale-grounding recommendations in the woman's clinical condition by direct reference to tumor characteristics and prognosis, (b) indirect clinical rationale-reference to the woman's clinical condition by outlining a pressing time-frame, and (c) sociodemographic rationale-focus on the woman's family status. Women's responses revealed primarily detachment and compliance alongside initiative and proactivism. CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS Beyond its contribution to women's future ability to conceive, FP may constitute an arena of personal autonomy and a coping resource for young BC patients. Raising awareness to this significance may sensitize healthcare providers to the role that FP may play in the moment of cancer diagnosis in adding, alongside sickness and prognosis, a focus on family future planning. As such, FP may affect women's quality of life and even survival.
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16
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Nahata L, Ziniel SI, Garvey KC, Yu RN, Cohen LE. Fertility and sexual function: a gap in training in pediatric endocrinology. J Pediatr Endocrinol Metab 2017; 30:3-10. [PMID: 27658131 DOI: 10.1515/jpem-2016-0044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infertility and sexual dysfunction result from many different pediatric conditions and treatments and can profoundly impact quality of life. The American Academy of Pediatrics (AAP) has recommended consulting "fertility specialists" for counseling, but it remains unclear who these specialists are. Our objective was to assess whether pediatric subspecialists who manage hypogonadism and/or genitourinary conditions feel adequately trained to provide fertility and sexual function counseling. METHODS An online survey was distributed to members of Pediatric Endocrine Society (PES), Society for Pediatric Urology (SPU), and North American Society for Pediatric and Adolescent Gynecology (NASPAG). Providers' comfort in counseling various age groups about fertility and sexual function was assessed via a five-point Likert scale. Providers reported whether they felt adequately trained in these areas. RESULTS Two hundred and eighty-four surveys were completed by endocrinologists, 124 surveys by urologists, and 41 surveys by gynecologists. Respondents (44% male, 86% Caucasian) represented 39 states and Canada. Seventy-nine percent were at academic centers. Thirty-four percent of providers had been practicing for >20 years. Comfort level was variable and lowest in young males. Ninety-one percent of pediatric endocrinologists reported routinely seeing patients at risk for infertility, but only 36% felt adequately trained in fertility, and 25% felt adequately trained in sexual function. CONCLUSIONS Infertility and sexual dysfunction are often overlooked in pediatric care. Our results suggest that pediatric endocrinologists, who frequently manage male and female hypogonadism, should also receive formal training in these areas. Optimizing counseling would help prevent missed opportunities for fertility preservation and alleviate distress among patients and families.
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17
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Hariton E, Bortoletto P, Cardozo ER, Hochberg EP, Sabatini ME. The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists. J Patient Exp 2016; 3:131-136. [PMID: 28725849 PMCID: PMC5513651 DOI: 10.1177/2374373516685960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the impact of the establishment of a dedicated oncofertility clinic on the frequency of patient referrals for fertility preservation (FP) consultation and the time from patient referral to consultation. METHODS A retrospective chart review of all women aged 21 to 44 years with an active cancer diagnosis who were referred for FP consultation from 2011 to 2015. RESULTS A total of 6895 female patients eligible for FP were seen at the Massachusetts General Hospital (MGH) Cancer Center. Of those eligible, a total of 209 patients were referred for FP consultation with 150 included in the final analysis. Since the establishment of the oncofertility clinic, the mean time to nonemergent consultation with a reproductive endocrinologist decreased by 27%, from 10.4 to 7.6 days (P = .03). Furthermore, the proportion of reproductive-aged females seen at the MGH Cancer Center referred for FP consultation increased from 1.7% to 3.0% (P < .01). CONCLUSION A dedicated oncofertility clinic increases physician referrals for FP and decreases the mean time to consultation, improving access to FP consultation for reproductive-aged women with cancer.
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Affiliation(s)
- Eduardo Hariton
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
- Eduardo Hariton and Pietro Bortoletto contributed equally to this work and are co-first authors
| | - Pietro Bortoletto
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
- Eduardo Hariton and Pietro Bortoletto contributed equally to this work and are co-first authors
| | - Eden R Cardozo
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Ephraim P Hochberg
- Division of Hematology/Oncology, Department of Medicine, Yawkey Center for Outpatient Care, Massachusetts General Hospital, Boston, MA, USA
| | - Mary E Sabatini
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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18
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Peavey M, Arian S, Gibbons W, Lu K, Gershenson D, Woodard T. On-Site Fertility Preservation Services for Adolescents and Young Adults in a Comprehensive Cancer Center. J Adolesc Young Adult Oncol 2016; 6:229-234. [PMID: 27845854 DOI: 10.1089/jayao.2016.0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Adolescents and young adults (AYAs) receiving cancer treatments that may impair fertility should receive counseling about risk of infertility and options for fertility preservation (FP) before treatment and/or during survivorship. Our objective was to define the AYA patient population referred to an on-site fertility consultation service within a comprehensive cancer center and determine factors associated with patients proceeding with FP treatment. METHODS We conducted a retrospective chart review of AYA women who completed a consultation at the MD Anderson Fertility Preservation and Family Building Service during the first year of service. Records of 154 referred AYA patients were reviewed for age, ethnicity, cancer type gravidity and parity, survivorship status, and decision to pursue FP treatment. RESULTS Patients (mean age 29.7) were Caucasian (55%), Hispanic (23%), and African American (10%). The majority of women (67%) were seen for FP before cancer treatment and the remaining sought options for family building while in survivorship. The most common cancer types were hematologic (29%), breast (25%), and gynecologic (23%). CONCLUSIONS Patients referred to an on-site fertility consultation service were medically and ethnically diverse. Interest in fertility counseling and treatment was apparent in both survivorship pre- and postcancer treatment. Although the referral group was ethnically diverse, Caucasian women were most likely to pursue FP treatment compared to women of other ethnicities.
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Affiliation(s)
- Mary Peavey
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas
| | - Sara Arian
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas
| | - William Gibbons
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas
| | - Karen Lu
- 2 Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center , Houston, Texas
| | - David Gershenson
- 2 Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center , Houston, Texas
| | - Terri Woodard
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas.,2 Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center , Houston, Texas
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19
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Kim J, Mersereau JE, Su HI, Whitcomb BW, Malcarne VL, Gorman JR. Young female cancer survivors' use of fertility care after completing cancer treatment. Support Care Cancer 2016; 24:3191-9. [PMID: 26939923 DOI: 10.1007/s00520-016-3138-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study is to investigate factors associated with female young adult cancer survivors' (YCSs) use of fertility care (FC), including consultation or fertility treatment, after completing their cancer treatment. METHODS In this cross-sectional study, females between that ages of 18 and 35 years who had been diagnosed with childhood, adolescent, or young adult cancers completed a 20-min web-based survey that included demographics, reproductive history, use of FC, fertility-related informational needs, and reproductive concerns. RESULTS A total of 204 participants completed the survey. Participants' mean age was 28.3 ± 4.5 years. Thirty (15 %) participants reported using FC after cancer treatment. The majority of participants recalled not receiving enough information about fertility preservation options at the time of cancer diagnosis (73 %). In multivariable analysis, those with higher concerns about having children because of perceived risk to their personal health (P = 0.003) were less likely to report use of FC after cancer treatment. Those who had used FC before cancer treatment (P = 0.003) and who felt less fertile than age-matched women (P = 0.02) were more likely to use FC after their cancer treatment. CONCLUSIONS While most YCSs in this cohort believed that they did not receive enough information about fertility and most wanted to have children, the vast majority did not seek FC. The findings of this study offer further evidence of the need for improved education and emotional support regarding reproductive options after cancer treatment is completed. Targeted discussions with YCSs about appropriate post-treatment FC options may improve providers' capacity to help YCSs meet their parenthood goals.
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Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
- Department of Obstetrics and Gynecology, CHA Seoul Fertility Center, CHA University, Seoul, South Korea
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
| | - H Irene Su
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, 92182, USA
| | - Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 2250 SW Jefferson Way, Corvallis, OR, 97331-6406, USA.
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20
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Banerjee R, Tsiapali E. Occurrence and recall rates of fertility discussions with young breast cancer patients. Support Care Cancer 2015; 24:163-171. [PMID: 25967235 DOI: 10.1007/s00520-015-2758-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Fertility preservation is an important issue for premenopausal cancer patients; however, not all patients receive counseling about chemotherapy-induced infertility and potential mitigation strategies. We aimed to identify characteristics of premenopausal breast cancer patients less likely to receive fertility counseling. We also investigated patient recall of chart-documented fertility discussions and patient attitudes toward fertility preservation. METHODS The study was approved by our institution's Institutional Review Board. All female patients with invasive primary breast cancer of any type, aged 40 or younger at the time of diagnosis, who were diagnosed during or up to 5 years prior to the study period were eligible. The study was conducted between February 2012 and October 2013. Enrolled patients completed an anonymous survey, and their medical charts were subsequently reviewed to identify provider documentation of fertility discussions, referral to fertility specialists, or implementation of fertility preservation. Patient comments regarding their fertility were solicited and examined thematically. RESULTS Forty-nine patients consented to participate. Fertility discussions were documented by providers in 55% of patients. Patients aged over 35 and multiparous patients were significantly less likely than their counterparts (p < 0.01 in both cases) to have had chart-documented fertility discussions. Only 52% of patients with chart-documented discussions recalled having had such a conversation. Patient comments highlighted the difficulty of considering fertility at the time of diagnosis and also the risks and obstacles facing fertility preservation. CONCLUSIONS Despite increasing awareness, fertility is not universally discussed with premenopausal breast cancer patients at the time of diagnosis; older and multiparous patients are at particular risk of not receiving fertility counseling. Even when such discussions are documented, only about half of patients recall the conversation. Patient-reported barriers to fertility preservation include lack of education combined with the stress of diagnosis, financial costs, and perceived treatment toxicities.
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Affiliation(s)
- Rahul Banerjee
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ekaterini Tsiapali
- Medstar Regional Breast Health Program at Medstar Southern Maryland Hospital Center, Department of Surgery, Georgetown University, Washington, DC, USA. .,, 7501 Surratts Road, Suite 303, Clinton, MD, 20735, USA.
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