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Stal J, Miller KA, Mullett TW, Boughey JC, Francescatti AB, Funk E, Nelson H, Freyer DR. Cancer Survivorship Care in the United States at Facilities Accredited by the Commission on Cancer. JAMA Netw Open 2024; 7:e2418736. [PMID: 38958979 PMCID: PMC11222991 DOI: 10.1001/jamanetworkopen.2024.18736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/21/2024] [Indexed: 07/04/2024] Open
Abstract
Importance Since 2021, American College of Surgeons Commission on Cancer (CoC) accreditation standards require providing a survivorship program for patients with adult-onset cancer treated with curative intent. Since more than 70% of all patients with cancer in the US are treated at CoC-accredited facilities, this presents an opportunity for a landscape analysis of survivorship care availability. Objective To determine the prevalence, types, and outcomes of cancer survivorship services at CoC-accredited facilities. Design, Setting, and Participants This survey study used an anonymous, online, cross-sectional survey conducted from May 4 to 25, 2023. Participants were CoC-accredited facilities in the US representing diverse CoC program categories, institutional characteristics, geographic regions, and practice types. Department of Veterans Affairs cancer programs were excluded due to data usage restrictions. Data were analyzed from July to October 2023. Exposure CoC Survivorship Standard 4.8 was released in October 2019 and programs were expected to adhere to the Standard beginning January 1, 2021. Main Outcomes and Measures Questions included self-reported survivorship program characteristics, availability of services aligned to CoC Survivorship Standard 4.8, and perceived program impacts. Response frequencies and proportions were determined in aggregate and by CoC program category. Results There were 1400 eligible programs, and 384 programs participated (27.4% response rate). All regions and eligible program categories were represented, and most had analytic caseloads of 500 to 4999 patients in 2021. Most survivorship program personnel included nurses (334 programs [87.0%]) and social workers (278 programs [72.4%]), while physical (180 programs [46.9%]) and occupational (87 programs [22.7%]) therapists were less common. Services most endorsed as available for all survivors were screening for new cancers (330 programs [87.5%]), nutritional counseling (325 programs [85.3%]), and referrals to specialists (320 programs [84.7%]), while treatment summaries (242 programs [64.7%]), and survivorship care plans (173 programs [43.0%]), sexual health (217 programs [57.3%]), and fertility (214 programs [56.9%]) were less common. Survivorship services were usually delivered by cancer treatment teams (243 programs [63.3%]) rather than specialized survivorship clinics (120 programs [31.3%]). For resources needed, additional advanced practice clinicians with dedicated survivorship effort (205 programs [53.4%]) and electronic health record enhancements (185 programs [48.2%]) were most endorsed. Lack of referrals and low patient awareness were endorsed as the primary barriers. A total of 335 programs (87.2%) agreed that Survivorship Standard 4.8 helped advance their programs. Conclusions and Relevance These findings of this survey study of CoC-accredited programs establish a benchmark for survivorship care delivery in the US, identify gaps in specific services and opportunities for intervention, contribute to longitudinal reevaluation for tracking progress nationally, and suggest the value of survivorship care standards.
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Affiliation(s)
- Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
- Cancer Research Program, American College of Surgeons, Chicago, Illinois
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Timothy W. Mullett
- Markey Cancer Center, Cancer Prevention and Control Program, University of Kentucky, Lexington
- Department of Surgery, College of Medicine, University of Kentucky, Lexington
- Commission on Cancer, American College of Surgeons, Chicago, Illinois
| | - Judy C. Boughey
- Cancer Research Program, American College of Surgeons, Chicago, Illinois
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth Funk
- Cancer Research Program, American College of Surgeons, Chicago, Illinois
| | - Heidi Nelson
- Cancer Research Program, American College of Surgeons, Chicago, Illinois
- Commission on Cancer, American College of Surgeons, Chicago, Illinois
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - David R. Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
- USC Norris Comprehensive Cancer Center, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, California
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Romero SAD, Au L, Flores-Ortega RE, Helsten T, Palomino H, Kaiser BN, Echevarria M, Lukas K, Freeman K, Zou J, Aristizabal P, Armenian S, Su HI. Let's TOC Fertility: A stepped wedge cluster randomized controlled trial of the Telehealth Oncofertility Care (TOC) intervention in children, adolescent and young adult cancer survivors. Contemp Clin Trials 2024; 141:107537. [PMID: 38614445 DOI: 10.1016/j.cct.2024.107537] [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: 12/15/2023] [Revised: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Children, adolescent, and young adult cancer survivors experience overall increased risks of infertility that are preventable through effective fertility preservation services prior to starting cancer treatment. Oncofertility care is the evidence-based practice of informing newly diagnosed cancer patients about their reproductive risks and supporting shared decision-making on fertility preservation services. Despite longstanding clinical guidelines, oncofertility care delivery continues to be limited and highly variable across adult and pediatric oncology settings. MATERIALS AND METHODS We describe the design of a stepped wedge cluster randomized clinical trial to evaluate the effectiveness of the multi-component Telehealth Oncofertility Care (TOC) intervention conducted in 20 adult and pediatric oncology clinics across three health systems in Southern California. Intervention components are: 1) electronic health record-based oncofertility needs screen and referral pathway to a virtual oncofertility hub; 2) telehealth oncofertility counseling through the hub; and 3) telehealth oncofertility financial navigation through the hub. We hypothesize the intervention condition will be associated with increased proportions of patients who engage in goal-concordant oncofertility care (i.e., engagement in reproductive risk counseling and fertility preservation services that meet the patient's fertility goals) and improved patient-reported outcomes, compared to the usual care control condition. We will also evaluate intervention implementation in a mixed-methods study guided by implementation science frameworks. DISCUSSION Our overall goal is to speed implementation of a scalable oncofertility care intervention at cancer diagnosis for children, adolescent and young adult cancer patients to improve their future fertility and quality of life. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05443737.
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Affiliation(s)
- Sally A D Romero
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, School of Medicine, United States of America; Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, United States of America.
| | - Lauren Au
- Department of Medicine, University of Hawai'i at Mānoa John A Burns School of Medicine, United States of America
| | - Ricardo E Flores-Ortega
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, School of Medicine, United States of America
| | - Teresa Helsten
- Department of Medicine, University of California San Diego, School of Medicine, United States of America; Moores Cancer Center, University of California San Diego, United States of America
| | - Helen Palomino
- Cancer Resource Center of the Desert, United States of America
| | - Bonnie N Kaiser
- Department of Anthropology and Global Health Program, University of California San Diego, United States of America
| | | | - Kara Lukas
- City of Hope Comprehensive Cancer Center, United States of America
| | - Kendall Freeman
- City of Hope Comprehensive Cancer Center, United States of America
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, United States of America
| | - Paula Aristizabal
- Moores Cancer Center, University of California San Diego, United States of America; Department of Pediatrics, University of California San Diego, School of Medicine, United States of America
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, United States of America
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, School of Medicine, United States of America; Moores Cancer Center, University of California San Diego, United States of America
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Drechsel KCE, IJgosse IM, Slaats S, Raasen L, Stoutjesdijk FS, van Dulmen-den Broeder E, Wallace WH, Beishuizen A, Körholz D, Mauz-Körholz C, Cepelova M, Uyttebroeck A, Ronceray L, Kaspers GJL, Broer SL, Veening MA. Fertility-Preserving Treatments and Patient- and Parental Satisfaction on Fertility Counseling in a Cohort of Newly Diagnosed Boys and Girls with Childhood Hodgkin Lymphoma. Cancers (Basel) 2024; 16:2109. [PMID: 38893227 PMCID: PMC11171249 DOI: 10.3390/cancers16112109] [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: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE The purpose of this study is to evaluate the use of fertility-preserving (FP) treatments and fertility counseling that was offered in a cohort of newly diagnosed children with classical Hodgkin lymphoma (cHL). METHODS In this observational study, boys and girls with cHL aged ≤ 18 years with scheduled treatment according to the EuroNet-PHL-C2 protocol were recruited from 18 sites (5 countries), between January 2017 and September 2021. In 2023, a subset of Dutch participants (aged ≥ 12 years at time of diagnosis) and parents/guardians were surveyed regarding fertility counseling. RESULTS A total of 101 boys and 104 girls were included. Most post-pubertal boys opted for semen cryopreservation pre-treatment (85% of expected). Invasive FP treatments were occasionally chosen for patients at a relatively low risk of fertility based on scheduled alkylating agent exposure (4/5 testicular biopsy, 4/4 oocyte, and 11/11 ovarian tissue cryopreservation). A total of 17 post-menarchal girls (20%) received GnRH-analogue co-treatment. Furthermore, 33/84 parents and 26/63 patients responded to the questionnaire. Most reported receiving fertility counseling (97%/89%). Statements regarding the timing and content of counseling were generally positive. Parents and patients considered fertility counseling important (94%/87% (strongly agreed) and most expressed concerns about (their child's) fertility (at diagnosis 69%/46%, at present: 59%/42%). CONCLUSION Systematic fertility counseling is crucial for all pediatric cHL patients and their families. FP treatment should be considered depending on the anticipated risk and patient factors. We encourage the development of a decision aid for FP in pediatric oncology.
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Affiliation(s)
- Katja C. E. Drechsel
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands (M.A.V.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Irene M. IJgosse
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Sofie Slaats
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Lisanne Raasen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Francis S. Stoutjesdijk
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands (M.A.V.)
| | - Eline van Dulmen-den Broeder
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands (M.A.V.)
| | - W. Hamish Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh EH16 4TJ, UK
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Haematology/Oncology, Erasmus MC-Sophia Children’s Hospital, 3000 CA Rotterdam, The Netherlands
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Standort Giessen—Zentrum für Kinderheilkunde und Jugendmedizin, Feulgenstr. 12, 35392 Giessen, Germany (C.M.-K.)
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Standort Giessen—Zentrum für Kinderheilkunde und Jugendmedizin, Feulgenstr. 12, 35392 Giessen, Germany (C.M.-K.)
- Clinic for Paediatric and Adolescent Medicine, Medical Faculty of the Martin-Luther University of Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, Faculty Hospital Motol and 2nd Medical Faculty, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Anne Uyttebroeck
- Department of Paediatric Haematology and Oncology, KU Leuven, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Leila Ronceray
- Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, Kinderspitalgasse 6, A-1090 Wien, Austria
| | - Gertjan J. L. Kaspers
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands (M.A.V.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Simone L. Broer
- Department of Reproductive Medicine & Gynecology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Margreet A. Veening
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands (M.A.V.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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Grimes AC, Sugalski AJ, Nuño MM, Ramakrishnan S, Beauchemin MP, Robinson PD, Santesso N, Walsh AM, Wrightson AR, Yu LC, Parsons SK, Sung L, Dupuis LL. Clinical Practice Guideline-Inconsistent Management of Fertility Preservation in Pediatric Cancer Patients in Community Settings: A Children's Oncology Group Study. J Adolesc Young Adult Oncol 2024. [PMID: 38770790 DOI: 10.1089/jayao.2024.0022] [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] [Indexed: 05/22/2024] Open
Abstract
Background: The primary objective was to measure adherence to clinical practice guideline (CPG) recommendations for fertility preservation (FP) in pediatric cancer patients treated in National Cancer Institute Community Oncology Research Program (NCORP) sites. Secondary objectives were to describe factors such as site size associated with CPG-inconsistent care delivery and cryopreservation completion. Methods: This retrospective, multicenter study included patients 15 to 21 years old with a first cancer diagnosis from January 2014 through December 2015 who were previously enrolled to a Children's Oncology Group (COG) study and received care at a participating NCORP site. Patients were randomly selected from a list generated by the COG for chart review by participating sites. Primary outcome was care delivery that was inconsistent with a strong CPG recommendation on FP, namely discussion and offering of FP options before cancer treatment initiation, as adjudicated centrally by a panel. Results: A total of 129 patients from 25 sites were included. Among these, 48% (62/129) received CPG-inconsistent care. Most CPG-inconsistent care was due to lack of FP discussion documentation (93.5%, 58/62). Small site size, treatment at a pediatric (vs mixed adult/pediatric) site, and female sex were associated with higher odds of CPG-inconsistent care delivery. Conclusions: Newly diagnosed pediatric cancer patients often received CPG-inconsistent care for FP, with disproportionate gaps noted for females, and those treated at smaller or pediatric NCORP sites. The primary reason for CPG-inconsistent care is lack of FP discussion from clinicians. Opportunities to improve FP CPG implementation are highlighted.
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Affiliation(s)
- Allison C Grimes
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Aaron J Sugalski
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Michelle M Nuño
- Children's Oncology Group, Monrovia, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alexandra M Walsh
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, USA
| | - Andrea R Wrightson
- Clinical Research Nurse Coordinator, Nemours Center for Cancer and Blood Disorders, Wilmington, Delaware, USA
| | - Lolie C Yu
- LSUHSC/Children's Hospital, New Orleans, Louisiana, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lillian Sung
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, The Hospital for Sick Children; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Lee Dupuis
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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VanLandingham HB, Ellison RL, Turchmanovych-Hienkel N, Alfonso D, Oh A, Kaseda ET, Basurto K, Tse PKY, Khan H. Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards. Clin Neuropsychol 2024:1-32. [PMID: 38641949 DOI: 10.1080/13854046.2024.2343147] [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: 07/24/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.
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Affiliation(s)
- Hannah B VanLandingham
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rachael L Ellison
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Demy Alfonso
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Alison Oh
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Karen Basurto
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Phoebe K Y Tse
- Department of Psychology, The Chicago School, Chicago, IL, USA
| | - Humza Khan
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
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Ke Y, Zhou H, Chan RJ, Chan A. Decision aids for cancer survivors' engagement with survivorship care services after primary treatment: a systematic review. J Cancer Surviv 2024; 18:288-317. [PMID: 35798994 PMCID: PMC10960885 DOI: 10.1007/s11764-022-01230-y] [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: 03/31/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To elucidate existing decision aids (DAs) in supporting cancer survivors' decisions to engage in cancer survivorship care services after primary treatment. Secondary objectives are to assess the DA acceptability, impact of DAs, and implementation barriers. METHODS Databases (PubMed, Embase, PsycINFO, CINAHL) were searched to collect publications from inception through September 2021. Studies describing the development or evaluation of DAs used for survivorship care services after primary cancer treatment were included. Article selection and critical appraisal were conducted independently by two authors. RESULTS We included 16 studies that described 13 DAs and addressed multiple survivorship care domains: prevention of recurrence/new cancers in Hodgkin lymphoma survivors and breast cancer gene mutation carriers, family building options, health insurance plans, health promotion (substance use behavior, cardiovascular disease risk reduction), advanced care planning, and post-treatment follow-up intensity. The electronic format was used to design most DAs for self-administration. The content presentation covered decisional context, options, and value clarification exercises. DAs were acceptable and associated with higher knowledge but presented inconclusive decisional outcomes. Implementation barriers included lack of design features for connectivity to care, low self-efficacy, and low perceived DA usefulness among healthcare professionals. Other survivor characteristics included age, literacy, preferred timing, and setting. CONCLUSIONS A diverse range of DAs exists in survivorship care services engagement with favorable knowledge outcomes. Future work should clarify the impact of DAs on decisional outcomes. IMPLICATIONS FOR CANCER SURVIVORS DA characterization and suggestions for prospective developers could enhance support for cancer survivors encountering complex decisions throughout the survivorship continuum.
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Affiliation(s)
- Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hanzhang Zhou
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA5042, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, QLD, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, CA, USA.
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Singh S, Nguyen T, Deleemans J, Oberoi D, Piedalue KA, Carlson LE. A Phenomenological Qualitative Exploration of Mind-Body Therapy Use and Effectiveness Among Young, Middle, and Older Adult Cancer Survivors. Integr Cancer Ther 2024; 23:15347354241253847. [PMID: 38767143 PMCID: PMC11107309 DOI: 10.1177/15347354241253847] [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: 03/18/2023] [Revised: 04/13/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Having been diagnosed with and treated for cancer can have negative psychosocial repercussions that may differ across the lifespan. Mind-body therapies (MBTs), such as tai-chi/qigong (TCQ) or mindfulness-based cancer recovery (MBCR), have shown promise in decreasing negative psychosocial outcomes in cancer survivors, but few studies have explored potential differences in MBT use and effectiveness across age groups. METHODS A descriptive phenomenological qualitative design was used. Participants included young (18-39), middle (40-64), and older (65+) adult cancer survivors who were diagnosed with any type of cancer and had participated in Mindfulness-Based Cancer Recovery (MBCR) or Tai Chi/Qigong (TCQ) MBTs. Semi-structured qualitative interviews explored participants' experiences in MBTs and these were analyzed using descriptive phenomenological analysis. RESULTS Among the interviews (n = 18), young (n = 6), middle-aged (n = 8), and older (n = 4) adults participated. 5 themes emerged: influences in joining the program, unique lifestyles, positive class experiences, use of media, and program impacts. Though all age groups benefitted from MBT participation, variations between age groups with respect to the benefits received and motivations for joining the program were observed. DISCUSSION MBTs had beneficial physical and mental health effects on survivors of all age groups. These benefits were particularly connected to the ongoing life stresses common to each age cohort, such as relief from work and family roles for young adults or support during retirement transition for older adults. Hence, access to MBT programs may be beneficial as part of the survivorship plan for patients and the recruitment strategies or content can be adapted by MBT providers to better target and support age-specific groups. More research is required with a larger sample.
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Affiliation(s)
- Sarthak Singh
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Tina Nguyen
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Julie Deleemans
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Devesh Oberoi
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Katherine-Ann Piedalue
- Department of Science, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Linda E. Carlson
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
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8
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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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Nerb L, Yang E, Exume D, Dornisch A, Zhou B, Helsten T, Kaiser BN, Romero SA, Su HI. Development, Usability Testing, and Implementation Assessment of Cancer Related Infertility Score Predictor, an Online Cancer Related Infertility Risk Counseling Tool. J Adolesc Young Adult Oncol 2023; 12:843-850. [PMID: 37184539 PMCID: PMC10739786 DOI: 10.1089/jayao.2022.0187] [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] [Indexed: 05/16/2023] Open
Abstract
Purpose: Oncofertility counseling of female cancer patients lacks efficient access to tailored and valid infertility risk estimates to support shared decision-making on fertility preservation treatments. The objective was to develop, conduct user-centered design, and plan clinic-based implementation of the Cancer Related Infertility Score Predictor (CRISP), a web-based tool to support infertility risk counseling. Methods: Using a mixed methods design, literature review was undertaken to abstract data on infertility, primary ovarian insufficiency, and amenorrhea risks of common cancer treatments. The CRISP website was programmed to take user input about patient ages and cancer treatments and generate a risk summary. Using user experience methodology and semistructured interviews, usability testing and implementation assessment were conducted with 12 providers recruited from 5 medical centers in Southern California. Results: The web-based CRISP tool encompasses infertility risk data for 60 treatment regimens among 10 cancer types. Usability testing demonstrated that the tool is intuitive and informed minor modifications, including adding crowd-sourced submission of additional cancer treatments. Participants rated the tool as credible, advantageous over current provider methods to ascertain infertility risks, and useful for tailoring treatment planning and counseling patients. A key barrier was lack of information on some cancer treatments. Fit within clinical workflow was feasible, particularly with electronic health record integration. Conclusions: The novel, web-based CRISP tool is a feasible, acceptable, and appropriate tool to address provider knowledge gap about cancer related infertility risks and use for patient counseling. CRISP has significant potential to support tailored oncofertility counseling in the heterogeneous young cancer patient population.
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Affiliation(s)
- Laura Nerb
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Emily Yang
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Dominique Exume
- Department of Obstetrics and Gynecology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Anna Dornisch
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Beth Zhou
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Teresa Helsten
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Bonnie N. Kaiser
- Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, California, USA
| | - Sally A.D. Romero
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - H. Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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10
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Rodriguez-Wallberg KA, Ahlgren J, Smedby KE, Gorman JR, Hellman K, Henriksson R, Ståhl O, Wettergren L, Lampic C. Prevalence and predictors for fertility-related distress among 1010 young adults 1.5 years following cancer diagnosis - results from the population-based Fex-Can Cohort study. Acta Oncol 2023; 62:1599-1606. [PMID: 37909865 DOI: 10.1080/0284186x.2023.2272291] [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: 09/05/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Cancer treatment during reproductive ages may negatively impact fertility and there is a need of firm knowledge about the prevalence and predictors of fertility-related distress. The aim was to examine fertility-related distress in a population-based sample of young women and men recently treated for cancer and to identify predictors for this outcome. MATERIAL AND METHODS This nationwide cohort study included 1010 individuals (694 women and 316 men), mean age 34.5 ± 4.9 and 32.1 ± 5.5, respectively, diagnosed with breast, cervical, ovarian, testicular cancers, brain tumors or lymphoma at ages 18-39 in Sweden. Participants completed a survey 1.5-year post-diagnosis to assess fertility-related distress (RCAC), emotional distress (HADS) and self-efficacy, as well as sociodemographic and clinical factors and fertility preservation. Logistic regression was used to examine associations between explanatory factors and high fertility-related distress (RCAC subscale mean >4). RESULTS Many participants (69% of women and 47% of men) had previous children and about half reported a wish for future children. High fertility-related distress was more prevalent among women (54%) than men (27%), and women were more likely than men to report distress concerning all but one RCAC dimension after adjustment for sociodemographic factors. Use of fertility preservation was unevenly distributed (15% of women and 71% of men) and was not associated with decreased fertility-related distress. In multivariable logistic regression models, a wish for future children, being single, not having previous children, symptoms of anxiety and low self-efficacy regarding one's ability to handle threats of infertility were associated with high fertility-related distress. CONCLUSION This nationwide study found a high prevalence of fertility-related distress in young women and men recently treated for cancer and identified sociodemographic and psychological predictors. Fertility preservation was not found to act as a buffer against fertility-related distress, indicating the continuous need to identify strategies to alleviate fertility distress following cancer.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Regional Cancer Centre, Mid-Sweden, Uppsala, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Roger Henriksson
- Department of Radiation Science and Oncology, Umeå University, Umeå, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Lena Wettergren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Lampic
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
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11
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Liu C, Liu C, Gao H, Yu X, Chen C, Lin H, Qiu L, Chen L, Tian H. Mediation Effects of Coping Styles on Fear of Progression and Reproductive Concerns in Breast Cancer Patients of Reproductive Age. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:245-252. [PMID: 37944797 DOI: 10.1016/j.anr.2023.11.002] [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: 01/19/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE This study aimed to investigate reproductive concerns among breast cancer patients of reproductive age, analyze the influencing factors, explore the relationship between coping styles, fear of progression (FOP), and reproductive concerns, and identify the multiple effects of coping styles on the relationship between FOP and reproductive concerns among Chinese breast cancer patients. METHODS A cross-sectional, descriptive study was conducted among breast cancer patients in four tertiary grade A hospitals in Fujian, China, from January 2022 to September 2022. A total of 210 patients were recruited to complete paper-based questionnaires, which included the general data questionnaires, the Reproductive Concerns After Cancer Scale (RCACS), the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), and the Medical Coping Modes Questionnaire (MCMQ). Structural equation models were utilized to evaluate the multiple effects of coping styles on FOP and reproductive concerns. RESULTS Reproductive concerns in breast cancer patients had a mean score of 53.02 (SD, 10.69), out of a total score of 90, and coping styles for cancer (confrontation, avoidance) were closely associated with FOP and reproductive concerns. FOP showed a significant positive correlation with reproductive concerns (r = .52, p < .01). At the same time, confrontation was significantly negatively correlated with both FOP (r = -.28, p < .01) and reproductive concerns (r = -.39, p < .01). Avoidance was positively correlated to both FOP (r = .25, p < .01) and reproductive concerns (r = .34, p < .01). The impact of FOP on reproductive concerns is partially mediated by confrontation and avoidance, with effect sizes of .07 and .04, respectively. These mediating factors account for 22.0% of the total effect. CONCLUSIONS The FOP directly impacted reproductive concerns, while coping styles could partially mediate the association between FOP and reproductive concerns. This study illustrates the role of confrontation and avoidance in alleviating reproductive concerns, suggesting that it is necessary to focus on the changes in reproductive concerns among reproductive-age breast cancer patients. Healthcare professionals can improve disease awareness and reduce patients' FOP, thereby promoting positive psychological and coping behaviors and ultimately alleviating reproductive concerns.
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Affiliation(s)
- Cuiting Liu
- School of Nursing, Putian University, Putian, Fujian, China
| | - Cuiping Liu
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Huiting Gao
- Department of Breast Surgery, Women and Children Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xuefen Yu
- Department of Breast Surgery, Women and Children Hospital, Xiamen University, Xiamen, Fujian, China
| | - Chunying Chen
- Nursing Department, The First Hospital of Putian City, Putian, Fujian, China
| | - Hangying Lin
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Lijuan Qiu
- Department of Neurology, The First Hospital of Longyan City, Longyan, Fujian, China
| | - Liangying Chen
- School of Nursing, Putian University, Putian, Fujian, China.
| | - Hongmei Tian
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, China.
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12
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Din HN, Singh-Carlson S, Corliss HL, Hartman SJ, Strong D, Madanat H, Su HI. Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer. JAMA Netw Open 2023; 6:e2337245. [PMID: 37819662 PMCID: PMC10568355 DOI: 10.1001/jamanetworkopen.2023.37245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Fertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population's fertility perceptions and their alignment with objective infertility risk are scant. Objective To assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception. Design, Setting, and Participants This retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022. Exposures Participants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review. Main Outcomes and Measures Participants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk. Results This study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation. Conclusions and Relevance In this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.
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Affiliation(s)
- Hena Naz Din
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- School of Public Health, San Diego State University, San Diego, California
| | | | - Heather L. Corliss
- School of Public Health, San Diego State University, San Diego, California
- Center for Research on Sexuality and Sexual Health, San Diego State University, San Diego, California
- Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - Sheri J. Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- Moores Cancer Center, University of California San Diego, La Jolla
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- Moores Cancer Center, University of California San Diego, La Jolla
| | - Hala Madanat
- School of Public Health, San Diego State University, San Diego, California
- Division of Research and Innovation, San Diego State University, San Diego, California
- Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - H. Irene Su
- Moores Cancer Center, University of California San Diego, La Jolla
- Division of Reproductive Endocrinology and Infertility, University of California San Diego, La Jolla
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13
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Adamakidou T, Menti K, Charalambous A, Tsiou C, Vlachou E, Govina O. Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study. Eur J Oncol Nurs 2023; 66:102358. [PMID: 37572628 DOI: 10.1016/j.ejon.2023.102358] [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: 02/25/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1). METHODS This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients. RESULTS A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004). CONCLUSION The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.
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Affiliation(s)
- Theodoula Adamakidou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Konstantina Menti
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece; Agios Savvas Anticancer Hospital, Athens, Greece.
| | | | - Chrysoula Tsiou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Eugenia Vlachou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Ourania Govina
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
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14
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Camp L, Coffman E, Chinthapatla J, Boey KA, Lux L, Smitherman A, Manning ML, Vizer LM, Haines E, Valle CG. Active Treatment to Survivorship Care: A Mixed-Methods Study Exploring Resource Needs and Preferences of Young Adult Cancer Survivors in Transition. J Adolesc Young Adult Oncol 2023; 12:735-743. [PMID: 36706031 PMCID: PMC10618808 DOI: 10.1089/jayao.2022.0095] [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] [Indexed: 01/28/2023] Open
Abstract
Purpose: The purpose of this study was to identify resource needs and preferences of young adult cancer survivors (YAs) during the transition from active treatment to survivorship care to inform tailored care tools to support YAs during this period. Methods: A mixed methods study following a sequential explanatory approach was conducted among YAs between the ages of 15 and 39. Online surveys were distributed to assess participant information and resource needs, and responses were further explored during virtual focus group and interview discussions. Frequencies and proportions were calculated to identify quantitative resource needs, and a descriptive qualitative approach was used to gather and analyze qualitative data. Results: Thirty-one participants completed the online surveys, and 27 participated in qualitative data collection. The top resource needs identified in the surveys and discussed in focus groups and interviews were (1) fear of recurrence, (2) sleep and fatigue, (3) anxiety, (4) nutrition, (5) physical activity, and (6) finances. Emergent themes identified during transcript analyses included the need for (1) tailored, customizable resources, (2) connection with other survivors, (3) tools to guide conversations about cancer, (4) clarity in what to expect during treatment and survivorship, and (5) consistent and equitable care in YA oncology. Conclusions: Participants identified six important information needs in addition to an overarching need for tailored support and equitable distribution of resources while transitioning into early survivorship. Thus, tailored interventions are needed to enhance the distribution of YA-centered resources, improve equity in YA cancer care, and connect YAs with peer survivors.
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Affiliation(s)
- Lindsey Camp
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Erin Coffman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Juhitha Chinthapatla
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelly Ann Boey
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Lauren Lux
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pediatrics, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle L Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa M Vizer
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Haines
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Shen J, Jiang H, Lin H, Fan S, Yu D, Yang L, Chen L. Fertility concerns in cancer patients: a bibliometric analysis via CiteSpace: A review. Medicine (Baltimore) 2023; 102:e35211. [PMID: 37746999 PMCID: PMC10519520 DOI: 10.1097/md.0000000000035211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Fertility concerns are a pervasive issue but very subtle in patients with cancer. Though various studies have focused on fertility concerns, limited research endeavor has been dedicated to bibliometric analysis. Given this, to visually analyze the hot frontier trends of research related to fertility concerns of patients with cancer using CiteSpace and provide new insights for future research in this field using the bibliometric method. We used CiteSpace software to retrieve the literature related to fertility concerns of patients with cancer in the Web of Science core collection database from the year of establishment to 2022 and conducted visual analysis in terms of authors, countries and regions, research institutions, and keywords. The search resulted in 201 valid articles, and the annual publication volume of literature related to fertility concerns in patients with cancer was generally on the rise; the country with the most publications was the United States, which also had the highest influence; the main research institution was Sloan Kettleson Cancer Research Center; the core research scholar was Jessica R. Gorman; the research hotspots mainly centered on quality of survival, women, survivorship, preservation, breast cancer, adolescence, and infertility. The results of this bibliometric study provide the current status and trends in the fertility concerns of patients with cancer and may help researchers identify the hotspots and frontier trends in this field.
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Affiliation(s)
- Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Siyue Fan
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Doudou Yu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liping Yang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
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16
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Moslehi AH, Hoseinpour F, Saber A, Akhavan Taheri M, Hashemian AH. Fertility-enhancing effects of inositol & vitamin C on cisplatin induced ovarian and uterine toxicity in rats via suppressing oxidative stress and apoptosis. Food Chem Toxicol 2023; 179:113995. [PMID: 37619831 DOI: 10.1016/j.fct.2023.113995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/22/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Cisplatin can lead to infertility due to its negative impact on the uterus and ovaries. This study aimed to explore the effects of Inositol and vitamin C on cisplatin-induced infertility. Forty-eight adult female Wistar rats were divided into eight groups (N = 6) and orally treated for 21 days. The treatments were as follows: negative control (saline), positive control (saline and cisplatin injected into the abdomen on day 15), T1-T3: rats given vitamin C (150 mg/kg), Inositol (420 mg/kg), and vitamin C + Inositol, respectively, along with cisplatin injected into the abdomen on day 15, T4-T6: rats given only vitamin C, Inositol, and vitamin C + Inositol, respectively. Vitamin C and Inositol enhanced cisplatin-induced histopathological improvements in the uterus and ovaries, raising progesterone and estradiol serum levels. Furthermore, the supplements enhanced ESR1 gene expression in the uterus and ovary, reducing uterine and ovarian apoptosis caused by cisplatin through modulation of caspase 3, 8, and Bcl-2 gene levels. These substances decreased ovarian and uterine malondialdehyde levels, boosted total antioxidant capacity and superoxide dismutase, and alleviated oxidative stress. The findings reveal that vitamin C and Inositol shield against cisplatin-related infertility by reducing oxidative stress and apoptosis in the uterus and ovaries.
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Affiliation(s)
- Amir Hosein Moslehi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
| | - Fatemeh Hoseinpour
- Department of Basic Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran.
| | - Amir Saber
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Maryam Akhavan Taheri
- Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran; Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Hashemian
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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17
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Wytiaz V, Levin NJ, Tan CY, Stelmak D, Iannarino N, Zhang A, Ellman E, Herrel L, Moravek M, Walling E, Chugh R, Zebrack B. Body image disturbances in adolescent and young adult cancer patients confronting infertility risk and fertility preservation decisions. J Psychosoc Oncol 2023; 42:208-222. [PMID: 37452662 PMCID: PMC10788379 DOI: 10.1080/07347332.2023.2235607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to explore the experiences of AYAs as they considered their risk of infertility and options for fertility preservation (FP), specifically the ways in which this impacted body image and FP decision-making. METHODS AYA cancer patients (n = 27) aged 12-25 years whose cancer and treatment conferred risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. RESULTS Body image concerns, related to both physical appearance and body functioning emerged. Common concerns included anticipating change as it pertains to the body and its functions, physical discomfort, fear of judgment, and meeting expectations of the body. While these themes are broad in nature, they have been previously explored in relation to body image in general and their emergence in the oncofertility space provides guidance for further optimization of infertility and fertility preservation discussions. CONCLUSIONS AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and fertility preservation. In identifying and exploring these themes, future opportunities for improving oncofertility practice and discussions among AYAs with a focus on body image positivity are called upon.
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Affiliation(s)
- Victoria Wytiaz
- Department of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nina Jackson Levin
- Department of Anthropology, University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Nick Iannarino
- Department of Language, Culture and Communication, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- Univsersity of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- Univsersity of Michigan School of Social Work, Ann Arbor, Michigan, USA
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18
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Frederick NN, Klosky JL, Meacham L, Quinn GP, Kelvin JF, Cherven B, Freyer DR, Dvorak CC, Brackett J, Ahmed-Winston S, Bryson E, Su HI, Chow EJ, Levine J. Fertility Preservation Practices at Pediatric Oncology Institutions in the United States: A Report From the Children's Oncology Group. JCO Oncol Pract 2023; 19:e550-e558. [PMID: 36763922 PMCID: PMC10113112 DOI: 10.1200/op.22.00349] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Fertility discussions are an integral part of comprehensive care for pediatric, adolescent, and young adult patients newly diagnosed with cancer and are supported by national guidelines. Current institutional practices are poorly understood. METHODS A cross-sectional survey was distributed to 220 Children's Oncology Group member institutions regarding fertility discussion practices. Descriptive statistics were calculated for all variables. The association between specific practices and selected outcomes on the basis of sex was examined via multivariable logistic regression. RESULTS One hundred forty-four programs (65.5%) returned surveys. Of these, 65 (45.1%) reported routine discussions of fertility with all female patients and 55 (38.5%) all male patients (P = .25). Ninety-two (63.8%) reported no specific criteria for offering females fertility preservation (FP), compared with 40 (27.7%) for males (P < .001). Program characteristics associated with fertility discussions included reproductive endocrinology and infertility on site (females odds ratio [OR], 2.1; 95% CI, 1.0 to 4.3), discussion documentation mandate (females OR, 2.3; 95% CI, 1.0 to 5.5; males OR, 3.5; 95% CI, 1.4 to 8.7), and cumulative institution-based FP infrastructure (which included [1] routine practice of documentation, [2] template for documentation, [3] mandate for documentation, and [4] availability of FP navigation; females OR, 1.6; 95% CI, 1.1 to 2.3; males OR, 2.3; 95% CI, 1.6 to 3.4). Utilization of practices unsupported by guidelines included offering sperm banking after treatment initiation (39/135 programs; 28.9%), gonadotropin-releasing hormone analogs for ovarian suppression/FP (75/144 programs; 52.1%), ovarian tissue cryopreservation at diagnosis for patients with leukemia (19/64 programs; 29.7%), and testicular tissue cryopreservation (23/138 programs; 16.7%) not part of a clinical trial. CONCLUSION Despite recommended guidelines, fertility discussions with patients/families before treatment initiation are not routine at Children's Oncology Group institutions. Standard criteria to determine which options should be offered to patients are more common for males than females.
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Affiliation(s)
- Natasha N. Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | - James L. Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lillian Meacham
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Gwendolyn P. Quinn
- Division of Medical Ethics, Departments of OB-GYN, Population Health, Grossman School of Medicine, New York University, New York, NY
| | | | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - David R. Freyer
- Cancer and Blood Disease Institute, Children's Hospital, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology and Bone Marrow Transplant, University of California San Francisco, San Francisco, CA
| | - Julienne Brackett
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX
| | | | - Elyse Bryson
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - H. Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA
| | - Eric J. Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, WA
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, New York, NY
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19
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Terzic M, Makhadiyeva D, Bila J, Andjic M, Dotlic J, Aimagambetova G, Sarria-Santamera A, Laganà AS, Chiantera V, Vukovic I, Kocijancic Belovic D, Aksam S, Bapayeva G, Terzic S. Reproductive and Obstetric Outcomes after Fertility-Sparing Treatments for Cervical Cancer: Current Approach and Future Directions. J Clin Med 2023; 12:jcm12072614. [PMID: 37048696 PMCID: PMC10095321 DOI: 10.3390/jcm12072614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Cervical cancer is one of the leading causes of cancer-related death in women of reproductive age. The established fertility-sparing approaches for the management of early-stage cervical cancer for women who plan pregnancy are associated with a decline in fecundity and an increased risk of pregnancy complications. This article aims to offer an overview of fertility-sparing approaches and the management of potential subfertility and pregnancy complications after these treatments. An extensive search for the available data about infertility and cervical cancer, fertility-sparing techniques in patients with cervical cancer, fertility treatment, obstetrical complications, and pregnancy outcomes in cervical cancer patients was completed. Fertility-preserving procedures such as loop electrosurgical excision procedure (LEEP), cold-knife conization, and trachelectomy in women diagnosed with cervical cancer can be considered as safe and effective treatments that preserve reproductive potential. Current fertility-preserving procedures, based on the balance of the oncological characteristics of patients as well as their desire for reproduction, allow one to obtain acceptable reproductive and obstetric outcomes in women treated for cervical cancer. Nevertheless, careful monitoring of pregnancies obtained after fertility-preserving procedures is recommended, since this cohort of patients should be considered at higher risk compared with a healthy population.
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Affiliation(s)
- Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
- Clinical Academic Department of Women’s Health, National Research Center for Maternal and Child Health, Corporate Fund “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Dinara Makhadiyeva
- School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
| | - Jovan Bila
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Mladen Andjic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
- Correspondence:
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Ivana Vukovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Dusica Kocijancic Belovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Slavica Aksam
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, National Research Center for Maternal and Child Health, Corporate Fund “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
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20
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Qin N, Wan Z, Kang Y, Luo Y, Duan Y, Xie J, Cheng AS. Effectiveness and feasibility of online fertility preservation decision aids for young female patients with cancer: a systematic review protocol. BMJ Open 2023; 13:e070294. [PMID: 36940948 PMCID: PMC10030757 DOI: 10.1136/bmjopen-2022-070294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Cancer diagnosis and treatment can impair fertility, and younger female patients with cancer have a particularly strong need for fertility preservation. Fertility preservation decision aids are thought to help patients make proactive and informed treatment decisions. This systematic review aims to assess the effectiveness and feasibility of online fertility preservation decision aids for young female patients with cancer. METHODS AND ANALYSIS PubMed, Web of Science Core Collection, Embase, The Cochrane Central Register of Controlled Trials, PsycINFO and CHINAL, along with three grey literature sources (Google Scholar, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform), will be searched from each database's establishment to 30 November 2022. Two trained reviewers will independently screen the articles, and the data extraction and methodological quality of eligible randomised controlled trials and quasiexperimental studies will be assessed. A meta-analysis will be performed using Review Manager V.5.4 (Cochrane Collaboration) software, and heterogeneity will be assessed using I² statistics. If a meta-analysis is not possible, a narrative synthesis will be done. ETHICS AND DISSEMINATION Since this systematic review is based on published data, no ethical approval is required. The study's findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022363287.
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Affiliation(s)
- Ning Qin
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Ziyu Wan
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yue Kang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yating Luo
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong, China
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21
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El Alaoui-Lasmaili K, Nguyen-Thi PL, Demogeot N, Lighezzolo-Alnot J, Gross MJ, Mansuy L, Chastagner P, Koscinski I. Fertility discussions and concerns in childhood cancer survivors, a systematic review for updated practice. Cancer Med 2023; 12:6023-6039. [PMID: 36224740 PMCID: PMC10028046 DOI: 10.1002/cam4.5339] [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: 05/13/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To provide ways to improve the clinical practice of fertility preservation (FP) for children, adolescents, and young adults (AYA) with cancer. DESIGN A systematic research of online databases was undertaken in March 2020 following the PRISMA criteria, including Medline and Web of Science. RESULTS Fifty-nine articles were included. Surveys, interviews, and focus groups were used to collect data from patients, parents, and health care providers (HCPs). Four themes worth exploring emerged: (a) what do patients and professionals think of and know about FP? (b) what makes the fertility discussion happen or not? (c) what, retrospectively, led to FP being pursued or not? and (d) how do patients and HCPs feel about fertility issues? CONCLUSION A minority of AYAs preserve their fertility (banking assay for 45% of boys and 23% of girls). Yet fertility concerns have a significant impact on the quality of life of young cancer survivors. Although recommendations and guidelines regarding FP are available internationally, there are no specific guidelines as to how to conduct fertility counseling for children and adolescents. Some barriers are not removable, such as a poor prognosis of an obvious severe disease, time constraints for starting treatment, and cultural and religious beliefs. In response to aspects hindering patients and families to be receptive to any discussion at the time of diagnosis, psychological support could reduce the level of emotional distress and help restore a degree of open-mindedness to open a window for discussion. Moreover, as the lack of knowledge of professionals about fertility is frequently pointed out as a limiting factor for fertility discussion, reinforcing professional training regarding FP could be proposed to promote fertility discussion and eventually referral for FP.
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Affiliation(s)
| | - Phi Linh Nguyen-Thi
- Unité d'évaluation médicale, Unité de Méthodologie, Data management et Statistique - UMDS, CHRU de Nancy
| | - Nadine Demogeot
- Interpsy Laboratory (UR4432), University of Lorraine, Nancy, France
| | | | | | - Ludovic Mansuy
- Department of Pediatric Hematology and Oncology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Isabelle Koscinski
- Laboratory of Biology of Reproduction-CECOS Lorraine, University Hospital of Nancy, Nancy, France
- INSERM U1256, NGERE, Université de Lorraine, Nancy, France
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22
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Drechsel KCE, Pilon MCF, Stoutjesdijk F, Meivis S, Schoonmade LJ, Wallace WHB, van Dulmen-den Broeder E, Beishuizen A, Kaspers GJL, Broer SL, Veening MA. Reproductive ability in survivors of childhood, adolescent, and young adult Hodgkin lymphoma: a review. Hum Reprod Update 2023:7034966. [PMID: 36779325 DOI: 10.1093/humupd/dmad002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/21/2022] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Owing to a growing number of young and adolescent Hodgkin lymphoma (HL) survivors, awareness of (long-term) adverse effects of anticancer treatment increases. The risk of impaired reproductive ability is of great concern given its impact on quality of life. There is currently no review available on fertility after childhood HL treatment. OBJECTIVE AND RATIONALE The aim of this narrative review was to summarize existing literature on different aspects of reproductive function in male and female childhood, adolescent, and young adult HL survivors. SEARCH METHODS PubMed and EMBASE were searched for articles evaluating fertility in both male and female HL survivors aged <25 years at diagnosis. In females, anti-Müllerian hormone (AMH), antral follicle count, premature ovarian insufficiency (POI), acute ovarian failure, menstrual cycle, FSH, and pregnancy/live births were evaluated. In males, semen-analysis, serum FSH, inhibin B, LH, testosterone, and reports on pregnancy/live births were included. There was profound heterogeneity among studies and a lack of control groups; therefore, no meta-analyses could be performed. Results were presented descriptively and the quality of studies was not assessed individually. OUTCOMES After screening, 75 articles reporting on reproductive markers in childhood or adolescent HL survivors were included. Forty-one papers reported on 5057 female HL survivors. The incidence of POI was 6-34% (median 9%; seven studies). Signs of diminished ovarian reserve or impaired ovarian function were frequently seen (low AMH 55-59%; median 57%; two studies. elevated FSH 17-100%; median 53%; seven studies). Most survivors had regular menstrual cycles. Fifty-one studies assessed fertility in 1903 male HL survivors. Post-treatment azoospermia was highly prevalent (33-100%; median 75%; 29 studies). Long-term follow-up data were limited, but reports on recovery of semen up to 12 years post-treatment exist. FSH levels were often elevated with low inhibin B (elevated FSH 0-100%; median 51.5%; 26 studies. low inhibin B 19-50%; median 45%; three studies). LH and testosterone levels were less evidently affected (elevated LH 0-57%, median 17%; 21 studies and low testosterone 0-43%; median 6%; 15 studies). In both sexes, impaired reproductive ability was associated with a higher dose of cumulative chemotherapeutic agents and pelvic radiotherapy. The presence of abnormal markers before treatment indicated that the disease itself may also negatively affect reproductive function (Females: AMH<p10 9%; one study and Males: azoospermia 0-50%; median 10%; six studies). Reports on chance to achieve pregnancy during survivorship are reassuring, although studies had their limitations and the results are difficult to evaluate. In the end, a diminished ovarian reserve does not exclude the chance of a live birth, and males with aberrant markers may still be able to conceive. WIDER IMPLICATIONS This review substantiates the negative effect of HL treatment on gonadal function and therefore young HL survivors should be counseled regarding their future reproductive life, and fertility preservation should be considered. The current level of evidence is insufficient and additional trials on the effects of HL and (current) treatment regimens on reproductive function are needed. In this review, we make a recommendation on reproductive markers that could be assessed and the timing of (repeated) measurements.
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Affiliation(s)
- Katja C E Drechsel
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Cancer Center Amsterdam, Amsterdam UMC, Location VUmc, VU Amsterdam, Amsterdam, The Netherlands
| | - Maxime C F Pilon
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Francis Stoutjesdijk
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Salena Meivis
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Eline van Dulmen-den Broeder
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Haematology/Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gertjan J L Kaspers
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Simone L Broer
- Department of Reproductive Medicine & Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margreet A Veening
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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23
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Exploration of fertility and early menopause related information needs and development of online information for young breast cancer survivors. BMC Womens Health 2022; 22:329. [PMID: 35922784 PMCID: PMC9351061 DOI: 10.1186/s12905-022-01901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Approximately half of premenopausal women diagnosed with breast cancer desire to conceive after they finish treatment. Counseling about the risk of infertility prior to cancer treatment has been proven to improve quality of life after cancer treatment. As a result of this, guidelines focus on informing women on this topic prior to treatment. However, it is equally important to provide fertility related information after primary treatment has been completed, when the wish to conceive might become actual. Therefore, the aim of this study was to identify the fertility and early menopause related information needs of young breast cancer survivors and to design, develop and implement online information material with input of stakeholders.
Methods
A phenomenological qualitative study consisting of four phases was performed: identification of information needs through semi-structured interviews from a professional perspective (1) and a patient perspective (2). Exploration of stakeholders perspective regarding development and implementation of online information material (3) and development and implementation of the information material (4).
Results
Professionals indicated that there are no guidelines regarding the provision of fertility related information during cancer survivorship. Survivors reported unmet information needs. Women identified the following as most important information needs (a) fertility preservation options, (b) the risk of menopause or infertility, and (c) long term consequences of early menopause. A wide range of stakeholders involved in breast cancer care were interviewed. Based on their proposed design the information material was implemented on a nationwide website aiming at informing and supporting breast cancer patients.
Conclusions
Fertility and early menopause related information needs of young breast cancer survivors and their professionals were identified. Information material has been designed, developed and nationally implemented. This way, professionals in breast cancer care are provided with an information tool that helps them meet the information needs and preferences of their patients.
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24
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Cherven B, Kelling E, Lewis RW, Pruett M, Meacham L, Klosky JL. Fertility-related worry among emerging adult cancer survivors. J Assist Reprod Genet 2022; 39:2857-2864. [PMID: 36447078 PMCID: PMC9790831 DOI: 10.1007/s10815-022-02663-1] [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: 07/12/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Cancer survivors with a history of gonadotoxic treatment are at risk for future infertility and reproductive concerns, including worry about infertility. The purpose of this study was to describe factors associated with fertility-related worry among emerging adult survivors of childhood cancer. METHODS This chart review included patients aged 18.00-25.99 years and > 1 year from cancer treatment completion with a history of gonadotoxic treatment. Survivors were offered structured fertility-focused discussions at age ≥ 18 years, which assessed worry about future infertility. Data from this discussion (i.e., reported fertility-related worry (yes/no), sociodemographic, and clinical characteristics were abstracted from the medical record. Multivariable logistic regression with backwards elimination was used to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with fertility-related worry. RESULTS Survivors (N = 249) were a mean age of 19.1 ± 1.2 years at initial fertility discussion; 55.8% were male, 58.2% non-Hispanic White, and 27.3% were at high risk for future treatment-related infertility. Fertility-related worry was reported by 66.3% of survivors. Factors related to worry on multivariable analysis included female sex (OR: 2.64, 95%CI: 1.44-4.96, p = .002), solid tumor diagnosis (OR: 2.31, 95%CI: 1.15-4.71, p = .019), moderate and high risk of infertility (OR: 2.94, 95%CI: 1.23-7.64, p = .02; OR: 3.25, 95%CI: 1.55-7.17, p = .002), and ≥ 2 fertility discussions during survivorship care OR: 2.71, 95%CI: 1.46-5.20, p = .002). CONCLUSIONS Two-thirds of emerging adult cancer survivors expressed worry about future infertility, which has been linked to a variety of adverse quality of life outcomes. Survivors who are worried about infertility may benefit from psychological interventions.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Erin Kelling
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca Williamson Lewis
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
| | - Megan Pruett
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
| | - Lillian Meacham
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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25
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Ahmed Y, Khan AMH, Rao UJ, Shaukat F, Jamil A, Hasan SM, Abrar S, Qureshi BM, Abbasi AN. Fertility preservation is an imperative goal in the clinical practice of radiation oncology: a narrative review. Ecancermedicalscience 2022; 16:1461. [PMID: 36819826 PMCID: PMC9934885 DOI: 10.3332/ecancer.2022.1461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Indexed: 02/24/2023] Open
Abstract
With reduced cancer mortality in recent years, increased efforts must be put into safeguarding cancer survivors' long-term quality of life (QOL). Fertility preservation is recognised as a key component of QOL in survivorship. Concerns about fertility have been seen to significantly impact cancer patients' emotional and mental health as, generally, both malignancy and its treatment may cause a temporary or permanent reduction in infertility. This article reviews the primary effects of radiation therapy on male and female gonads and has further highlighted procedures through which the functioning of these organs can be protected before or during radiation treatment. We have also emphasised the importance of the establishment of multidisciplinary tumour boards and patient education regarding future reproductive function which is an important component of the care of individuals with cancer. This article highlights that infertility is a persistent and major concern that can add to long-term stress in cancer survivors, and education about fertility preservation before the initiation of any treatment is especially important.
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Affiliation(s)
- Yumna Ahmed
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | | | | | - Fatima Shaukat
- Department of Radiation Oncology, Cyberknife and Tomotherapy Centre, JPMC, Karachi 75510, Pakistan
| | - Arhum Jamil
- Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Sehrish Abrar
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Bilal Mazhar Qureshi
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ahmed Nadeem Abbasi
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
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Han J, Park S, Kim SH. Supporting decision‐making regarding fertility preservation in patients with cancer: An integrative review. Eur J Cancer Care (Engl) 2022; 31:e13748. [DOI: 10.1111/ecc.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jeehee Han
- Red Cross College of Nursing Chung‐Ang University Seoul Korea
| | - Sangwoo Park
- Severance Hospital Yonsei University Health System Seoul Korea
| | - Sung Hae Kim
- Department of Nursing, College of Health, Welfare and Education Tongmyong University Busan Korea
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Xiao PP, Ding SQ, Duan YL, Luo XF, Zhou Y, Cheng QQ, Liu XY, Xie JF, Cheng ASK. Metacognitions associated with reproductive concerns: A cross-sectional study of young adult female cancer survivors in China. Front Psychol 2022; 13:987221. [PMID: 36237684 PMCID: PMC9552999 DOI: 10.3389/fpsyg.2022.987221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Cancer and its treatments affect patients’ fertility potential. This study examined the prevalence of reproductive concerns and their relationship with metacognitions among Chinese young adult female cancer survivors (YAFCS). Methods A total of 318 YAFCS (aged 18–39) completed an online survey from March to December 2021. Participants reported sociodemographic characteristics, reproductive concerns and metacognitions. Reproductive concerns were measured using the Reproductive Concerns after Cancer scale (RCAC), and metacognitions were measured by the Short Form of Metacognitions Questionnaire (MCQ-30). We used Pearson correlation analysis to examine associations between metacognitions and reproductive concerns across multiple domains and multivariable linear regression to determine the influencing factors of reproductive concerns. Results The mean score of reproductive concern among YAFCS was 49.97 ± 12.52. A total of 57.9% of participants reported a high level of concern regarding at least one dimension of reproductive concerns, and they were most concerned about their child’s health and least concerned about partner disclosure of fertility status. We also found a moderate association between RCAC and MCQ-30 scores (r = 0.408, p < 0.001). In multivariate analyses, metacognitions, especially negative metacognitive beliefs had an impact on reproductive concerns among YAFCS (p < 0.001). Conclusion Higher reproductive concerns were associated with higher metacognitions among YAFCS, especially with negative metacognitive beliefs. Oncology professionals should pay attention to assessing reproductive concerns in patients who want to have children or who have no children. Moreover, metacognitive beliefs may be an intervention target for alleviating reproductive concerns among YAFCS.
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Affiliation(s)
- Pan Pan Xiao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Si Qing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ying Long Duan
- Department of Emergency, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Fei Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yi Zhou
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qin Qin Cheng
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiang Yu Liu
- Hunan Cancer Hospital, Health Management Center, Changsha, China
| | - Jian Fei Xie
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jian Fei Xie,
| | - Andy SK Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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28
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Fertility and CAR T-cells: Current practice and future directions. Transplant Cell Ther 2022; 28:605.e1-605.e8. [DOI: 10.1016/j.jtct.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 01/09/2023]
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van den Berg M, Kaal SEJ, Schuurman TN, Braat DDM, Mandigers CMPW, Tol J, Tromp JM, van der Vorst MJDL, Beerendonk CCM, Hermens RPMG. Quality of integrated female oncofertility care is suboptimal: A patient-reported measurement. Cancer Med 2022; 12:2691-2701. [PMID: 36031940 PMCID: PMC9939180 DOI: 10.1002/cam4.5149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend to inform female cancer patients about their infertility risks due to cancer treatment. Unfortunately, it seems that guideline adherence is suboptimal. In order to improve quality of integrated female oncofertility care, a systematic assessment of current practice is necessary. METHODS A multicenter cross-sectional survey study in which a set of systematically developed quality indicators was processed, was conducted among female cancer patients (diagnosed in 2016/2017). These indicators represented all domains in oncofertility care; risk communication, referral, counseling, and decision-making. Indicator scores were calculated, and determinants were assessed by multilevel multivariate analyses. RESULTS One hundred twenty-one out of 344 female cancer patients participated. Eight out of 11 indicators scored below 90% adherence. Of all patients, 72.7% was informed about their infertility, 51.2% was offered a referral, with 18.8% all aspects were discussed in counseling, and 35.5% received written and/or digital information. Patient's age, strength of wish to conceive, time before cancer treatment, and type of healthcare provider significantly influenced the scores of three indicators. CONCLUSIONS Current quality of female oncofertility care is far from optimal. Therefore, improvement is needed. To achieve this, improvement strategies that are tailored to the identified determinants and to guideline-specific barriers should be developed.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Suzanne E. J. Kaal
- Department of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands,Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands
| | - Teska N. Schuurman
- Center for Gynecologic Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch HospitalDen BoschThe Netherlands
| | - Jacqueline M. Tromp
- Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands,Department of Medical OncologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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30
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Meernik C, Mersereau JE, Baggett CD, Engel SM, Moy LM, Cannizzaro NT, Peavey M, Kushi LH, Chao CR, Nichols HB. Fertility Preservation and Financial Hardship among Adolescent and Young Adult Women with Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1043-1051. [PMID: 35506248 DOI: 10.1158/1055-9965.epi-21-1305] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Financial hardship among adolescents and young adults (AYA) with cancer who receive gonadotoxic treatments may be exacerbated by the use of fertility services. This study examined whether AYA women with cancer who used fertility preservation had increased financial hardship. METHODS AYA women with cancer in North Carolina and California completed a survey in 2018-2019. Cancer-related financial hardship was compared between women who cryopreserved oocytes or embryos for fertility preservation after cancer diagnosis (n = 65) and women who received gonadotoxic treatment and reported discussing fertility with their provider, but did not use fertility preservation (n = 491). Multivariable log-binomial regression was used to estimate prevalence ratios and 95% confidence intervals (CI). RESULTS Women were a median age of 33 years at diagnosis and 7 years from diagnosis at the time of survey. Women who used fertility preservation were primarily ages 25 to 34 years at diagnosis (65%), non-Hispanic White (72%), and had at least a Bachelor's degree (85%). In adjusted analysis, use of fertility preservation was associated with 1.50 times the prevalence of material financial hardship (95% CI: 1.08-2.09). The magnitude of hardship was also substantially higher among women who used fertility preservation: 12% reported debt of ≥$25,000 versus 5% in the referent group. CONCLUSIONS This study provides new evidence that cryopreserving oocytes or embryos after cancer diagnosis for future family building is associated with increased financial vulnerability. IMPACT More legislation that mandates insurance coverage to mitigate hardships stemming from iatrogenic infertility could improve access to fertility preservation for young women with cancer.
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Affiliation(s)
- Clare Meernik
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jennifer E Mersereau
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Christopher D Baggett
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Lisa M Moy
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Nancy T Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Mary Peavey
- Atlantic Reproductive Medicine Associates, Raleigh, North Carolina
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
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31
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Zhou B, Kwan B, Desai MJ, Nalawade V, Ruddy KJ, Nathan PC, Henk HJ, Murphy JD, Whitcomb BW, Su HI. Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors. Fertil Steril 2022; 117:1047-1056. [PMID: 35216831 PMCID: PMC9081208 DOI: 10.1016/j.fertnstert.2022.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data. DESIGN In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups. SETTING Commercially insured females in the United States. PATIENT(S) Females with and without breast cancer. EXPOSURE(S) Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy. MAIN OUTCOME MEASURE(S) AMH levels. RESULT(S) A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed. CONCLUSION(S) In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.
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Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Milli J. Desai
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic, Rochester, 200 1st St SW, Rochester, MN 55905, USA
| | - Paul C. Nathan
- The Hospital for Sick Children, 555 University Avenue Toronto ON M5G 1X8, CA
| | - Henry J. Henk
- OptumLabs, 11000 Optum Cir, Eden Prarie, MN 55344, USA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Brian W. Whitcomb
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 433 Arnold House, Amherst, MA, 01003, USA
| | - H. Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
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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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Pitch N, Stefaniuk S, MacMillan M, Catsburg J, Gupta AA, Vora T. Looking Back to Move Forward: Lessons Learned from a Successful, Sustainable, Replicable Model of Adolescent and Young Adult Program of a Tertiary Cancer Care Center. J Adolesc Young Adult Oncol 2022; 11:181-188. [PMID: 35007440 PMCID: PMC9057888 DOI: 10.1089/jayao.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The Princess Margaret Cancer Centre (PM) established the adolescent and young adult (AYA) oncology program in 2014 to address the unique needs of AYA by delivering targeted, evidence-based care through a multidisciplinary team. Methods: We performed a retrospective analysis of patients who underwent a consultation with the PM AYA program from 2014 to 2020. The association between the health domain concerns reported and age at consultation, cancer diagnoses, and time since diagnosis was analyzed using chi-square test of independence in SPSS. Results: In our cohort of 1128 AYA, the median age at assessment was 28.2 years. The most common diagnoses were lymphoma (n = 251, 22.2%), leukemia (n = 207, 18.4%), and breast cancer (n = 162, 14.4%). The most common concerns reported were related to fertility (n = 882, 78.2%) and work/school (n = 472, 41.8%). Fertility concerns were most common in 25–34 age group (443/540, 82.0%) and work-/school-related concerns were highest in 18–24 age group (191/355, 53.8%). Diagnoses significantly affect majority of concerns reported. Fertility concerns were most common in AYA consulted near diagnosis, while body image-, exercise-, and diet-related concerns were more frequently reported, while on active treatments. Conclusions: Supporting fertility concerns remains the cornerstone of any successful AYA program. Work-/school-related concerns deserve more elucidation and attention. We identified important patterns in the health-related concerns of AYA, especially as they relate to age, diagnoses, and time since diagnosis. This insight will guide us for improving patient-centered care delivery to AYA.
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Affiliation(s)
- Natalie Pitch
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Stephanie Stefaniuk
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Meghan MacMillan
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Alberta Health Services, Edmonton, Canada
| | - Jennifer Catsburg
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Abha A Gupta
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Tushar Vora
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Gorman JR, Drizin JH, Smith E, Flores-Sanchez Y, Harvey SM. Patient-Centered Communication to Address Young Adult Breast Cancer Survivors' Reproductive and Sexual Health Concerns. HEALTH COMMUNICATION 2021; 36:1743-1758. [PMID: 32703034 DOI: 10.1080/10410236.2020.1794550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Women faced with a diagnosis of breast cancer as young adults commonly experience negative effects of cancer and cancer treatment on their reproductive and sexual health (RSH) that are inadequately addressed by their healthcare providers (HCPs). The objectives of this study were to 1) identify approaches to improving RSH communication from YA breast cancer survivors' perspectives, 2) identify facilitators and barriers to the approaches identified, and 3) identify specific strategies to improve patient-centered RSH communication. We conducted individual telephone interviews with 29 women who were diagnosed with breast cancer under age 40 years. We used a grounded theory approach to identify themes, and explored how the themes related to the PCC framework to elucidate specific strategies for improving communication. Three main themes emerged: 1) Normalizing and integrating assessment of RSH concerns; 2) HCP conveying genuine caring and investment; and 3) Improving accessibility of comprehensive RSH services after cancer. Results revealed concrete strategies for improving patient-centered RSH communication at the patient-provider and health system levels. These included reminding patients that RSH concerns are common, routinely asking about RSH, using active listening, and connecting patients to HCP who can address their RSH concerns.
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Affiliation(s)
- Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | - Julia H Drizin
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | - Ellie Smith
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | | | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
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35
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Oncofertility: a Review. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2021. [DOI: 10.1007/s13669-021-00312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Micaux C, Wiklander M, Eriksson LE, Wettergren L, Lampic C. Efficacy of Fex-Can Fertility, a web-based psychoeducational intervention for young adults with fertility-related distress following cancer: a randomized controlled trial. (Preprint). JMIR Cancer 2021; 8:e33239. [PMID: 35348459 PMCID: PMC9006131 DOI: 10.2196/33239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/18/2021] [Accepted: 02/07/2022] [Indexed: 01/02/2023] Open
Affiliation(s)
- Claire Micaux
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Lena Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
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Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11080704. [PMID: 34442350 PMCID: PMC8400427 DOI: 10.3390/jpm11080704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. METHODS A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger's and Begg's tests were used to assess the risk of publication bias. RESULTS Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of -1.97 (95% CI: -3.12, -0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. CONCLUSIONS Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.
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Infertility After Cancer: How the Need to Be a Parent, Fertility-Related Social Concern, and Acceptance of Illness Influence Quality of Life. Cancer Nurs 2021; 44:E244-E251. [PMID: 32209862 DOI: 10.1097/ncc.0000000000000811] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) given a diagnosis of cancer who experience infertility concerns often report having poorer quality of life (QoL). However, the role of infertility-related stressors and illness acceptance on QoL is not clear. OBJECTIVE The aim of this study was to describe the impact of psychosocial factors surrounding cancer treatment and infertility on QoL. We hypothesized that need for parenthood and infertility-related social concerns would be directly related to QoL and indirectly related to QoL through acceptance of illness. METHODS Cancer patients/survivors (n = 178; 75.3% female) aged 15 to 29 years completed measures of QoL, acceptance of illness, infertility-related social concerns, and need for parenthood. Path analysis was used to test the hypothesized and subsequent models to determine the best fit for predictors of QoL. RESULTS The final model explained 28.36% of the variance in QoL. Lower infertility-related social concerns were directly and indirectly related to higher QoL scores. Need for parenthood did not directly relate to QoL, instead relating directly to increased infertility-related social concerns. Higher acceptance of illness (β = .39) and older age (β = .19) were directly related to higher QoL scores. Female patients had higher need for parenthood (β = .17). CONCLUSIONS These findings suggest that social concerns and expectations surrounding infertility have a negative impact on AYA cancer survivors' and patients' QoL, which increases as AYAs approach socially normative parenting age. IMPLICATIONS FOR PRACTICE Providing survivors with specialist support to manage their infertility-related social concerns and improve their acceptance of illness has the potential to improve their QoL.
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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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Ussher JM, Perz J, Hawkey AJ. A randomized controlled evaluation of an educational resource to address fertility concerns after cancer. Psychooncology 2021; 30:1442-1448. [PMID: 33860553 DOI: 10.1002/pon.5703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study evaluated the acceptability and impact of a written oncofertility educational resource (ER), as a self-help intervention (SH), and as an adjunct to a one-hour health-care professional discussion (HP). METHODS Within a randomized control trial (RCT), 194 adults with cancer (175 womens; 19 mens) were allocated to the SH or HP intervention. 127 completed 6-weeks post-intervention measures, a retention rate of 65.85%. RESULTS Across interventions, the ER was rated as highly acceptable and useful, in terms of ease of understanding, and information. Heath literacy significantly increased post-intervention, including functional literacy, communicative literacy, and critical health literacy. There were no significant changes in ratings of fertility distress or general distress pre-post intervention. Quality of life was significantly reduced post intervention. Those in the HP condition reported higher quality of life and greater likelihood of communication with others about fertility, most notably with intimate partners, post-intervention. Qualitative identification of increased knowledge, confidence with communication and normalization of fertility concerns, reflects increased health literacy, and provides explanation for significant reductions in feeling nervous and fearful about fertility treatments post-intervention. CONCLUSIONS Our findings confirm the importance of information provision about the impact of cancer on fertility. Written ERs are a useful adjunct to a patient-clinician discussion, increasing health literacy, which facilitates knowledge, self-efficacy and management of fertility concerns and changes.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
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van den Berg M, van der Meij E, Bos AME, Boshuizen MCS, Determann D, van Eekeren RRJP, Lok CAR, Schaake EE, Witteveen PO, Wondergem MJ, Braat DDM, Beerendonk CCM, Hermens RPMG. Development and testing of a tailored online fertility preservation decision aid for female cancer patients. Cancer Med 2021; 10:1576-1588. [PMID: 33580749 PMCID: PMC7940215 DOI: 10.1002/cam4.3711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Decision making regarding future fertility can be very difficult for female cancer patients. To support patients in decision making, fertility preservation decision aids (DAs) are being developed. However, to make a well-informed decision, patients need personalized information tailored to their cancer type and treatment. Tailored cancer-specific DAs are not available yet. METHODS Our DA was systematically developed by a multidisciplinary steering group (n = 21) in an iterative process of draft development, three rounds of alpha testing, and revisions. The drafts were based on current guidelines, literature, and patients' and professionals' needs. RESULTS In total, 24 cancer-specific DAs were developed. In alpha testing, cancer survivors and professionals considered the DA very helpful in decision making, and scored an 8.5 (scale 1-10). In particular, the cancer-specific information and the tool for recognizing personal values were of great value. Revisions were made to increase readability, personalization, usability, and be more careful in giving any false hope. CONCLUSIONS A fertility preservation DA containing cancer-specific information is important in the daily care of female cancer patients and should be broadly available. Our final Dutch version is highly appraised, valid, and usable in decision making. After evaluating its effectiveness with newly diagnosed patients, the DA can be translated and adjusted according to (inter)national guidelines.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Elleke van der Meij
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Annelies M. E. Bos
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | | | | | - Christianne A. R. Lok
- Centre for Gynecological Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Eva E. Schaake
- Department of RadiotherapyThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | | | - Marielle J. Wondergem
- Department of HematologyVU University Medical Center AmsterdamAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
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Medica ACO, Whitcomb BW, Shliakhsitsava K, Dietz AC, Pinson K, Lam C, Romero SAD, Sluss P, Sammel MD, Su HI. Beyond Premature Ovarian Insufficiency: Staging Reproductive Aging in Adolescent and Young Adult Cancer Survivors. J Clin Endocrinol Metab 2021; 106:e1002-e1013. [PMID: 33141175 PMCID: PMC7823232 DOI: 10.1210/clinem/dgaa797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Although stages of reproductive aging for women in the general population are well described by STRAW+10 criteria, this is largely unknown for female adolescent and young adult cancer survivors (AYA survivors). OBJECTIVE This work aimed to evaluate applying STRAW + 10 criteria in AYA survivors using bleeding patterns with and without endocrine biomarkers, and to assess how cancer treatment gonadotoxicity is related to reproductive aging stage. DESIGN The sample (n = 338) included AYA survivors from the Reproductive Window Study cohort. Menstrual bleeding data and dried-blood spots for antimüllerian hormone (AMH) and follicle-stimulating hormone (FSH) measurements (Ansh DBS enzyme-linked immunosorbent assays) were used for reproductive aging stage assessment. Cancer treatment data were abstracted from medical records. RESULTS Among participants, mean age 34.0 ± 4.5 years and at a mean of 6.9 ± 4.6 years since cancer treatment, the most common cancers were lymphomas (31%), breast (23%), and thyroid (17%). Twenty-nine percent were unclassifiable by STRAW + 10 criteria, occurring more frequently in the first 2 years from treatment. Most unclassifiable survivors exhibited bleeding patterns consistent with the menopausal transition, but had reproductive phase AMH and/or FSH levels. For classifiable survivors (48% peak reproductive, 30% late reproductive, 12% early transition, 3% late transition, and 7% postmenopause), endocrine biomarkers distinguished among peak, early, and late stages within the reproductive and transition phases. Gonadotoxic treatments were associated with more advanced stages. CONCLUSIONS We demonstrate a novel association between gonadotoxic treatments and advanced stages of reproductive aging. Without endocrine biomarkers, bleeding pattern alone can misclassify AYA survivors into more or less advanced stages. Moreover, a large proportion of AYA survivors exhibited combinations of endocrine biomarkers and bleeding patterns that do not fit the STRAW + 10 criteria, suggesting the need for modified staging for this population.
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Affiliation(s)
- Alexa C O Medica
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California
| | - Brian W Whitcomb
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Ksenya Shliakhsitsava
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern, Dallas, Texas
| | - Andrew C Dietz
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Kelsey Pinson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California
| | - Christina Lam
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, California
| | - Sally A D Romero
- Moores Cancer Center and Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | | | - Mary D Sammel
- Division of Biostatistics and Bioinformatics, School of Public Health, University of Colorado, Denver, Colorado
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences and Moores Cancer Center, University of California, San Diego, La Jolla, California
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Hawkey A, Ussher JM, Perz J, Parton C. Talking but not always understanding: couple communication about infertility concerns after cancer. BMC Public Health 2021; 21:161. [PMID: 33468106 PMCID: PMC7816453 DOI: 10.1186/s12889-021-10188-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer related infertility can have an impact on couple relationships, with evidence that couple communication facilitates coping. However, little is known about the ways in which couples communicate about cancer-related fertility concerns. The aim of this article is to examine couple communication about fertility concerns in the context of cancer, and the perceived quality of such communication from the perspective of cancer survivors and their partners. METHODS Eight-hundred and seventy-eight cancer survivors (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey which examined cancer related fertility concerns. Seventy-eight survivors (61 women and 17 men), and 26 partners (13 women and 13 men), participated in semi-structured interviews, in order to examine the subjective experience of fertility concerns in-depth. Thematic analysis was used to analyse the interviews and open ended survey questions. Valid percentages for single items from the relationships subscale of the Fertility Preservation Inventory (FPI) related to qualitative themes, identified frequency of responses. RESULTS The major theme was 'talking but not always understanding". 89.6% of cancer survivors and partners (95.1%) reported working well together handling fertility questions (FPI), but agreed that communication could be improved (65.9% survivors; 65% partners). Open and honest couple communication was associated with feelings of support, understanding and relationship growth, including perception of partner comfort (79.2% survivors, 81.6% partners). However, 32% survivors and 31.1% partners concealed fertility concerns to avoid upsetting their partner, or reported that their partner doesn't understand their fertility concerns (survivors 25.5%, partners 14.6%), with 14.1% of cancer survivors and 19.4% partners reporting fear of relationship breakdown because of fertility issues. Fear of rejection when forming new relationships, and concerns about how to talk to future partners, was reported by non-partnered individuals. CONCLUSION Health-care professionals should include partners of cancer survivors in fertility discussions. Couple interventions developed in general psycho-oncology should be extended to the domain of fertility, in order to facilitate effective couple communication. Communication in future relationships needs to be addressed for single people and adolescents and young adults (AYAs) who have fertility concerns.
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Affiliation(s)
- Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
| | - Chloe Parton
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
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Anderson RA, Su HI. The Clinical Value and Interpretation of Anti-Müllerian Hormone in Women With Cancer. Front Endocrinol (Lausanne) 2020; 11:574263. [PMID: 33117288 PMCID: PMC7577190 DOI: 10.3389/fendo.2020.574263] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022] Open
Abstract
Cancer treatments can be damaging to the ovary, with implications for future fertility and reproductive lifespan. There is therefore a need for a biomarker than can usefully provide an assessment of the ovary and its potential for long-term function after cancer treatment, and ideally also be of value pre-treatment, for the prediction of post-treatment function. In this review we assess the value of anti-Müllerian hormone (AMH) in this context. Measurement of AMH at the time of cancer diagnosis has been shown to be predictive of whether or not there will remain some ovarian function post-treatment in women with breast cancer, in conjunction with age. AMH may however be reduced at the time of diagnosis in some conditions, including lymphoma, but probably not in women with breast cancer unless they are carriers of BRCA1 mutations. Following chemotherapy, AMH is often much reduced compared to pretreatment levels, with recovery dependent on the chemotherapy regimen administered, the woman's age, and her pretreatment AMH. Recent data show there may be a long duration of relative stability of AMH levels over 10 to 15 years prior to decline rather than a rapid decline for many young women after cancer. Post-treatment AMH may have utility in determining that ovarian function will not recover, contributing to assessment of the need for ovarian suppression in women with hormone-sensitive breast cancer. AMH measurement provides an index of treatment gonadotoxicity, allowing comparison of different treatment regimens, although extrapolation to effects on fertility requires caution, and there are very limited data regarding the use of AMH to estimate time to menopause in the post-cancer setting.
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Affiliation(s)
- Richard A. Anderson
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - H. Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
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Fertility counseling information adequacy as a moderator of regret among adolescent and young adult breast cancer survivors. Support Care Cancer 2020; 29:2689-2697. [PMID: 32980927 DOI: 10.1007/s00520-020-05771-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Current literature disagrees on whether fertility counseling decreases or increases decision regret among young breast cancer survivors. This study investigates whether fertility counseling provided to pre-menopausal breast cancer patients regarding infertility due to treatment is associated with decision regret post-treatment, and how that relationship is moderated by information adequacy. METHODS Breast cancer patients aged 18-35 listed in the Pennsylvania Cancer Registry as diagnosed between 2007 and 2012 were surveyed. Basic descriptive analyses were conducted, and linear regression models were estimated. RESULTS Receipt of fertility counseling was not directly associated with decision regret. However, as fertility information adequacy increased, decision regret significantly decreased among women who received fertility counseling after finishing treatment or before and after finishing treatment. On average, a woman who receives fertility counseling before and after treatment with an information adequacy score of 1.5 had a regret score of 2.68. In contrast, a woman who received fertility counseling before and after treatment who had a fertility information adequacy score of 5 had a regret score of only 1.26 on average. CONCLUSION Information adequacy is a significant moderator in the relationship between fertility counseling and decision regret. This suggests a possible explanation for disagreement in the literature regarding the benefits of fertility counseling and highlights the need for an increased focus on the adequacy of the information provided. IMPLICATIONS FOR CANCER SURVIVORS Fertility counseling should be pursued for young adult breast cancer patients and survivors, provided that their satisfaction with the information received is monitored and remains high.
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Jardim FA, Lopes-Júnior LC, Nascimento LC, Neves ET, de Lima RAG. Fertility-Related Concerns and Uncertainties in Adolescent and Young Adult Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2020; 10:85-91. [PMID: 32945713 DOI: 10.1089/jayao.2020.0058] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: This study aimed to uncover the fertility-related concerns and uncertainties in adolescent and young adult (AYA) childhood cancer survivors. Methods: In this qualitative study, participants were recruited from an oncohematology outpatient clinic at a university hospital in Brazil. Twenty-four AYA cancer survivors, aged 18- 24 years (13 men and 11 women), participated in individual semistructured interviews focusing on two parts-sociodemographic and clinical variables and guiding questions that enabled understanding of the concerns and uncertainties regarding the risks of infertility and their impact on relationships and the need for guidance. Data were analyzed using inductive thematic analysis. Results: Four themes were identified from the data-(1) knowledge about fertility, (2) emotional impact and fertility-related uncertainty, (3) sharing the possible risk of infertility with partners, and (4) need for information on possible loss of fertility. Conclusion: The meanings attributed to the loss of fertility after cancer treatment uncovered the need for health professionals to organize survivor services in line with the survivors' needs, and include reproductive concerns and uncertainties in this planning. The study results provide insights for the development of health care services that meet the real needs of this particular population that has long-term follow-up demands.
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Affiliation(s)
- Fabrine Aguilar Jardim
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil
| | | | - Lucila Castanheira Nascimento
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil
| | | | - Regina Aparecida Garcia de Lima
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil
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"Looking at future cancer survivors, give them a roadmap": addressing fertility and family-building topics in post-treatment cancer survivorship care. Support Care Cancer 2020; 29:2203-2213. [PMID: 32889581 DOI: 10.1007/s00520-020-05731-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Fertility is an important issue among adolescent and young adult female (AYA-F) cancer survivors. This study examined AYA-F survivors' unmet needs and recommendations for care to address fertility/family-building in post-treatment survivorship. METHODS Semi-structured interviews (45-60 min) explored themes related to fertility and family-building after cancer. Coding categories were derived based on grounded theory methods. Themes were identified through an iterative process of coding and review. RESULTS Participants (N = 25) averaged 29 years old (SD = 6.2; range, 15-39) were primarily White and well educated, and averaged 5.81 years post-treatment (SD = 5.43); 32% had undergone fertility preservation (pre- or post-cancer). Six recommendations for improving care were identified: addressing patient-provider communication, need to provide informational, emotional, and peer support, financial information, and decision-making support. AYA-Fs believed the best way to learn about resources was through online platforms or doctor-initiated discussions. Telehealth options and digital resources were generally considered acceptable. Face-to-face interactions were preferred for in-depth information, when AYA-Fs anticipated having immediate questions or distressing emotions, and with concerns about Internet security. Thus, a combined approach was preferred such that information (via web-based communication) should be provided first, with follow-up in-person visits and referrals when needed. CONCLUSION Informational and support services are needed to better educate patients about gonadotoxic effects and options to have children after cancer treatment is completed. Future work should evaluate how to best support oncology providers in meeting the needs of survivors concerned about fertility and family-building including referral to clinical specialties and supportive resources.
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Primary and Secondary Markers of Doxorubicin-Induced Female Infertility and the Alleviative Properties of Quercetin and Vitamin E in a Rat Model. Reprod Toxicol 2020; 96:316-326. [PMID: 32810592 DOI: 10.1016/j.reprotox.2020.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022]
Abstract
The incidence of cancer has recently risen among the women at the reproductive age. Therefore, exposure to doxorubicin (DOX) chemotherapy has become a cause of reproductive toxicity followed by secondary destructive effects. The present study aimed to evaluate the effects of quercetin (QCT) and vitamin.E (Vit.E) on doxorubicin-induced toxicity in the ovary and uterus, and the secondary bone-related effects in a rat model. Animals were divided into six groups including control normal saline/corn oil (CON), QCT at 20 mg/Kg, Vit.E at 200 mg/Kg, DOX at accumulative 15 mg/Kg, DOX/QCT, and DOX/Vit.E. After 21 days of treatment, the alterations were analyzed in histoarchitecture, apoptosis, hormones secretion, the gene expression of aromatase and estrogen α-receptor (ER-α) in the uterine and ovarian tissues, and serum levels of bone-related factors. The results demonstrated the ameliorative effects of QCT and Vit.E on doxorubicin caused altered ovarian histology, increased apoptosis, decreased ovarian aromatase and ER-α gene expression (p-value<0.05), decreased estrogen and progesterone levels, decreased ALP (p-value<0.001), and increased osteocalcin (p-value<0.05). The findings suggested that the studied antioxidants administration could be a promising fertility preservation strategy in DOX-treated females.
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Fertility under uncertainty: exploring differences in fertility-related concerns and psychosocial aspects between breast cancer survivors and non-cancer infertile women. Breast Cancer 2020; 27:1177-1186. [DOI: 10.1007/s12282-020-01124-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/14/2020] [Indexed: 12/27/2022]
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Ljungman L, Eriksson LE, Flynn KE, Gorman JR, Ståhl O, Weinfurt K, Wiklander M, Lampic C, Wettergren L. Sexual Dysfunction and Reproductive Concerns in Young Men Diagnosed With Testicular Cancer: An Observational Study. J Sex Med 2020; 16:1049-1059. [PMID: 31255211 DOI: 10.1016/j.jsxm.2019.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The survival rates for testicular cancer are excellent; still, there is a lack of knowledge regarding important survivorship issues, such as sexual dysfunction and reproductive concerns. AIM The aim of this study was to investigate the prevalence and predictors of sexual dysfunction and reproductive concerns and the potential association between these issues in young men ∼2 years after a diagnosis of testicular cancer. METHODS Data were collected from 111 men (response rate = 50%) diagnosed with testicular cancer at age 16-39. Patients were identified via the Swedish National Quality Registry for Testicular Cancer and approached with a survey, including standardized measures of sexual function, reproductive concerns, body image, and health-related quality of life. The survey was sent to participants approximately 2 years after their cancer diagnosis. Clinical variables were collected from the registry. Predictors were identified by multivariable linear regression analyses. MAIN OUTCOME MEASURES The main outcomes were sexual function, assessed with the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction measure version 2.0, and reproductive concerns, assessed with the Reproductive Concerns After Cancer scale. RESULTS Sexual dysfunction was reported by 26% of men, and a high level of reproductive concerns was reported by 28%. Lower satisfaction with sex life was associated with older age (β = -0.41), negative body image (β = -0.42), not having a partner (β = 4.8), and dissatisfaction with sex life before cancer (β = 8.31). Negative body image was associated with reproductive concerns in the dimensions of fertility potential (β = 0.06), partner disclosure (β = 0.08), and child's health (β = 0.07), whereas having had fertility preservation predicted higher levels of concerns with regard to personal health (β = 0.52) and achieving pregnancy (β = 0.53). Clinical variables did not predict either sexual function or reproductive concerns. CLINICAL IMPLICATIONS Our results show that the majority of young men diagnosed with testicular cancer do not report sexual dysfunction or reproductive concerns 2 years after diagnosis. A sizeable minority, however, does report dysfunction or reproductive concerns, which should be recognized in the follow-up care of this population. STRENGTHS & LIMITATIONS A strength of the study is the use of high-quality registry data and validated instruments. The lack of Swedish norms for sexual function and reproductive concerns is a possible limitation. CONCLUSION A subgroup of young men treated for testicular cancer report sexual dysfunction or reproductive concerns approximately 2 years after diagnosis. Factors associated with these issues seem to mainly be psychological, rather than medical, nature. Ljungman L, Eriksson LE, Flynn KE, et al. Sexual Dysfunction and Reproductive Concerns in Young Men Diagnosed With Testicular Cancer: An Observational Study. J Sex Med 2019;16:1049-1059.
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Affiliation(s)
- L Ljungman
- Department of Women's and Children's Health, Karolinska Institutet, Sweden.
| | - L E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden; School of Health Sciences, City, University of London, United Kingdom
| | - K E Flynn
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - J R Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - O Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - K Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - M Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - C Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - L Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
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