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Takekawa Y, Sugimoto K, Masaki K, Koizumi T, Mori H, Shiraishi E, Maezawa T, Tanigaki S, Shirai C, Suzuki N. Differences Between Cancer Survivors and Healthy Subjects in Factors that Facilitate and Obstruct the Use of the Foster Parent System and Special Adoption System: A Nationwide Cross-Sectional Study in Japan. J Adolesc Young Adult Oncol 2024; 13:534-540. [PMID: 38237110 DOI: 10.1089/jayao.2023.0088] [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] [Indexed: 06/27/2024] Open
Abstract
Purpose: To investigate factors that obstruct and facilitate the use of the foster parent and special adoption systems (i.e., foster systems) by cancer survivors, and examine how to effectively provide information. Methods: This was a cross-sectional study that compared the results of a questionnaire survey of foster parents and adoptive parents (i.e., foster parents) who were and were not cancer survivors belonging to foster parent associations in 33 locations in Japan. This study was supported by a 2022 Ministry of Health, Labor, and Welfare Grant-in-Aid for Scientific Research (Grant No. 20EA1004). Results: "Lack of information," an obstructive factor and "Sympathetic understanding and cooperation from my partner and family," a facilitative factor were the highest score in both groups. Significant differences between the two groups were found in "Support from government agencies and others for foster parents," a facilitative factor, which was lower in the cancer survivors' group. There were no other significant differences between both the groups. Conclusion: This study found that when considering the use of the foster systems, a lack of information was the biggest obstructive factor and family understanding was the most helpful for both cancer survivors and noncancer groups. It was thought that stronger government support for cancer survivors might encourage cancer survivors to consider becoming foster parents. It would be effective for cancer treatment facilities, reproductive medical facilities, the government, and foster parent associations to work together to provide information carefully to cancer survivors.
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Affiliation(s)
- Yukiko Takekawa
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kouhei Sugimoto
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kiyo Masaki
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tomoe Koizumi
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hirofumi Mori
- Japan Society for Fertility Preservation, Yokohama, Kanagawa, Japan
| | - Eriko Shiraishi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Tadashi Maezawa
- Department of Obstetrics and Gynecology, Mie University, Tsu, Mie, Japan
| | - Shinji Tanigaki
- Department of Obstetrics and Gynecology, The Kyorin University, Mitaka, Tokyo, Japan
| | - Chiaki Shirai
- Faculty of Humanities and Social Sciences, Shizuoka University, Shizuoka, Shizuoka, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Nahata L, Anazodo A, Cherven B, Logan S, Meacham LR, Meade CD, Zarnegar-Lumley S, Quinn GP. Optimizing health literacy to facilitate reproductive health decision-making in adolescent and young adults with cancer. Pediatr Blood Cancer 2023; 70 Suppl 5:e28476. [PMID: 32633029 PMCID: PMC7785658 DOI: 10.1002/pbc.28476] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022]
Abstract
Despite being considered "standard of care" by many organizations, fertility and reproductive health communications and counseling practices remain inconsistent for adolescents and young adults (AYAs) newly diagnosed with cancer and during survivorship. One factor known to affect how information is provided and received in the medical setting is health literacy. Providers should consider health literacy to optimize reproductive health communication with AYAs as they cope with their diagnosis, understand what it means for their future, process information about treatment options, learn about their potential harmful effects on fertility, make quick decisions about fertility preservation, and navigate a future family planning course. Thus, the objectives of this manuscript are to (a) summarize literature on reproductive health literacy; (b) describe health literacy frameworks; (c) examine ways to assess health literacy; and (d) identify ways to enhance clinician-patient communication in the AYA oncofertility setting.
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Affiliation(s)
- Leena Nahata
- Division of Endocrinology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women and Children’s Health, University of New South Wales, Sydney, Australia
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta
- Department of Pediatrics, Emory University School of Medicine
| | - Shanna Logan
- School of Women and Children’s Health, University of New South Wales, Sydney, Australia
| | - Lillian R. Meacham
- Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta
- Department of Pediatrics, Emory University School of Medicine
| | - Cathy D. Meade
- Moffitt Cancer Center, Division of Population Science, Health Outcomes & Behavior
| | - Sara Zarnegar-Lumley
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gwendolyn P. Quinn
- Obstetrics and Gynecology, New York University School of Medicine, New York, New York
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3
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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: 6] [Impact Index Per Article: 6.0] [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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Barriers to Oncofertility Care among Female Adolescent Cancer Patients in Canada. Curr Oncol 2022; 29:1583-1593. [PMID: 35323333 PMCID: PMC8947634 DOI: 10.3390/curroncol29030133] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
High survival rates in adolescent cancer patients have shifted the medical focus to the long-term outcomes of cancer treatments. Surgery, chemotherapy, and radiation increase the risk of infertility and infertility-related distress in adolescent cancer patients and survivors. The aims of this narrative review were to (1) describe the psychosocial impacts of cancer-related infertility in adolescents, (2) identify multilevel barriers to fertility preservation (FP) conversations and referrals, and (3) conclude with evidence-based clinical solutions for improving the oncofertility support available to Canadian adolescents. The results of this review revealed that FP decisions occur within the patient, parent, and health care provider (HCP) triad, and are influenced by factors such as parent attitudes, patient maturity, and HCP knowledge. Decision tools and HCP education can promote the occurrence of developmentally appropriate fertility discussions. At the systems level, cost and resource barriers prevent patients from receiving sufficient fertility information and referrals. Clinical models of care (MOCs) can define interdisciplinary roles and referral pathways to improve the integration of oncofertility services into adolescent cancer care. The continued integration of oncofertility care will ensure that all Canadian adolescents receive the exemplary medical and psychological support necessary to make empowered decisions about their own fertility.
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Álvarez-García V, Rubio-Romero L, Maldonado MA, Gómez-Suárez M, de-la-Torre A. Ocular toxoplasmosis in immunocompetent adults: current cost-effectiveness of four treatment regimens in Colombia. Heliyon 2021; 7:e08265. [PMID: 34778574 PMCID: PMC8577134 DOI: 10.1016/j.heliyon.2021.e08265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/20/2021] [Accepted: 10/22/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Ocular toxoplasmosis is an infection caused by Toxoplasma gondii. In South America, the clinical course of ocular toxoplasmosis is more severe than in Europe and North America because virulent strains of the parasite are present. Ocular toxoplasmosis is the leading cause of posterior uveitis and retinochoroiditis in Colombia, requiring timely and appropriate treatment. However, there is no standardized therapy protocol based on economic studies for the country. PURPOSE To compare the cost-effectiveness of four first-line treatment regimens for active ocular toxoplasmosis in immunocompetent adults in Colombia, using the number of averted therapeutic failures as the outcome. METHODS We performed an economic and cost-effectiveness analysis to compare four first-line treatment regimens for ocular toxoplasmosis from the perspective of a third-party payer (Colombian General System of Social Security in Health). A decision analysis tree was used over a 24-week time horizon, considering only direct costs. Additionally, we performed a discrete sensitivity analysis and a probabilistic sensitivity analysis with 10,000 iterations in the Monte Carlo simulation. RESULTS For the base case, trimethoprim/sulfamethoxazole showed 86% effectiveness at a cost of <57 United States Dollars, resulting in the most cost-effective first-line alternative. When performing the probabilistic sensitivity analysis and maintaining the willingness to pay 466.00 United States Dollars, the trimethoprim/sulfamethoxazole regimen remained the most cost-effective alternative. CONCLUSION Ocular toxoplasmosis is a public health issue in Latin America. Despite severe visual consequences for affected patients, there are no standardized treatment guidelines in countries such as Colombia. Our evidence supports the use of trimethoprim/sulfamethoxazole as first-line treatment in Colombia because of its availability and optimal cost-effectiveness performance; it reduces recurrences and complications, while averting therapeutic failure. Furthermore, our evidence can be generalized to other Latin American countries with similar frequencies and severities of Toxoplasma gondii ocular infection and health systems similar to the Colombian system.
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Affiliation(s)
- Valentina Álvarez-García
- Neuroscience Research Group (NEUROS), Neuroscience Center (NeuroVitae), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
| | - Lorena Rubio-Romero
- Neuroscience Research Group (NEUROS), Neuroscience Center (NeuroVitae), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
| | - María Alejandra Maldonado
- Neuroscience Research Group (NEUROS), Neuroscience Center (NeuroVitae), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
| | - Marcela Gómez-Suárez
- Universidad Nacional de Colombia, Doctorado Interfacultades en Salud Pública, Facultad de Medicina, Grupo de Equidad en Salud, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neuroscience Center (NeuroVitae), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Colombia
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6
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Delattre S, Segers I, Van Moer E, Drakopoulos P, Mateizel I, Enghels L, Tournaye H, De Vos M. Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study. Hum Reprod 2021; 35:2524-2536. [PMID: 32951035 DOI: 10.1093/humrep/deaa193] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)? SUMMARY ANSWER In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising. WHAT IS KNOWN ALREADY FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future. STUDY DESIGN, SIZE, DURATION Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment. MAIN RESULTS AND THE ROLE OF CHANCE Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue 'ex vivo' (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception. LIMITATIONS, REASONS FOR CAUTION Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions. WIDER IMPLICATIONS OF THE FINDINGS Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study and the authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Delattre
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - I Segers
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - E Van Moer
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - P Drakopoulos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - I Mateizel
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - L Enghels
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - M De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
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7
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Woodruff TK, Ataman-Millhouse L, Acharya KS, Almeida-Santos T, Anazodo A, Anderson RA, Appiah L, Bader J, Becktell K, Brannigan RE, Breech L, Bourlon MT, Bumbuliene Ž, Burns K, Campo-Engelstein L, Campos JR, Centola GM, Chehin MB, Chen D, De Vos M, Duncan FE, El-Damen A, Fair D, Famuyiwa Y, Fechner PY, Fontoura P, Frias O, Gerkowicz SA, Ginsberg J, Gracia CR, Goldman K, Gomez-Lobo V, Hazelrigg B, Hsieh MH, Hoyos LR, Hoyos-Martinez A, Jach R, Jassem J, Javed M, Jayasinghe Y, Jeelani R, Jeruss JS, Kaul-Mahajan N, Keim-Malpass J, Ketterl TG, Khrouf M, Kimelman D, Kusuhara A, Kutteh WH, Laronda MM, Lee JR, Lehmann V, Letourneau JM, McGinnis LK, McMahon E, Meacham LR, Mijangos MFV, Moravek M, Nahata L, Ogweno GM, Orwig KE, Pavone ME, Peccatori FA, Pesce RI, Pulaski H, Quinn G, Quintana R, Quintana T, de Carvalho BR, Ramsey-Goldman R, Reinecke J, Reis FM, Rios J, Rhoton-Vlasak AS, Rodriguez-Wallberg KA, Roeca C, Rotz SJ, Rowell E, Salama M, Saraf AJ, Scarella A, Schafer-Kalkhoff T, Schmidt D, Senapati S, Shah D, Shikanov A, Shnorhavorian M, Skiles JL, Smith JF, Smith K, Sobral F, Stimpert K, Su HI, Sugimoto K, Suzuki N, Thakur M, Victorson D, Viale L, Vitek W, Wallace WH, Wartella EA, Westphal LM, Whiteside S, Wilcox LH, Wyns C, Xiao S, Xu J, Zelinski M. A View from the past into our collective future: the oncofertility consortium vision statement. J Assist Reprod Genet 2021; 38:3-15. [PMID: 33405006 PMCID: PMC7786868 DOI: 10.1007/s10815-020-01983-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. Methods The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. Results This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. Conclusion The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.
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Affiliation(s)
- Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly S Acharya
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Duke Fertility Center, Durham, NC, USA
| | - Teresa Almeida-Santos
- Reproductive Medicine Unit, Coimbra Hospital and University Centre, Coimbra, Portugal.,Clinical Academic Center of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Nelune Comprehensive Cancer Centre, Sydney, Australia.,Prince of Wales Hospital, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Richard A Anderson
- Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland, UK
| | - Leslie Appiah
- Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Joy Bader
- ReproTech, Ltd., Saint Paul, MN, USA
| | | | - Robert E Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lesley Breech
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maria T Bourlon
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Žana Bumbuliene
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Karen Burns
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa Campo-Engelstein
- Institute for the Medical Humanities, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Grace M Centola
- Dadi, Inc., Brooklyn, NY, USA.,Phoenix Sperm Bank of Seattle Sperm Bank, Phoenix, AZ, USA.,New England Cryogenic Center/New England Cord Blood Bank, Marlborough, MA, USA
| | | | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine and Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michel De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Follicle Biology Laboratory (FOBI), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ahmed El-Damen
- IVIRMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates.,Division of Embryology and Comparative Anatomy, Faculty of Science, Cairo University, Giza, Egypt
| | - Douglas Fair
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Yemi Famuyiwa
- Montgomery Fertility Center, Rockville, MD, USA.,Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, DC, USA
| | - Patricia Y Fechner
- Department of Pediatrics, Division of Endocrinology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Olivia Frias
- Department of Obstetrics and Gynecology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Jill Ginsberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - Kara Goldman
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Veronica Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Michael H Hsieh
- Department of Urology, George Washington University, Washington, DC, USA
| | - Luis R Hoyos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Alfonso Hoyos-Martinez
- Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Robert Jach
- Department of Obstetrics and Gynecology, Medical College Jagiellonian University, Krakow, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Murid Javed
- OriginElle Fertility Clinic and Women's Health Centre, Ottawa, ON, Canada
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology Royal Women's Hospital, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Roohi Jeelani
- Vios Fertility Institute, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Wayne State School of Medicine, Detroit, MI, USA
| | - Jacqueline S Jeruss
- Departments of Surgery, Pathology, and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Nalini Kaul-Mahajan
- Mother & Child Hospital, New Delhi, India.,Ferticity Fertility Clinics, New Delhi, India
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, Charlottesville, VA, USA.,Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tyler G Ketterl
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA, USA.,Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Dana Kimelman
- Centro de Esterilidad Montevideo, Montevideo, Uruguay
| | - Atsuko Kusuhara
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - William H Kutteh
- Department of Reproductive Endocrinology, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Monica M Laronda
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jung Ryeol Lee
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Fertility Preservation and Enhancement Research Laboratory, Seongnam, Korea
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joseph M Letourneau
- University of Utah Center for Reproductive Medicine, Salt Lake City, UT, USA
| | - Lynda K McGinnis
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Eileen McMahon
- Sinai Health System, Mount Sinai Fertility, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Lillian R Meacham
- Department of Pediatrics, Aflac Cancer Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Monserrat Fabiola Velez Mijangos
- Biology of Human Reproduction Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Molly Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - George Moses Ogweno
- Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology, The Nairobi Hospital, Nairobi, Kenya.,Esis Health Services (EHS), Nairobi, Kenya
| | - Kyle E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Romina Ileana Pesce
- Reproductive Medicine Unit, Obstetrics and Gynecology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Hanna Pulaski
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gwendolyn Quinn
- Departments of Obstetrics and Gynecology, Center for Medical Ethics, Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | | | | | | | - Rosalind Ramsey-Goldman
- Department of Medicine/Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Fernando M Reis
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Julie Rios
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Obstetrics and Gynecology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Alice S Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kenny A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Cassandra Roeca
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Erin Rowell
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mahmoud Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amanda J Saraf
- Riley Hospital for Children at Indiana University, Indianapolis, IN, USA
| | - Anibal Scarella
- Centro de Reproducción Humana, Facultad Medicina, Universidad de Valparaíso, Valparaíso, Chile.,Departamento de Obstetricia y Ginecología, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | | | - Deb Schmidt
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Suneeta Senapati
- Division of Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - Divya Shah
- Division of Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariella Shikanov
- Department of Biomedical Engineering, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Margarett Shnorhavorian
- Department of Urology, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, University of Washington, Seattle, WA, USA
| | - Jodi L Skiles
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James F Smith
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Kristin Smith
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fabio Sobral
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - Kyle Stimpert
- Department of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Kouhei Sugimoto
- International Center for Reproductive Medicine, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mili Thakur
- Reproductive Genomics Program, The Fertility Center, Grand Rapids, MI, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - David Victorson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Wendy Vitek
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA.,Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - W Hamish Wallace
- Paediatric Oncology, University of Edinburgh & Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| | - Ellen A Wartella
- Center on Media and Human Development, School of Communication, Northwestern University, Evanston, IL, USA
| | - Lynn M Westphal
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Stacy Whiteside
- Fertility & Reproductive Health Program, Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Christine Wyns
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Shuo Xiao
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Environmental Health Sciences Institute, Rutgers University, New Brunswick, NJ, USA
| | - Jing Xu
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA.,Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Mary Zelinski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA.,Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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8
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Predictors and outcomes in breast cancer patients who did or did not pursue fertility preservation. Breast Cancer Res Treat 2021; 186:429-437. [PMID: 33392838 DOI: 10.1007/s10549-020-06031-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast cancer is the most common cancer in reproductive age women, and treatment can affect fertility; however, there is often concern regarding the safety of increased estradiol (E2) levels and potential delays in treatment with ovarian stimulation for fertility preservation (FP). The aim of this study was to compare recurrence and survival in breast cancer patients who pursued FP without concurrent letrozole to those who did not (non-FP). METHODS We reviewed charts of women with breast cancer who contacted the FP patient navigator (PN) at Northwestern University from 01/2005-01/2018. Oncology and fertility outcome data were collected. Data were analyzed by Chi-square test or regression, as appropriate. Kaplan-Meier curves were used to examine breast cancer recurrence and survival. Statistical analyses were performed with SPSS IBM Statistics 26.0 for Windows. RESULTS 332 patients were included, of which 157 (47.3%) underwent FP. Median days to treatment after consulting the PN was 35 in the FP group and 21 in non-FP (p < 0.05). Cancer recurrence was noted in 7 (4.7%) FP patients and 13 (7.9%) non-FP patients (NS), and mortality in 5 (3.2%) FP patients and 7 (4.2%) non-FP patients (NS). Within the FP group, no significant differences were found in recurrence or mortality based on ER status, age, BMI, peak E2 level or total gonadotropin dose. Likelihood of pursuing FP was primarily a function of age and parity, and was not affected by breast cancer stage. To date, 21 have used cryopreserved specimens, and 13 (62%) had a live birth. CONCLUSIONS FP is safe and effective in breast cancer patients, regardless of receptor status; E2 elevations and the 2-week delay in treatment start are unlikely to be clinically significant. These findings are unique in that our institution does not use concomitant letrozole during stimulation to minimize E2 elevations in breast cancer patients.
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9
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Shiraishi E, Sugimoto K, Shapiro JS, Ito Y, Kamoshita K, Kusuhara A, Haino T, Koizumi T, Okamoto A, Suzuki N. Study of the Awareness of Adoption as a Family-Building Option Among Oncofertility Stakeholders in Japan. JCO Glob Oncol 2020; 6:350-355. [PMID: 35275743 PMCID: PMC9812456 DOI: 10.1200/go.22.00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The oncofertility decision tree was developed by the oncofertility consortium as a tool to support healthcare professionals and patients through the complicated process of deciding the most appropriate fertility preservation strategy for patients with cancer. Various strategies include oocyte retrieval, oocyte donation, use of a gestational carrier and adoption. However, differences in the cultural and legal landscape present serious barriers to utilizing some of these strategies in Japan. PATIENTS AND METHODS We surveyed Japanese oncofertility stakeholders including 60 cancer survivors, 27 oncology facilities, 78 reproductive medicine facilities and 15 adoption agencies by a questionnaire to characterize awareness among oncofertility stakeholders in Japan about parenting options including adoption to inform work to establish guidelines for decision-making by cancer survivors in an oncofertility. RESULTS Our results indicate that oncologists and reproductive endocrinologists in Japan have an insufficient understanding of adoption that prevents them from adequately informing their patients. Japanese cancer survivors self-describe a lack in confidence in finding a suitable partner and raising a child. Contrastingly, of the 9 adoption agencies which responded, no agency included being a cancer survivor as a criterion for disqualification and 4 of 9 (44%) adoption agencies reported at least 1 adoption to a cancer survivor in the last year. CONCLUSION Our work demonstrates that a cancer survivor's medical history itself is not a hurdle to adoption and investment in patient-provider education could be a viable strategy to improve the utilization of adoption as a fertility preservation strategy in Japan.
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Affiliation(s)
| | | | | | - Yuki Ito
- The Jikei University School of Medicine, Tokyo,
Japan
| | | | | | | | - Tomoe Koizumi
- National Research Institute for Child Health and
Development, Tokyo, Japan
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo,
Japan
| | - Nao Suzuki
- St Marianna University School of Medicine, Kanagawa,
Japan
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10
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Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach. Ann Oncol 2019; 30:1760-1775. [PMID: 31418765 DOI: 10.1093/annonc/mdz284] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during, and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is essential to guarantee high standard of care.
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Affiliation(s)
- M Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA.
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11
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Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, Bradford N, Cohn R, Birdsall M, Barr R, Suzuki N, Takae S, Marinho R, Xiao S, Qiong-Hua C, Mahajan N, Patil M, Gunasheela D, Smith K, Sender L, Melo C, Almeida-Santos T, Salama M, Appiah L, Su I, Lane S, Woodruff TK, Pacey A, Anderson RA, Shenfield F, Ledger W, Sullivan E. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2019; 25:159-179. [PMID: 30462263 PMCID: PMC6390168 DOI: 10.1093/humupd/dmy038] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/15/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services. SEARCH METHODS A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOMES A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices. WIDER IMPLICATIONS This analysis identifies core components for delivery of oncofertility MOC. The provision of oncofertility services requires planning to ensure services have safe and reliable referral pathways and that they are age-appropriate and include medical and psychological oncofertility care into the survivorship period. In order for this to happen, collaboration needs to occur between clinicians, allied HCPs and executives within paediatric and adult hospitals, as well as fertility clinics across both public and private services. Training of both cancer and non-cancer HCPs is needed to improve the knowledge of HCPs, the quality of care provided and the confidence of HCPs with these consultations.
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Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
| | - Paula Laws
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
| | - Shanna Logan
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
- Fertility and Research Centre, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW, Australia
| | - Carla Saunders
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, Australia
| | - Jo Travaglia
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, Australia
| | - Brigitte Gerstl
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia
| | - Natalie Bradford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland, Australia
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
| | - Mary Birdsall
- Fertility Associates, 7 Ellerslie Racecourse Drive, Auckland City, New Zealand
| | - Ronald Barr
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Nao Suzuki
- St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki Kanagawa Prefecture, Japan
| | - Seido Takae
- St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki Kanagawa Prefecture, Japan
| | - Ricardo Marinho
- Pro Criar Medicina Reprodutiva, Rua Bernardo Guimarães 2063, Belo Horizonte, Brazil
| | - Shuo Xiao
- Reproductive Health and Toxicology Lab, Dept. Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene St, Rm 327, Columbia, SC, USA
| | - Chen Qiong-Hua
- Obstetrics and Gynecology Department, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Siming Qu, Xiamen Shi 35, China
| | - Nalini Mahajan
- Mother and Child Hospital, D-59 Defence Colony, New Delhi, India
| | - Madhuri Patil
- Dr. Patil’s Fertility and Endoscopy Center, Center for Assisted Reproductive Technology, Endoscopic Surgery and Andrology, Bangalore, India
| | - Devika Gunasheela
- Gunasheela Surgical & Maternity Hospital, No. 1, Dewan Madhava Road, Opp. M. N. Krishna Rao Park, Basavanagudi, Bengaluru, Karnataka, India
| | - Kristen Smith
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
| | - Leonard Sender
- Children’s Hospital Orange County, 1201 W La Veta Avenue, Orange, CA, USA
| | - Cláudia Melo
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Edifício de São Jerónimo, Piso 2, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Edifício de São Jerónimo, Piso 2, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mahmoud Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
- Reproductive Medicine Department, National Research Center, Buhouth Street 33, Cairo, Egypt
| | - Leslie Appiah
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
- Nationwide Children’s Hospital, Department of Paediatric Surgery, 700 Children’s Drive, Columbus, OH, USA
| | - Irene Su
- University of California San Diego, 355 Dickinson St # 315, San Diego, CA, USA
| | - Sheila Lane
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
- University of Oxford, Wellington Square, Oxford, UK
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
| | - Allan Pacey
- Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, South Yorkshire, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh University, 47 Little France Crescent, Scotland, UK
| | - Francoise Shenfield
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, 25 Grafton Way, London, UK
| | - William Ledger
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
- Fertility and Research Centre, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW, Australia
| | - Elizabeth Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, 15 Broadway, Ultimo, Sydney, NSW, Australia
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12
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Zhao H, Jin L, Li Y, Zhang C, Wang R, Li Y, Huang W, Cui C, Zhang H, Wang H, Ma D, Liao S. Oncofertility: What can we do from bench to bedside? Cancer Lett 2019; 442:148-160. [DOI: 10.1016/j.canlet.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
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13
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Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK. Oncofertility-An emerging discipline rather than a special consideration. Pediatr Blood Cancer 2018; 65:e27297. [PMID: 29972282 PMCID: PMC6150802 DOI: 10.1002/pbc.27297] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
Originally absent from the oncologist's consult, then placed in a 'quality of life' rubric, oncofertility should now be an essential part of a comprehensive cancer treatment plan in patients of reproductive age, including adolescents and young adults (AYAs). Oncofertility encompasses the endocrine health of the patient, as well as fertility management options. Thus, pubertal transitions in males and females, bone health, and menstrual health are all part of this discipline, enabling practitioners to work in interdisciplinary teams to solve problems in reproductive health. This review provides a summary of the essential considerations required for the assessement of reproductive risk and choice of fertility preservation options as well as considerations for developing oncofertility services for AYAs.
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Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women’s and Children’s Hospital, University of New South Wales, Sydney
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology University of Melbourne Royal Women’s Hospital, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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14
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Shiraishi E, Sugimoto K, Shapiro JS, Ito Y, Kamoshita K, Kusuhara A, Haino T, Koizumi T, Okamoto A, Suzuki N. Study of the Awareness of Adoption as a Family-Building Option Among Oncofertility Stakeholders in Japan. J Glob Oncol 2018; 4:JGO.18.00043. [PMID: 32259157 PMCID: PMC7853874 DOI: 10.1200/jgo.18.00043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose The oncofertility decision tree was developed by the oncofertility consortium as a tool to support healthcare professionals and patients through the complicated process of deciding the most appropriate fertility preservation strategy for patients with cancer. Various strategies include oocyte retrieval, oocyte donation, use of a gestational carrier and adoption. However, differences in the cultural and legal landscape present serious barriers to utilizing some of these strategies in Japan. Patients and Methods We surveyed Japanese oncofertility stakeholders including 60 cancer survivors, 27 oncology facilities, 78 reproductive medicine facilities and 15 adoption agencies by a questionnaire to characterize awareness among oncofertility stakeholders in Japan about parenting options including adoption to inform work to establish guidelines for decision-making by cancer survivors in an oncofertility. Results Our results indicate that oncologists and reproductive endocrinologists in Japan have an insufficient understanding of adoption that prevents them from adequately informing their patients. Japanese cancer survivors self-describe a lack in confidence in finding a suitable partner and raising a child. Contrastingly, of the 9 adoption agencies which responded, no agency included being a cancer survivor as a criterion for disqualification and 4 of 9 (44%) adoption agencies reported at least 1 adoption to a cancer survivor in the last year. Conclusion Our work demonstrates that a cancer survivor's medical history itself is not a hurdle to adoption and investment in patient-provider education could be a viable strategy to improve the utilization of adoption as a fertility preservation strategy in Japan.
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Affiliation(s)
| | | | | | - Yuki Ito
- The Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | - Tomoe Koizumi
- National Research Institute for Child Health and Development, Tokyo, Japan
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Nao Suzuki
- St Marianna University School of Medicine, Kanagawa, Japan
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15
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Johnson AC, Mays D, Rehberg K, Shad A, Tercyak KP. Knowledge and Beliefs About Oncofertility and Associations with Quality of Life Among Adolescent and Young Adult Survivors of Pediatric Cancer. J Adolesc Young Adult Oncol 2018; 7:424-429. [PMID: 29672191 DOI: 10.1089/jayao.2018.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Adolescent and young adult (AYA) cancer survivors experience fertility and childrearing challenges in adulthood, but there is limited evidence on awareness, beliefs, and concerns about oncofertility in this population, needs for supportive resources, and associations with quality of life (QoL). METHODS Participants were 69 AYAs aged 12-25 who were diagnosed with cancer at age 18 years or younger and ≥1 year cancer free, recruited from childhood cancer clinical records and support organizations. Participants completed self-report assessment of oncofertility knowledge and beliefs, information needs, and measures of QoL. Analyses examined associations between oncofertility-related variables and QoL. RESULTS Knowledge and beliefs about oncofertility options were considerably low in the sample, and participants reported unmet oncofertility resource needs. In multivariable analyses, QoL was associated with beliefs valuing the importance of fertility in childhood cancer (β = 0.87, p = 0.01) and lower information needs (β = -1.19, p = 0.022). CONCLUSIONS Infertility is a well-documented effect of childhood cancer treatment. Our findings indicate that clinical providers are a preferred source of information for AYA patients, and there is a need to address oncofertility concerns and challenges in this group. Research is needed to examine barriers to addressing fertility issues in childhood cancer treatment and ways to promote dialogue between providers and patients and their families.
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Affiliation(s)
- Andrea C Johnson
- 1 Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, District of Columbia
| | - Darren Mays
- 2 Lombardi Comprehensive Cancer Center, Georgetown University Medical Center , Washington, District of Columbia
| | - Kathryn Rehberg
- 2 Lombardi Comprehensive Cancer Center, Georgetown University Medical Center , Washington, District of Columbia
| | - Aziza Shad
- 3 Division of Pediatric Hematology Oncology, The Herman & Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland
| | - Kenneth P Tercyak
- 2 Lombardi Comprehensive Cancer Center, Georgetown University Medical Center , Washington, District of Columbia
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Long-term outcomes in cancer patients who did or did not pursue fertility preservation. Fertil Steril 2018; 109:349-355. [PMID: 29338854 DOI: 10.1016/j.fertnstert.2017.10.029] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/08/2017] [Accepted: 10/20/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare long-term outcomes of cancer patients who pursued fertility preservation (FP) with those who did not and compare random-start (RS) and menstrual cycle-specific (CS) protocols for FP. DESIGN Retrospective cohort. SETTING Single urban academic institution. PATIENT(S) Oncology patients who contacted the FP patient navigator, 2005-2015. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Time to cancer treatment, disease-free survival, and reproductive outcomes in FP versus no-FP patients and cycle outcomes for RS versus CS protocols. Data were analyzed by χ2 and logistic regression. RESULT(S) Of 497 patients who met the inclusion criteria, 41% elected FP. The median number of days to cancer treatment was 33 and 19 days in the FP and no-FP groups, respectively. There was no difference in cancer recurrence or mortality. There were no differences in stimulation parameters, outcomes, or days to next cancer treatment in RS versus CS protocols. Twenty-one patients returned to use cryopreserved specimens, resulting in 16 live births. Eight of 21 returning patients used a gestational carrier. Thirteen FP (6.4%) and 16 no-FP (5.5%) patients experienced a spontaneous pregnancy. CONCLUSION(S) FP is both safe and efficacious for eligible cancer patients. Only 10% of patients returned to use cryopreserved specimens, and almost half used a gestational carrier, suggesting the need for further research into reproductive decision-making in cancer survivors.
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Silva C, Almeida-Santos AT, Melo C, Ribeiro Rama AC. Antineoplastic Agents and (In)fertility: Informing Patients to Improve Decisions. J Adolesc Young Adult Oncol 2018; 7:306-314. [PMID: 29298112 DOI: 10.1089/jayao.2017.0094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Infertility is a potential adverse effect of cancer treatment, and future fertility is an important issue for cancer patients. In Portugal, the Centre for Fertility Preservation of CHUC, EPE, conducted a project to develop and disseminate oncofertility information resources. In this study, we report the results of the specific component of this program, which intended to produce information resources that promote patients' awareness of the subject and to support decisions concerning fertility preservation. METHODS Guidance for writing health information for patients and criteria for developing decision aids were gathered. Information needs were assessed (literature review and locally applied questionnaire). Resources were pre-tested with a sample of patients and professionals. Their readability, presentation quality, and ability to support decisions were evaluated. RESULTS General information handouts on infertility risk and decision aids about fertility preservation options were developed and positively evaluated. The resources are currently being distributed in collaboration with several national organizations. CONCLUSIONS Through our multidisciplinary information program, reproductive-age cancer patients now have access to relevant information resources that will support timely, shared decision-making concerning fertility preservation.
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Affiliation(s)
- Cristina Silva
- 1 Pharmacology Department, Faculty of Pharmacy, University of Coimbra , Coimbra, Portugal
| | - Ana Teresa Almeida-Santos
- 2 Centre for Fertility Preservation, Human Reproduction Department, Coimbra Hospital and University Centre (CHUC) , EPE, Coimbra, Portugal .,3 Faculty of Medicine, University of Coimbra , Coimbra, Portugal
| | - Cláudia Melo
- 4 Faculty of Psychology and Educational Sciences, University of Coimbra , Coimbra, Portugal
| | - Ana Cristina Ribeiro Rama
- 1 Pharmacology Department, Faculty of Pharmacy, University of Coimbra , Coimbra, Portugal .,5 Centre for 20th Century Interdisciplinary Studies CEIS20, University of Coimbra , Coimbra, Portugal
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Hanselin MR, Roybal DL, Leininger TB. Ethics and Oncofertility: A Call for Religious Sensitivity. J Oncol Pract 2017; 13:e582-e589. [DOI: 10.1200/jop.2016.020487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines do not address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient’s faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today. We recommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient’s moral and religious preferences into the treatment plan. We encourage providers to be prepared to offer resources to patients who desire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources.
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Salama M, Woodruff TK. Anticancer treatments and female fertility: clinical concerns and role of oncologists in oncofertility practice. Expert Rev Anticancer Ther 2017; 17:687-692. [PMID: 28537815 DOI: 10.1080/14737140.2017.1335199] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Anticancer treatments such as aggressive chemotherapy and radiotherapy have deleterious gonadotoxic side effects and are considered the most common causes of pathological and iatrogenic fertility loss in women. Areas covered: In order to preserve fertility of young women and girls with cancer, several established, experimental, and debatable options can be offered in the emerging field of oncofertility. This article reviews the effects of anticancer treatments on female fertility and discusses the current challenges and future directions of fertility preservation options that can be offered to the female patients with cancer. Expert commentary: Although promising, several medical, economic, social and legal barriers face oncofertility practice around the globe especially in underserved areas. To overcome such barriers, more effective solutions should be provided to spread awareness and enhance communication between patients, oncologists and gynecologists. Early referral by oncologists before initiation of chemotherapy and radiotherapy is an important key factor for success in female fertility preservation strategies.
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Affiliation(s)
- Mahmoud Salama
- a Department of Obstetrics and Gynecology, Medical Faculty , University of Cologne , Cologne , Germany
| | - Teresa K Woodruff
- b Department of Obstetrics and Gynecology, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
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20
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Lawson AK, McGuire JM, Noncent E, Olivieri JF, Smith KN, Marsh EE. Disparities in Counseling Female Cancer Patients for Fertility Preservation. J Womens Health (Larchmt) 2017; 26:886-891. [PMID: 28498013 DOI: 10.1089/jwh.2016.5997] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Female cancer patients who are exposed to gonadotoxic chemotherapy are at risk of future infertility. Research suggests that disparities in fertility preservation counseling (FPC) may exist. Previous research is limited by recall bias; therefore, this study examined objective electronic medical chart data regarding FPC at an academic medical center. MATERIALS AND METHODS This study included reproductive-aged women (18-45 years old) with a diagnosis of breast, gynecological, or hematological cancer and who were exposed to a gonadotoxic chemotherapeutic agent from 2009 to 2013. Chi-square and logistic regression analyses were utilized to analyze disparities in FPC. RESULTS Two hundred fifty-nine women met the study criteria. One hundred eighty-one women were diagnosed with breast cancer, 52 with hematological cancer, and 26 with gynecological cancer. 160/259 (62%) women had documented counseling for fertility preservation (FP), 60 (23%) women were not counseled as counseling was determined to be "not applicable," 16 (6%) women were not counseled and no explanation was given for the lack of counseling, and counseling was not documented in 23 (9%) charts. Age, marital status, and racial/ethnic background were related to counseling status. Patients with gynecological or hematological cancer were more likely to be counseled than other patients. Logistic regression results demonstrated that FPC was largely driven by cancer diagnosis. CONCLUSIONS Although cancer diagnosis was the greatest predictor of FPC, disparities were evident in the counseling of female cancer patients for FP treatment. Equality in counseling female patients for FP treatment is imperative to reduce the risk of emotional harm and future infertility.
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Affiliation(s)
- Angela K Lawson
- 1 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Jamie M McGuire
- 1 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Edernst Noncent
- 1 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - John F Olivieri
- 1 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Kristin N Smith
- 1 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Erica E Marsh
- 2 Department of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
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21
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Vu JV, Llarena NC, Estevez SL, Moravek MB, Jeruss JS. Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients. J Surg Oncol 2016; 115:116-121. [PMID: 27966219 DOI: 10.1002/jso.24418] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. METHODS An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007-2012, after program initiation. The study included women <45, stages 0-III, diagnosed before (n = 278) and after (n = 515) program initiation. RESULTS Demographics for the cohorts were similar. Fertility discussions (P < 0.0001), patients interested in maintaining fertility at diagnosis (P = 0.0041), referrals to reproductive endocrinologists (P < 0.0001), appointments (P < 0.0001), and fertility preservation procedures (P < 0.0183) increased significantly after programmatic implementation. CONCLUSIONS An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. J. Surg. Oncol. 2017;115:116-121. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Natalia C Llarena
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Jacqueline S Jeruss
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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22
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Ito Y, Shiraishi E, Kato A, Haino T, Sugimoto K, Okamoto A, Suzuki N. The Utility of Decision Trees in Oncofertility Care in Japan. J Adolesc Young Adult Oncol 2016; 6:186-189. [PMID: 27763800 DOI: 10.1089/jayao.2016.0045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To identify the utility and issues associated with the use of decision trees in oncofertility patient care in Japan. METHODS A total of 35 women who had been diagnosed with cancer, but had not begun anticancer treatment, were enrolled. We applied the oncofertility decision tree for women published by Gardino et al. to counsel a consecutive series of women on fertility preservation (FP) options following cancer diagnosis. Percentage of women who decided to undergo oocyte retrieval for embryo cryopreservation and the expected live-birth rate for these patients were calculated using the following equation: expected live-birth rate = pregnancy rate at each age per embryo transfer × (1 - miscarriage rate) × No. of cryopreserved embryos. RESULTS Oocyte retrieval was performed for 17 patients (48.6%; mean ± standard deviation [SD] age, 36.35 ± 3.82 years). The mean ± SD number of cryopreserved embryos was 5.29 ± 4.63. The expected live-birth rate was 0.66. CONCLUSIONS The expected live-birth rate with FP indicated that one in three oncofertility patients would not expect to have a live birth following oocyte retrieval and embryo cryopreservation. While the decision trees were useful as decision-making tools for women contemplating FP, in the context of the current restrictions on oocyte donation and the extremely small number of adoptions in Japan, the remaining options for fertility after cancer are limited. In order for cancer survivors to feel secure in their decisions, the decision tree may need to be adapted simultaneously with improvements to the social environment, such as greater support for adoption.
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Affiliation(s)
- Yuki Ito
- 1 Department of Obstetrics and Gynecology, The Jikei University School of Medicine , Tokyo, Japan
| | - Eriko Shiraishi
- 1 Department of Obstetrics and Gynecology, The Jikei University School of Medicine , Tokyo, Japan
| | - Atsuko Kato
- 1 Department of Obstetrics and Gynecology, The Jikei University School of Medicine , Tokyo, Japan
| | - Takayuki Haino
- 1 Department of Obstetrics and Gynecology, The Jikei University School of Medicine , Tokyo, Japan
| | - Kouhei Sugimoto
- 1 Department of Obstetrics and Gynecology, The Jikei University School of Medicine , Tokyo, Japan
| | - Aikou Okamoto
- 1 Department of Obstetrics and Gynecology, The Jikei University School of Medicine , Tokyo, Japan
| | - Nao Suzuki
- 2 Department of Obstetrics and Gynecology, St. Marianna University School of Medicine , Kawasaki, Japan
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Sifer C, Sellam-Chokron O, Sermondade N, Cedrin-Durnerin I, Sonigo C, Herbemont C, Grynberg M. Should metaphase 1 and 2 stages oocytes be vitrified in the same time for fertility preservation? Future Oncol 2016; 12:2297-305. [DOI: 10.2217/fon-2016-0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aims: Could metaphase 1 (M1) and 2 (M2) stages oocytes from in vitro maturation (IVM) cycles and controlled-ovarian hyperstimulation (COH) cycles be frozen at the same time without any adverse effect of vitrification on further survival (SR) and maturation rates (MR)? Materials & methods: M1 from cancer patients were prospectively included in IVM/COH groups, and in study or control subgroups if they were vitrified or not. In each study subgroup, SR were compared with that of M2 oocytes vitrified/warmed from egg donors. MR were compared with those of fresh-M1 oocytes from control IVM/COH subgroups. Results: SR were not different between groups. MR compared respectively between survived- and fresh-M1 oocytes were similar when resulting from COH (85.2 vs 81.1%) but significantly lower after IVM (39.1 vs 73.3%). Conclusion: Simultaneous freezing of M1/M2 oocytes could be applied to COH but not to IVM during the course of fertility preservation.
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Affiliation(s)
- Christophe Sifer
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
- UFR de Santé, Médecine et Biologie Humaine, Université Paris 13, 93017 Bobigny Cedex, France
- Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France
| | - Olivia Sellam-Chokron
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
| | - Nathalie Sermondade
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
| | - Isabelle Cedrin-Durnerin
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
| | - Charlotte Sonigo
- UFR de Santé, Médecine et Biologie Humaine, Université Paris 13, 93017 Bobigny Cedex, France
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
| | - Charlène Herbemont
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
- UFR de Santé, Médecine et Biologie Humaine, Université Paris 13, 93017 Bobigny Cedex, France
| | - Michael Grynberg
- UFR de Santé, Médecine et Biologie Humaine, Université Paris 13, 93017 Bobigny Cedex, France
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique – Hôpitaux de Paris, 93143 Bondy, France
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Chan JL, Letourneau J, Salem W, Cil AP, Chan SW, Chen LM, Rosen MP. Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv 2016; 11:58-63. [PMID: 27480882 DOI: 10.1007/s11764-016-0563-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/24/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Data have demonstrated an association between regret and lack of fertility counseling among patients undergoing treatment for non-gynecologic cancers. We sought to determine if fertility-related regret is reduced with pre-treatment counseling or fertility-sparing surgery (FSS) in patients with gynecologic cancers. METHODS A cross-sectional survey was administered to 593 reproductive-age survivors (18-40 years old at diagnosis) of localized cervix, ovarian, or endometrial cancers that were eligible for FSS. A validated decision regret score was used to evaluate regret in patients. RESULTS Four hundred seventy women completed the survey. Forty-six percent received pre-treatment counseling about treatment's effects on fertility. Having received counseling (adjusted ß-coefficient of -1.24, 95 % CI = -2.29 to -0.18, p = 0.02), satisfactory counseling (adjusted ß-coefficient of -2.71, 95 % CI = -3.86 to -1.57, p < 0.001), and FSS (adjusted ß-coefficient of -1.26, 95 % CI = -2.39 to -0.14, p = 0.03) were associated with lower regret post-treatment, after adjusting for age. Time since diagnosis, prior parity, socioeconomic status and cancer type were not associated with regret (p > 0.05). While 50 % of women reported desiring more children after diagnosis, desire for children after treatment was associated with increased regret (adjusted ß-coefficient of 3.97, 95 % CI = 2.92-5.02, p < 0.001). CONCLUSIONS Though less than half of study participants received counseling about the effect of cancer treatment on future fertility, both fertility counseling and FSS were associated with decreased regret in reproductive-aged women with gynecologic cancers. The desire for more children after treatment was associated with increased regret. IMPLICATIONS FOR CANCER SURVIVORS Inquiring about fertility desires and providing counseling regarding reproductive outcomes following cancer treatment should be implemented as part of the treatment process.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA. .,Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Wael Salem
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.,Department of Obstetrics and Gynecology, University of Southern California, 1240 North Mission Road, Los Angeles, CA, 90033, USA
| | - Aylin Pelin Cil
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.,Istanbul Memorial Hospital ART and Reproductive Genetics Center, Piyale Pasa Bulvari, 34385, Okmeydani Sisli, Istanbul, Turkey
| | - Sai-Wing Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
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Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR. Psychological Counseling of Female Fertility Preservation Patients. J Psychosoc Oncol 2015; 33:333-53. [PMID: 25996581 DOI: 10.1080/07347332.2015.1045677] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Young cancer patients are increasingly interested in preserving their fertility prior to undergoing gonadotoxic therapies. Although the medical safety and treatment protocols for fertility preservation have been well documented, limited research has addressed the emotional issues that arise in fertility preservation patients. We briefly review the literature on the psychosocial issues in adult female fertility preservation treatment and describe our experiences within this patient population. Our findings suggest that several important issues to be addressed during the psychological counseling of adult female fertility preservation patients include: (1) preexisting psychological distress in patients undergoing treatment, (2) choice of fertility preservation strategy in the face of an uncertain relationship future, (3) decision making regarding use of third-party reproduction (e.g., sperm/egg donation, gestational surrogacy), (4) treatment expectations regarding pregnancy and miscarriage, (5) ethical issues related to treatment including the creation, cryopreservation, and disposition of embryos/oocytes, and (6) decision regret from patients who declined fertility preservation.
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Affiliation(s)
- Angela K Lawson
- a Department of Obstetrics and Gynecology, Northwestern University , Chicago , IL , USA
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26
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Langbeen A, De porte HF, Bartholomeus E, Leroy JL, Bols PE. Bovine in vitro reproduction models can contribute to the development of (female) fertility preservation strategies. Theriogenology 2015; 84:477-89. [DOI: 10.1016/j.theriogenology.2015.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/01/2015] [Accepted: 04/11/2015] [Indexed: 01/06/2023]
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Woodruff TK. Oncofertility: a grand collaboration between reproductive medicine and oncology. Reproduction 2015; 150:S1-10. [PMID: 26130814 PMCID: PMC4710491 DOI: 10.1530/rep-15-0163] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/29/2015] [Indexed: 01/01/2023]
Abstract
In 2007, I was asked by the University of Calgary to participate in a symposium called 'Pushing the Boundaries--Advances that Will Change the World in 20 Years'. My topic was oncofertility, a word I had just coined to describe the intersection of two disciplines--oncology and fertility--and I was thrilled to share my passion for this new field and help young women with cancer protect their future reproductive health. Fertility preservation in the cancer setting lacked a concerted effort to bridge the disciplines in an organized manner. In early 2015, I was delighted to deliver a presentation for the Society for Reproduction and Fertility titled 'Sex in Three Cities', where I gave an update on the oncofertility movement, a remarkable cross-disciplinary, global collaboration created to address the fertility preservation needs of young cancer patients. During my tour of the UK, I was impressed by the interest among the society and its members to engage colleagues outside the discipline as well as the public in a dialogue about cutting-edge reproductive science. In this invited review, I will describe the work of the Oncofertility Consortium to provide fertility preservation options in the cancer setting and accelerate the acceptance of this critical topic on a global scale. I hope that one day this word and field it created will change the world for women who had been left out of the equation for far too long.
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Affiliation(s)
- Teresa K Woodruff
- The Thomas J Watkins Professor of Obstetrics and GynecologyDepartment of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E Superior Street, Lurie 10-250, Chicago, Illinois 60611, USA
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Dursun P, Doğan NU, Ayhan A. Oncofertility for gynecologic and non-gynecologic cancers: Fertility sparing in young women of reproductive age. Crit Rev Oncol Hematol 2014; 92:258-67. [DOI: 10.1016/j.critrevonc.2014.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022] Open
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Stein DM, Victorson DE, Choy JT, Waimey KE, Pearman TP, Smith K, Dreyfuss J, Kinahan KE, Sadhwani D, Woodruff TK, Brannigan RE. Fertility Preservation Preferences and Perspectives Among Adult Male Survivors of Pediatric Cancer and Their Parents. J Adolesc Young Adult Oncol 2014; 3:75-82. [PMID: 24940531 DOI: 10.1089/jayao.2014.0007] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: In this study, we set out to determine the preferences, concerns, and attitudes toward fertility preservation of adult male survivors of pediatric cancer and their parents. Methods: We conducted 3 focus groups with a total of 15 male survivors of pediatric cancer (age at diagnosis: mean=14, range: 10-20; age at study: mean=35, range: 25-47) and 2 groups with a total of 7 parents of survivors. Grounded theory methodology was used for the identification and analysis of recurrent themes expressed by survivors and their parents in the course of focus group discussions. Results: Themes most frequently expressed by survivors included concern regarding long-term treatment effects and a retrospective desire for fertility impairment to have been discussed when they were originally diagnosed with cancer. Parental themes included the same hindsight desire, as well as reliance upon the treating oncologist for direction in selecting the course of treatment, and an acknowledgment that input from a specialist in fertility preservation would have been beneficial. Conclusions: Although future reproductive potential was not consistently reported as a source of apprehension when diagnosed with cancer, both survivors and their parents noted it to be a paramount concern later in life. Parents and survivors both reported that fertility preservation discussions should be routinely incorporated in the clinical context of a pediatric cancer diagnosis.
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Affiliation(s)
- Daniel M Stein
- Department of Urology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. ; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - David E Victorson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. ; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago, Illinois
| | - Jeremy T Choy
- Department of Urology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Kate E Waimey
- The Oncofertility Consortium at Northwestern University , Chicago, Illinois
| | - Timothy P Pearman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. ; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago, Illinois
| | - Kristin Smith
- The Oncofertility Consortium at Northwestern University , Chicago, Illinois
| | - Justin Dreyfuss
- Department of Urology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Karen E Kinahan
- The Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago, Illinois
| | - Divya Sadhwani
- College of Medicine, University of Central Florida , Orlando, Florida
| | - Teresa K Woodruff
- The Oncofertility Consortium at Northwestern University , Chicago, Illinois
| | - Robert E Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. ; The Oncofertility Consortium at Northwestern University , Chicago, Illinois
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Kuhn L, Page K, Ward J, Worrall-Carter L. The process and utility of classification and regression tree methodology in nursing research. J Adv Nurs 2013; 70:1276-86. [PMID: 24237048 PMCID: PMC4265242 DOI: 10.1111/jan.12288] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/01/2022]
Abstract
Aim This paper presents a discussion of classification and regression tree analysis and its utility in nursing research. Background Classification and regression tree analysis is an exploratory research method used to illustrate associations between variables not suited to traditional regression analysis. Complex interactions are demonstrated between covariates and variables of interest in inverted tree diagrams. Design Discussion paper. Data sources English language literature was sourced from eBooks, Medline Complete and CINAHL Plus databases, Google and Google Scholar, hard copy research texts and retrieved reference lists for terms including classification and regression tree* and derivatives and recursive partitioning from 1984–2013. Discussion Classification and regression tree analysis is an important method used to identify previously unknown patterns amongst data. Whilst there are several reasons to embrace this method as a means of exploratory quantitative research, issues regarding quality of data as well as the usefulness and validity of the findings should be considered. Implications for Nursing Research Classification and regression tree analysis is a valuable tool to guide nurses to reduce gaps in the application of evidence to practice. With the ever-expanding availability of data, it is important that nurses understand the utility and limitations of the research method. Conclusion Classification and regression tree analysis is an easily interpreted method for modelling interactions between health-related variables that would otherwise remain obscured. Knowledge is presented graphically, providing insightful understanding of complex and hierarchical relationships in an accessible and useful way to nursing and other health professions.
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Affiliation(s)
- Lisa Kuhn
- St Vincent's Centre for Nursing Research, Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine (Victoria), Australian Catholic University, Melbourne, Victoria, Australia
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Ronn R, Holzer HEG. Oncofertility in Canada: an overview of Canadian practice and suggested action plan. ACTA ACUST UNITED AC 2013; 20:e465-74. [PMID: 24155643 DOI: 10.3747/co.20.1361] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, these fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. METHODS Here, we describe the services currently available in Canada and the challenges associated with their utilization. Finally, we outline strategies to help maximize and facilitate fertility preservation in the young cancer patient. RESULTS Despite an existing infrastructure to the oncofertility system in Canada, the ability of that system's components to function together and to coordinate patient care is a challenge. Areas of weakness include poor access and referral to fertility services, a lack of readily available education for patients and health care providers, and inconsistent interdisciplinary coordination in patient care. CONCLUSIONS The implementation of a framework for multidisciplinary resource allocation, education, patient referral, and established lines of communication may facilitate a functional oncofertility system in Canada.
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Affiliation(s)
- R Ronn
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
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Herrero MB, Delbes G, Chung JT, Son WY, Holzer H, Buckett W, Chan P. Case report: the use of annexin V coupled with magnetic activated cell sorting in cryopreserved spermatozoa from a male cancer survivor: healthy twin newborns after two previous ICSI failures. J Assist Reprod Genet 2013; 30:1415-9. [PMID: 24057155 DOI: 10.1007/s10815-013-0086-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/13/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of the study is to report successful outcome (live births) after sperm sorting with annexin V-MACS on cryopreserved spermatozoa with high level of sperm DNA fragmentation from a cancer patient survivor. METHODS Cryopreserved spermatozoa were sorted with annexin V-MACS prior to ICSI. Sperm DNA fragmentation was evaluated by SCSA(®) and TUNEL. RESULTS The couple had two previous IVF/ICSI cycles failures using sperm cryopreserved before cancer treatment. On third ICSI cycle attempt results were as follow: pre-annexin V-MACS sperm quality: 10 × 10(6)/ml, 3.3 % progressive motility, 1 % normal forms, TUNEL: 72.5 % positive cells, SCSA(®): 76.6 % DFI. Post-annexin V-MACS sperm quality: 2.8 × 10(6)/ml, 10 % progressive motility, TUNEL: 58.8 % positive cells. Eight metaphase II oocytes were collected, 4 fertilized, 2 embryos were transferred on day 3 and healthy twins were born (1 boy, 1 girl). CONCLUSIONS Annexin V-MACS technique could be a potential tool to improve sperm quality on cryopreserved spermatozoa of cancer patient and improve ICSI outcome.
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Affiliation(s)
- María Belén Herrero
- MUHC Reproductive Center, McGill University Health Center, 687 Pine Av. West, Montreal, Quebec, Canada
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Hershberger PE, Finnegan L, Altfeld S, Lake S, Hirshfeld-Cytron J. Toward theoretical understanding of the fertility preservation decision-making process: examining information processing among young women with cancer. Res Theory Nurs Pract 2013; 27:257-75. [PMID: 24552086 PMCID: PMC4164111 DOI: 10.1891/1541-6577.27.4.257] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. OBJECTIVE The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. METHODS Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. RESULTS In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. CONCLUSION Better understanding of theoretical underpinnings surrounding women's information processes can facilitate decision support and improve clinical care.
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Affiliation(s)
- Patricia E Hershberger
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA.
| | - Lorna Finnegan
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA
| | - Susan Altfeld
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA
| | - Sara Lake
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA
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Salama M, Winkler K, Murach KF, Seeber B, Ziehr SC, Wildt L. Female fertility loss and preservation: threats and opportunities. Ann Oncol 2012; 24:598-608. [PMID: 23129121 DOI: 10.1093/annonc/mds514] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ovarian aging and cytotoxic treatments are the most common causes for fertility loss in women. With increasing numbers of young female survivors following cytotoxic cancer treatments, the issue of fertility preservation has assumed greater importance. METHODS We review the literature on the causes of female fertility loss as well as the recent advances in fertility preservation options and strategies that might be of interest to oncologists. Currently, several methods and techniques exist for fertility preservation of female patients with cancer including embryo freezing, ovarian protection techniques, oocyte cryopreservation, ovarian tissue cryopreservation followed by autotransplantation, and recently in vitro culture of ovarian tissue, follicles, and oocytes. Each method or technique has advantages and disadvantages related to current success rate, required delay in cancer treatment, sperm requirement, and risk of reintroducing cancer cells. RESULTS To date, embryo freezing is the only established method successfully and widely used for fertility preservation of female patients with cancer. The other methods are promising but still considered experimental. CONCLUSION Patient awareness, physician knowledge, early counseling, costs management, international registry, interdisciplinary networks, and research development are necessary to improve the current care in the field of female fertility preservation.
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Affiliation(s)
- M Salama
- Department of Gynecological Endocrinology and Reproductive Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria
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Waimey KE, Krausfeldt AD, Taylor RL, Wallach HD, Woodruff TK. Understanding Technology and Human Interaction to Catalyze Oncofertility and Adolescent and Young Adult Oncology Research. J Adolesc Young Adult Oncol 2011; 1:160-163. [PMID: 23610736 DOI: 10.1089/jayao.2012.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Kate E Waimey
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University , Chicago, Illinois. ; Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
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Abstract
PURPOSE OF REVIEW With improved treatments for breast cancer forming a large community of young survivors, quality-of-life issues including fertility are becoming more important. Oncologists, whose treatments may put their young patient's fertility at risk, must be aware of the existing options for fertility preservation. RECENT FINDINGS Many commonly used chemotherapeutic agents diminish a woman's ovarian function. The mechanisms for this damage include follicular apoptosis and cortical fibrosis. While highly variable, depending on factors such as age at exposure, agent and dose, the incidence of permanent amenorrhea following adjuvant systemic therapy for breast cancer patients older than age 30 years spans 13-68%. There are many fertility preservation options available, and a growing number of systems in place to link patients with resources. Advances in the sciences of oocyte, embryo and ovarian tissue preservation are important, and an increase in the awareness of fertility preservation options by both physicians and patients is also critical. SUMMARY Fertility preservation is an important part of a young breast cancer patient's quality of life as she contemplates a cancer-free future. The authors will define the scope of the problem and its causes, and explore currently available strategies for fertility preservation in this patient population.
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Hirshfeld-Cytron J, Gracia C, Woodruff TK. Nonmalignant diseases and treatments associated with primary ovarian failure: an expanded role for fertility preservation. J Womens Health (Larchmt) 2011; 20:1467-77. [PMID: 21827325 DOI: 10.1089/jwh.2010.2625] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cancer treatments can be detrimental to fertility; recent literature has focused on the efforts of fertility preservation for this patient population. It should be recognized, however, that several nonmalignant medical conditions and therapeutic interventions could be similarly hazardous to fertility. Some of these nonmalignant diseases and their treatments that can adversely impact the reproductive axis are gastrointestinal diseases, rheumatologic disorders, nonmalignant hematologic conditions, neurologic disorders, renal disorders, gynecologic conditions, and metabolic diseases. Their negative effects on reproductive function are only now being appreciated and include impaired ovarian function, endocrine function, or sexual function and inability to carry a pregnancy to term. Complications and comorbidities associated with certain diseases may limit the success of established fertility preservation options. Recent advances in fertility preservation techniques may provide these patients with new options for childbearing. Here, we review several fertility-threatening conditions and treatments, describe current established and experimental fertility preservation options, and present three initiatives that may help minimize the adverse reproductive effects of these medical conditions and treatments by raising awareness of the issues and options: (1) increase awareness among practitioners about the reproductive consequences of specific diseases and treatments, (2) facilitate referral of patients to fertility-sparing or restorative programs, and (3) provide patient education about the risk of infertility at the time of diagnosis before initiation of treatment.
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Affiliation(s)
- Jennifer Hirshfeld-Cytron
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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38
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Current World Literature. Curr Opin Obstet Gynecol 2011. [DOI: 10.1097/gco.0b013e32834731fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Balthazar U, Fritz MA, Mersereau JE. Fertility preservation: a pilot study to assess previsit patient knowledge quantitatively. Fertil Steril 2011; 95:1913-6. [DOI: 10.1016/j.fertnstert.2011.02.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/20/2011] [Accepted: 02/04/2011] [Indexed: 11/30/2022]
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Duncan FE, Jozefik JK, Kim AM, Hirshfeld-Cytron J, Woodruff TK. The Gynecologist Has a Unique Role in Providing Oncofertility Care to Young Cancer Patients. US OBSTETRICS & GYNAECOLOGY 2011; 6:24-34. [PMID: 21927621 PMCID: PMC3171692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Facing a cancer diagnosis at any age is devastating. However, young cancer patients have the added burden that life-preserving cancer treatments, including surgery, chemotherapy, and radiotherapy, may compromise their future fertility. The possibility of reproductive dysfunction as a consequence of cancer treatment has a negative impact on the quality of life of cancer survivors. The field of oncofertility, which merges the clinical specialties of oncology and reproductive endocrinology, was developed to explore and expand fertility preservation options and to better manage the reproductive status of cancer patients. Fertility preservation for females has proved to be a particular challenge because mature female gametes are rare and difficult to acquire. The purpose of this article is to provide the gynecologist with a comprehensive overview of how cancer treatments affect the female reproductive axis, delineate the diverse fertility preservation options that are currently available or being developed for young women, and describe current measures of ovarian reserve that can be used pre- and post-cancer treatment. As a primary care provider, the gynecologist will likely interact with patients throughout the cancer care continuum. Thus, the gynecologist is in a unique position to join the oncofertility team in providing young cancer patients with up-to-date fertility preservation information and referrals to specialists.
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Affiliation(s)
- Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago
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DNA damage stress response in germ cells: role of c-Abl and clinical implications. Oncogene 2010; 29:6193-202. [PMID: 20818431 DOI: 10.1038/onc.2010.410] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cells experiencing DNA damage undergo a complex response entailing cell-cycle arrest, DNA repair and apoptosis, the relative importance of the three being modulated by the extent of the lesion. The observation that Abl interacts in the nucleus with several proteins involved in different aspects of DNA repair has led to the hypothesis that this kinase is part of the damage-sensing mechanism. However, the mechanistic details underlying the role of Abl in DNA repair remain unclear. Here, I will review the evidence supporting our current understanding of Abl activation following DNA insults, while focusing on the relevance of these mechanisms in protecting DNA-injured germ cells. Early studies have shown that Abl transcripts are highly expressed in the germ line. Abl-deficient mice exhibit multiple abnormalities, increased perinatal mortality and reduced fertility. Recent findings have implicated Abl in a cisplatin-induced signaling pathway eliciting death of immature oocytes. A p53-related protein, TAp63, is an important immediate downstream effector of this pathway. Of note, pharmacological inhibition of Abl protects the ovarian reserve from the toxic effects of cisplatin. This suggests that the extent of Abl catalytic outputs may shift the balance between survival (likely through DNA repair) and activation of a death response. Taken together, these observations are consistent with the evolutionary conserved relationship between DNA damage and activation of the p53 family of transcription factors, while shedding light on the key role of Abl in dictating the fate of germ cells upon genotoxic insults.
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