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Cherven BO, Demedis J, Frederick NN. Sexual Health in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:717-724. [PMID: 37856773 DOI: 10.1200/jco.23.01390] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023] Open
Abstract
Sexual health (SH), an integral aspect of overall health and quality of life, can be negatively affected by cancer and cancer treatment. SH is influenced by biological, psychological, social, and cultural factors, and, for adolescents and young adults (AYAs), developmental factors. The AYA population (age 15-39 years) is diverse in terms of psychosexual development, interpersonal relationships, and varying levels of independence, resulting in unique SH needs for this population. AYAs with cancer are particularly vulnerable to unmet SH needs related to contraception and infection prevention, sexual function, body image, and romantic/sexual relationships. Sexual dysfunction during and after cancer treatment is reported by 30%-100% of AYA cancer survivors. Clinical guidelines recommend discussing SH and screening for dysfunction but currently lack specifics regarding psychosexual interventions and strategies for incorporating screening into clinical care. Research and clinical priorities include improved provider-AYA communication regarding SH, standardization of SH measures and screening tools, infrastructure to support the SH needs of AYAs across pediatric and adult clinical environments, and engagement of sexual and gender minority AYAs in research. As the field of SH in cancer evolves, interventions need to be tailored to the developmental needs that are unique to AYAs and address the multidimensional aspects of SH.
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Affiliation(s)
- Brooke O Cherven
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Jenna Demedis
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Natasha N Frederick
- Center for Cancer & Blood Disorders, Connecticut Children's, Hartford, CT
- Division of Hematology and Oncology, Department of Pediatrics, University of Connecticut School of Medicine, Mansfield, CT
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Tenaw Z, Gari T, Gebretsadik A. Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study. BMC Public Health 2023; 23:1550. [PMID: 37582722 PMCID: PMC10428632 DOI: 10.1186/s12889-023-16511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia. METHODS A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach. RESULTS In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice. CONCLUSION Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities.
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Affiliation(s)
- Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Taye Gari
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Achamyelesh Gebretsadik
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Iverson E, Brammer WA, Osorio B, Tanaka D, Cuevas R. Associations of Reproductive Health Concerns, Health-Related Quality of Life, and Stress Among Adolescents and Young Adults with Chronic Illness. J Dev Behav Pediatr 2022; 43:e515-e524. [PMID: 36217246 DOI: 10.1097/dbp.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYA) living with chronic illness are as sexually active and interested in having children as healthy peers. Few studies have examined the intersection of managing chronic illness and concerns about realizing reproductive goals, including fertility, pregnancy, childbirth, and parenting. Even less is understood regarding how these concerns might be associated with psychological distress. This study examines associations between the reproductive health concerns (RHC) and health-related stress of AYA patients living with chronic conditions including rheumatologic, cardiac, pulmonology, gastrointestinal disorders, and solid organ transplant. METHODS A total of 140 patients aged 15 to 20 years (68% female; 81% Hispanic/Latinx) recruited from a transition program located at a safety-net pediatric institution completed surveys examining multiple dimensions of RHC and health-related quality of life (life satisfaction, illness burden, and illness-related anxiety) and condition-related stress. Exploratory factor analyses of RHC variables yielded 3 factors used in regression analyses to identify convergent validity of RHC factors with health-related mental health measures. RESULTS Three RHC factor loadings emerged: concern about availability to raise children (timing/future), impact of condition/medication on fertility and childbearing (pregnancy/fertility), and impact of condition on motivation to have children (motivation/decision-making). Positive associations were found between all RHC factors and illness-related anxiety; condition-related stress was associated with motivation/decision-making. CONCLUSION RHC, health-related anxiety, and stress can impede healthy sexual and reproductive health and development of AYA living with chronic conditions. Providers' proactive exploration of patients' concerns about their reproductive future can offer critical support as they navigate the unique existential challenges of early adulthood.
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Affiliation(s)
- Ellen Iverson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Whitney A Brammer
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Brenda Osorio
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Diane Tanaka
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Rachel Cuevas
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA
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Frederick NN, Fine E, Michaud A, Recklitis CJ, Bober SL. Pediatric hematology and oncology fellow education in sexual and reproductive health: A survey of fellowship program directors in the United States. Pediatr Blood Cancer 2020; 67:e28245. [PMID: 32147938 DOI: 10.1002/pbc.28245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Pediatric oncology clinicians identify a need for increased sexual and reproductive health (SRH) education with adolescent and young adult (AYA) cancer patients. By surveying pediatric oncology fellowship directors, this study clarifies the state of current fellowship education about SRH for the AYA patient. METHODS A survey was sent to all pediatric oncology fellowship program directors (PDs) in the United States consisting of 13 questions pertaining to three primary SRH domains: sexual health, fertility, and safe sex practices. Descriptive statistics and χ2 were used in data analyses. RESULTS Sixty-three PDs responded to the survey (91% response rate). Of these, 88% reported having formal instruction regarding fertility, 41% reported curriculum regarding contraception and 30% reported some education regarding sexual health. The curriculum "being too full" was identified as a barrier to education on fertility (29%), sexual health (40%), and safe sex practices (38%). Not being a required or expected part of the program was more likely to be endorsed as a barrier for sexual health (26%) and safe sex practices (30%) compared with fertility (8%) (P < 0.005). Lack of experts to teach was a more frequently endorsed barrier to education on sexual health (47%) compared with either fertility (23%) or safe sex practices (25%) (P < 0.005). CONCLUSIONS This study identifies important gaps in oncology fellow education about SRH. Future research must explore optimal education strategies that are feasible and acceptable by PDs and fellow learners, and effective in optimizing AYA SRH care.
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Affiliation(s)
- Natasha N Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Elizabeth Fine
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alexis Michaud
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sharon L Bober
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
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Pfaff N, Garnett C, Mihalek AJ, Mamey MR, Wu S. Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination. Glob Pediatr Health 2019; 6:2333794X19894123. [PMID: 31840039 PMCID: PMC6900615 DOI: 10.1177/2333794x19894123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022] Open
Abstract
Over a decade after its debut, human papillomavirus (HPV) vaccine coverage
remains suboptimal. The inpatient setting presents a largely unexplored
opportunity to increase vaccination rates. This study aims to describe pediatric
resident attitudes toward inpatient immunization and compare differences by
vaccine, in particular HPV. An anonymous survey of beliefs and practices
regarding inpatient vaccines was distributed to pediatric resident physicians at
a single freestanding urban children’s hospital in September 2017. A total of 58
surveys were collected (64% response rate). We found that pediatric residents
were more likely to report that they never or rarely discuss the HPV vaccine
during hospitalization compared with the primary childhood series
(P = .001), Tdap (P = .02), and the
influenza vaccine (P < .001), and rarely offer the HPV
vaccine during hospitalization compared with childhood vaccines
(P = .003) and influenza (P = .001). This
suggests that provider hesitancy still exists for the HPV vaccine, presenting
opportunities for further education and inpatient interventions.
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Affiliation(s)
- Nora Pfaff
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Mary Rose Mamey
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Susan Wu
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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Verlenden JV, Bertolli J, Warner L. Contraceptive Practices and Reproductive Health Considerations for Adolescent and Adult Women with Intellectual and Developmental Disabilities: A Review of the Literature. SEXUALITY AND DISABILITY 2019; 37:541-557. [PMID: 33005065 PMCID: PMC7527256 DOI: 10.1007/s11195-019-09600-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whereas progress has been made on increasing access to comprehensive healthcare for individuals with intellectual and developmental disabilities (I/DD), disparities continue in health outcomes, including those related to the reproductive health of adolescent and adult women with I/DD. This review summarizes reproductive care considerations for adolescent and adult women with I/DD and current practices regarding the delivery of contraceptive services to these women. Forty-seven (47) articles based on research conducted in the US between 1999 and 2019 were selected for inclusion in the review. Primary themes discussed include (1) common reproductive health concerns for adolescent and adult women with I/DD, other than pregnancy prevention; (2) contraceptive methods and disability-related concerns; (3) informed consent and reproductive decision-making; and (4) provider knowledge and education. The management of menses and hormonal dysregulation were identified as concerns that providers encounter among patients with I/DD and their families. Disability-related concerns with regard to use of contraception in general and considerations regarding certain methods in particular include challenges with prescription adherence, physical effects of hormonal therapies, drug interactions for individuals with additional health conditions, and legal and ethical concerns involved with decision-making and consent. The results of this review also suggest that focused efforts in partnership with health care providers may be needed to address barriers that adolescent and adult women with I/DD face when trying to obtain quality reproductive health services and contraceptive guidance.
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Affiliation(s)
- Jorge V. Verlenden
- Morehouse School of Medicine, Satcher Health Leadership Institute, Atlanta, USA
- Atlanta, USA
| | - Jeanne Bertolli
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
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Frederick NN, Revette A, Michaud A, Bober SL. A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients. Pediatr Blood Cancer 2019; 66:e27673. [PMID: 30767372 DOI: 10.1002/pbc.27673] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adolescent and young adult patients with cancer (AYAs) identify sexual and reproductive health (SRH) as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to explore AYA perceptions and experiences of SRH communication with oncology clinicians. METHODS Twenty-three AYA patients and survivors ages 15-25 years from a large academic oncology center participated in semistructured qualitative interviews investigating their experiences discussing SRH issues, including specific topics discussed, conversation barriers and facilitators, suggestions for clinicians on how to improve conversations, and education and resource needs. Interviews were audio recorded, transcribed, and coded using a thematic analysis approach. RESULTS Interviews with AYAs revealed two primary themes-a need for oncology clinicians to discuss SRH and critical gaps in current SRH communication practices. AYAs reported a need for improved SRH communication for the purposes of general education, addressing specific SRH issues experienced, and understanding the long-term impact of cancer and treatment on SRH. The current communication gaps are exacerbated by patient discomfort initiating conversations and the presence of family members. AYAs shared six key recommendations for clinicians on how to improve SRH communication. CONCLUSIONS AYAs identify a role for oncology clinicians in discussing SRH as a primary aspect of comprehensive health care during cancer treatment and in survivorship; however, multiple gaps and barriers interfere with such discussions. Future efforts must focus on clinician education and training in SRH as well as education and intervention opportunities for AYAs to optimize the care provided.
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Affiliation(s)
- Natasha N Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Anna Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alexis Michaud
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sharon L Bober
- Perini Family Survivors Center, Dana-Farber Cancer Institute, Boston, Massachusetts
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Wandresen G, Sgarbi F, Nisihara R. Management of contraceptives and menstrual complaints in patients with Down syndrome. Gynecol Endocrinol 2019; 35:103-108. [PMID: 30324830 DOI: 10.1080/09513590.2018.1501017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Enhanced health care for patients with Down syndrome (DS) results in improved overall quality of life and longer life expectancy. The main gynecologic complaints of patients with DS and their caregivers relate to menstrual cycles, hygiene and reproductive issues. Certain aspects, such as age of menarche, menstrual cycles, internal genitalia, and hormone profile are similar to those observed in the general population. However, individuals with DS may have a higher incidence of other disorders related to menstruation, such as hypothyroidism, epilepsy and use of anticonvulsants. Contraceptive measures for individuals with DS can be used for both contraception and control of menstrual symptoms. The physician must be to make an individualized recommendation aimed at offering the most efficient and least invasive method with the fewest side effects. Among medical options are oral contraceptives, quarterly injectable medroxyprogesterone acetate, oral progesterone, a levonorgestrel-releasing intrauterine system, transdermal patch and vaginal rings. Surgical methods, including hysterectomy, endometrial ablation, or tubal ligation, are rarely considered because they raise ethical and legal questions. This article reviews the literature and basic guidelines to assist physicians who attend adolescent girls and women with DS to provide guidance on the appropriate management of the main gynecologic complaints of this population.
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Affiliation(s)
- Gustavo Wandresen
- a Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná , Curitiba , Brazil
| | - Fernanda Sgarbi
- b Medicine Department , Positivo University , Curitiba , Brazil
| | - Renato Nisihara
- a Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná , Curitiba , Brazil
- b Medicine Department , Positivo University , Curitiba , Brazil
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The Fertility Management Experiences of Australian Women with a Non-communicable Chronic Disease: Findings from the Understanding Fertility Management in Contemporary Australia Survey. Matern Child Health J 2018; 22:830-840. [PMID: 29411252 DOI: 10.1007/s10995-018-2454-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction Despite the considerable and increasing proportion of women of reproductive age with a chronic non-communicable disease (NCD) and the potential adverse implications of many NCDs for childbearing, little is known about the fertility management experiences of women with an NCD, including their contraceptive use, pregnancy experiences and outcomes, and reproductive health care utilisation. The aim of this study was to investigate the fertility management experiences of women with an NCD and draw comparisons with women without an NCD. Method A sample of 18-50 year-old women (n = 1543) was randomly recruited from the Australian electoral roll in 2013. Of these women, 172 women reported a physical, chronic non-communicable disease: diabetes, arthritis, asthma, hypertension, heart disease, thyroid disorders, and cystic fibrosis. Respondents completed an anonymous, self-administered questionnaire. Factors associated with fertility management were identified in multivariable analyses. Results Women who reported having an NCD were significantly more likely than women who did not report an NCD to have ever been pregnant (75.9 vs. 67.5%, p = 0.034), have had an unintended pregnancy (33.47 vs. 25.5%, p = 0.026), and have had an abortion (20.3 vs. 14.2%, p = 0.044); they were less likely to consult a healthcare provider about fertility management (45.0 vs. 54.4%, p = 0.024). Similar proportions were using contraception (48.8 vs. 54.5%, p = 0.138). Conclusion The findings have implications for healthcare providers and women with an NCD and highlight the importance of addressing possible assumptions about the inability of women with an NCD to become pregnant, and ensuring women receive information about suitable methods of contraception and pre-pregnancy care.
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Frederick NN, Campbell K, Kenney LB, Moss K, Speckhart A, Bober SL. Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective. Pediatr Blood Cancer 2018; 65:e27087. [PMID: 29697189 DOI: 10.1002/pbc.27087] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice. PROCEDURE Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. RESULTS Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, the focus of current SRH conversations on fertility, the meaning of "sexual health" as safe sex and contraception only, clinician-reported barriers to SRH conversations, and the need for education and support. Communication barriers included lack of knowledge/experience, lack of resources/referrals, low priority, parents/family, patient discomfort, clinician discomfort, time, and lack of rapport. Clinicians identified resource and support needs, including formal education and SRH education materials for patients and families. CONCLUSIONS Although the study participants identified a role for pediatric oncology clinicians in SRH care for AYA patients with cancer, multiple barriers interfere with such discussions taking place on a regular basis. Future efforts must focus on resource development and provider education and training in SRH to optimize the care provided to this unique patient population.
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Affiliation(s)
- Natasha N Frederick
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Kevin Campbell
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Lisa B Kenney
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Kerry Moss
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | | | - Sharon L Bober
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts
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Fridgen O, Sehovic I, Bowman ML, Reed D, Tamargo C, Vadaparampil S, Quinn GP. Contraception: the Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:924-932. [PMID: 26880356 DOI: 10.1007/s13187-016-1003-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Little is known about oncology provider recommendations regarding best practices in contraception use during cancer treatment and through survivorship for adolescent and young adult (AYA) cancer patients. This review examined the literature to identify related studies on contraception recommendations, counseling discussions, and methods of contraception in the AYA oncology population. A literature review was conducted using PubMed, including all peer-reviewed journals with no publication date exclusions. A systematic review of the literature was conducted using combinations of the following phrases or keywords: "oncology OR cancer" AND "contraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agents, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization" AND "young adult OR adolescent" AND "young adult AND adolescent". Reviewers assessed articles using the "Quality Assessment Tool for Quantitative Studies" which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. A total of five articles were included and all studies were quantitative. Results showed no consistent recommendations among providers, references to guidelines, or methods of contraceptive types. Provider guidelines for discussions with AYA patients should be expanded to provide comprehensive, consistent, and quality cancer care in the AYA population.
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Affiliation(s)
- Olivia Fridgen
- Adolescent and Young Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA
| | - Ivana Sehovic
- Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL, 33612, USA
| | - Meghan L Bowman
- Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL, 33612, USA
| | - Damon Reed
- Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA
| | - Christina Tamargo
- Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL, 33612, USA
| | - Susan Vadaparampil
- Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA
- University of South Florida, Morsani College of Medicine University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Gwendolyn P Quinn
- Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA.
- University of South Florida, Morsani College of Medicine University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
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Nunes FRP, Neves FAD, Geraldes FDPB, Águas Lopes MFR. Contraception in adolescents with intellectual disability. EUR J CONTRACEP REPR 2017; 22:401-406. [PMID: 29188744 DOI: 10.1080/13625187.2017.1402875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of the study were to investigate the reasons for first gynaecological consultation in adolescents with intellectual disability (ID) and assess how contraception is prescribed with regard to the different contraceptive methods, their medical indications, adverse effects and compliance, in comparison with a group of adolescents without ID. METHODS A retrospective case-control study was conducted among 200 adolescents with ID (group A) and a control group of 200 adolescents without ID (group B). RESULTS The main reasons for gynaecological consultation in group A were 'need for contraception' (46.5% in group A vs 32.0% in group B, p = .003) and abnormal uterine bleeding (42.0% in group A vs 27.0% in group B, p = .002). Contraception was prescribed in 80.0% of the adolescents in both groups. Combined oral contraception was prescribed in 83.1% in group A vs. 91.3% in group B (p = .03). The transdermal patch was more prevalent in group A (6.3% vs. 0.6% in group B, p = .006). Other contraceptive methods were similar between the two groups. In group B there were 5.0% unintended pregnancies vs no cases in group A (p = .001). Sexual abuse occurred similarly in both groups (2.5% in group A vs 2.0% in group B, p = not significant). CONCLUSION The need for contraception in adolescents with ID is a frequent reason for gynaecological consultation, despite their younger age and lower number who are sexually active. Combined oral contraception is the most prescribed method in adolescents with ID; however, the transdermal patch also plays an important role in this group.
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Affiliation(s)
- Filipa Raquel Pereira Nunes
- a Department of Gynaecology , Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - Fabiane Amaral das Neves
- a Department of Gynaecology , Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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Lourenço B, Kozu KT, Leal GN, Silva MF, Fernandes EG, França CM, Souza FH, Silva CA. Contracepção para adolescentes com doenças reumáticas crônicas. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lourenço B, Kozu KT, Leal GN, Silva MF, Fernandes EGC, França CMP, Souza FHC, Silva CA. Contraception for adolescents with chronic rheumatic diseases. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:73-81. [PMID: 28137405 DOI: 10.1016/j.rbre.2016.07.016] [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] [Received: 09/09/2015] [Accepted: 06/12/2016] [Indexed: 10/21/2022] Open
Abstract
Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.
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Affiliation(s)
- Benito Lourenço
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade do Adolescente, São Paulo, SP, Brazil.
| | - Katia T Kozu
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Gabriela N Leal
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Radiologia, São Paulo, SP, Brazil
| | - Marco F Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Elisabeth G C Fernandes
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Camila M P França
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil
| | - Fernando H C Souza
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Clovis A Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Unidade do Adolescente, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
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Freiberger D, Lewis L, Helfand L. Human papillomavirus-related high-grade squamous intraepithelial lesions of the esophagus, skin, and cervix in an adolescent lung transplant recipient: a case report and literature review. Transpl Infect Dis 2014; 17:98-102. [PMID: 25537681 DOI: 10.1111/tid.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 08/22/2014] [Accepted: 09/25/2014] [Indexed: 01/20/2023]
Abstract
High-risk (carcinogenic) genotype human papillomavirus (HPV) infections can be associated with significant morbidity in the immunocompromised solid organ transplant (SOT) recipient. Immunosuppression-associated persistent infection can predispose to the development of rapidly progressive high-grade squamous intraepithelial lesions (HSIL) in this population. We present a case report of an adolescent bilateral lung transplant recipient who developed HSIL of the esophagus, cervix, and skin secondary to HPV. This review highlights the unique developmental needs of the sexually active adolescent SOT recipient and reviews guidelines for HPV-related screening and education of this population.
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Affiliation(s)
- D Freiberger
- Division of Pulmonary/Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
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