1
|
Umashankar S, Li M, Blevins K, Kim MO, Majure M, Park J, Huppert LA, Melisko M, Rugo HS, Esserman L, Chien AJ. Characterizing attitudes related to future child-bearing in young women diagnosed with early-stage breast cancer. Breast Cancer Res Treat 2024; 204:509-520. [PMID: 38194132 PMCID: PMC10959837 DOI: 10.1007/s10549-023-07206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE This study characterizes attitudes and decision-making around the desire for future children in young women newly diagnosed with early-stage breast cancer and assesses how clinical factors and perceived risk may impact these attitudes. METHODS This is a prospective study in women < 45 years with newly diagnosed stage 1-3 breast cancer. Patients completed a REDCap survey on fertility and family-building in the setting of hypothetical risk scenarios. Patient, tumor, and treatment characteristics were collected through surveys and medical record. RESULTS Of 140 study patients [median age = 41.4 (range 23-45)], 71 (50.7%) were interested in having children. Women interested in future childbearing were younger than those who were not interested (mean = 35.2 [SD = 5.2] vs 40.9 years [3.90], respectively, p < 0.001), and more likely to be childless (81% vs 31%, p < 0.001). 54 women (77.1% of patients interested in future children) underwent/planned to undergo oocyte/embryo cryopreservation before chemotherapy. Interest in future childbearing decreased with increasing hypothetical recurrence risk, however 17% of patients wanted to have children despite a 75-100% hypothetical recurrence risk. 24.3% of patients wanted to conceive < 2 years from diagnosis, and 35% of patients with hormone receptor positive tumors were not willing to complete 5 years of hormone therapy. CONCLUSION Many young women diagnosed with early-stage breast cancer prioritize childbearing. Interest in having a biologic child was not associated with standard prognostic risk factors. Interest decreased with increasing hypothetical recurrence risk, though some patients remained committed to future childbearing despite near certain hypothetical risk. Individual risk assessment should be included in family-planning discussions throughout the continuum of care as it can influence decision-making.
Collapse
Affiliation(s)
- Saumya Umashankar
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Moming Li
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Kaylee Blevins
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Mi-Ok Kim
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Melanie Majure
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - John Park
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Laura A Huppert
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Michelle Melisko
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Hope S Rugo
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - Laura Esserman
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA
| | - A Jo Chien
- Helen Diller Family Cancer Center, University of California San Francisco, San Franciso, CA, USA.
| |
Collapse
|
2
|
Meernik C, Engel SM, Wardell A, Baggett CD, Gupta P, Rodriguez-Ormaza N, Luke B, Baker VL, Wantman E, Rauh-Hain JA, Mersereau JE, Olshan AF, Smitherman AB, Cai J, Nichols HB. Disparities in fertility preservation use among adolescent and young adult women with cancer. J Cancer Surviv 2023; 17:1435-1444. [PMID: 35169982 PMCID: PMC9378772 DOI: 10.1007/s11764-022-01187-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Women face multiple barriers to fertility preservation after cancer diagnosis, but few studies have examined disparities in use of these services. METHODS Women aged 15-39 years diagnosed with cancer during 2004-2015 were identified from the North Carolina Central Cancer Registry and linked to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Women who cryopreserved oocytes or embryos for fertility preservation (n = 96) were compared to women who received gonadotoxic treatment but did not use fertility preservation (n = 7964). Conditional logistic and log-binomial regression were used to estimate odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Few adolescent and young adult women with cancer in our study (1.2%) used fertility preservation. In multivariable regression, women less likely to use fertility preservation were older at diagnosis (ages 25-29 vs. 35-39: OR = 6.27, 95% CI: 3.35, 11.73); non-Hispanic Black (vs. non-Hispanic White: PR = 0.44, 95% CI: 0.24, 0.79); and parous at diagnosis (vs. nulliparous: PR = 0.24, 95% CI: 0.13, 0.45); or lived in census tracts that were non-urban (vs. urban: PR = 0.12, 95% CI: 0.04, 0.37) or of lower socioeconomic status (quintiles 1-3 vs. quintiles 4 and 5: PR = 0.39, 95% CI: 0.25, 0.61). CONCLUSIONS Women with cancer who were older, non-Hispanic Black, parous, or living in areas that were non-urban or of lower socioeconomic position were less likely to use fertility preservation. IMPLICATIONS FOR CANCER SURVIVORS Clinical and policy interventions are needed to ensure equitable access to fertility services among women facing cancer treatment-related infertility.
Collapse
Affiliation(s)
- Clare Meernik
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Ally Wardell
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Christopher D Baggett
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Parul Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nidia Rodriguez-Ormaza
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer E Mersereau
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Andrew B Smitherman
- Department of Pediatrics and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| |
Collapse
|
3
|
Nichols HB, Wernli KJ, Chawla N, O’Meara ES, Gray MF, Green LE, Baggett CD, Casperson M, Chao C, Jones SMW, Kirchhoff AC, Kuo TM, Lee C, Malogolowkin M, Quesenberry CP, Ruddy KJ, Wun T, Zebrack B, Chubak J, Hahn EE, Keegan TH, Kushi LH. Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults. CURR EPIDEMIOL REP 2023; 10:115-124. [PMID: 37700859 PMCID: PMC10495081 DOI: 10.1007/s40471-022-00286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.
Collapse
Affiliation(s)
- Hazel B. Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Neetu Chawla
- Veterans Health Administration, Greater Los Angeles, CA
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Laura E. Green
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Christopher D. Baggett
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Chun Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, University of California Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Erin E. Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| |
Collapse
|
4
|
Montgomery K, Montgomery S, Campbell A, Nash DM. A comparison of the morphokinetic profiles of embryos developed from vitrified versus fresh oocytes. Reprod Biomed Online 2023; 47:51-60. [PMID: 37188558 DOI: 10.1016/j.rbmo.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
RESEARCH QUESTION Do morphokinetic profiles and treatment outcomes differ between embryos developed from vitrified or fresh oocytes? DESIGN Retrospective multicentre analysis using data from eight CARE Fertility clinics across the UK between 2012 and 2019. Patients receiving treatment using embryos developed from vitrified oocytes (n = 118 women, n = 748 oocytes), providing 557 zygotes during this time period, were recruited and matched with patients undergoing treatment with embryos developed from fresh oocytes (n = 123 women, n = 1110 oocytes), providing 539 zygotes in the same time frame. Time-lapse microscopy was used to assess morphokinetic profiles, including early cleavage divisions (2- through to 8-cell), post-cleavage stages including time to start of compaction, time to morula, time to start of blastulation and time to full blastocyst. Duration of key stages such as the compaction stage were also calculated. Treatment outcomes were compared between the two groups (live birth rate, clinical pregnancy rate and implantation rate). RESULTS A significant delay of 2-3 h across all early cleavage divisions (2- through to 8-cell) and time to start of compaction occurred in the vitrified group versus fresh controls (all P ≤ 0.01). The compaction stage was significantly shorter in vitrified oocytes (19.02 ± 0.5 h) compared with fresh controls (22.45 ± 0.6 h, P < 0.001). There was no difference in the time that fresh and vitrified embryos reached the blastocyst stage (108.03 ± 0.7 versus 107.78 ± 0.6 h). There was no significant difference in treatment outcomes between the two groups. CONCLUSION Vitrification is a useful technique for extending female fertility with no effects on IVF treatment outcome.
Collapse
Affiliation(s)
- Kathryn Montgomery
- Department of Life Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, UK
| | - Susan Montgomery
- CARE Fertility Manchester, 108-112 Daisy Bank Road, Victoria Park, Manchester, UK
| | - Alison Campbell
- CARE Fertility Manchester, 108-112 Daisy Bank Road, Victoria Park, Manchester, UK.
| | - Deborah Mary Nash
- Department of Life Sciences, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, UK
| |
Collapse
|
5
|
Meernik C, Jorgensen K, Wu CF, Murphy CC, Baker VL, Brady PC, Nitecki R, Nichols HB, Rauh-Hain JA. Disparities in the use of assisted reproductive technologies after breast cancer: a population-based study. Breast Cancer Res Treat 2023; 198:149-158. [PMID: 36607486 PMCID: PMC10184512 DOI: 10.1007/s10549-022-06857-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Equitable access to oncofertility services is a key component of cancer survivorship care, but factors affecting access and use remain understudied. METHODS To describe disparities in assisted reproductive technology (ART) use among women with breast cancer in California, we conducted a population-based cohort study using linked oncology, ART, and demographic data. We identified women age 18-45 years diagnosed with invasive breast cancer between 2000 and 2015. The primary outcome was ART use-including oocyte/embryo cryopreservation or embryo transfer-after cancer diagnosis. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to identify factors associated with ART use. RESULTS Among 36,468 women with invasive breast cancer, 206 (0.56%) used ART. Women significantly less likely to use ART were age 36-45 years at diagnosis (vs. 18-35 years: PR = 0.17, 95% CI 0.13-0.22); non-Hispanic Black or Hispanic (vs. non-Hispanic White: PR = 0.31, 95% CI 0.21-0.46); had at least one child (vs. no children: adjusted PR [aPR] = 0.39, 95% CI 0.25-0.60); or lived in non-urban areas (vs. urban: aPR = 0.28, 95% CI 0.10-0.75), whereas women more likely to use ART lived in high-SES areas (vs. low-/middle-SES areas: aPR = 2.93, 95% CI 2.04-4.20) or had private insurance (vs. public/other insurance: aPR = 2.95, 95% CI 1.59-5.49). CONCLUSION Women with breast cancer who are socially or economically disadvantaged, or who already had a child, are substantially less likely to use ART after diagnosis. The implementation of policies or programs targeting more equitable access to fertility services for women with cancer is warranted.
Collapse
Affiliation(s)
- Clare Meernik
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paula C Brady
- Columbia University Fertility Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Gynecologic Oncology and Reproductive Medicine, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| |
Collapse
|
6
|
Crown A, Muhsen S, Sevilimedu V, Kelvin J, Goldfarb SB, Gemignani ML. Fertility Preservation in Young Women with Breast Cancer: Impact on Treatment and Outcomes. Ann Surg Oncol 2022; 29:5786-5796. [PMID: 35672625 PMCID: PMC10118746 DOI: 10.1245/s10434-022-11910-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The impact of chemotherapy timing on the fertility preservation (FP) decision is poorly understood. Here we evaluate factors associated with FP completion among women age ≤ 45 years with breast cancer who received chemotherapy and consulted with a reproductive endocrinology and infertility (REI) specialist, and report pregnancy and oncologic outcomes. PATIENTS AND METHODS This retrospective review included all women age ≤ 45 years diagnosed with stage I-III unilateral breast cancer at Memorial Sloan Kettering Cancer Center between 2009 and 2015 who received chemotherapy and consulted with an REI specialist. Clinicopathologic features and factors associated with the decision to undergo FP were analyzed, and comparisons were made with the Wilcoxon rank-sum test, Chi-square test, or Fisher's exact test. Survival curves were constructed using the Kaplan-Meier method. RESULTS Among the 172 women identified, median age was 34 years (interquartile range 31-37 years). The majority of women were single (n = 99, 57.6%) and nulliparous (n = 134, 77.9%). Most women underwent FP (n = 121, 70.3%). Factors associated with the decision to undergo FP included younger median age (33 vs. 37 years, p < 0.001), having private insurance (p < 0.001), nulliparity (p < 0.001), and referral from Breast Surgery (p = 0.004). Tumor characteristics and treatments were similar between women who underwent FP and those who declined. Overall survival and recurrence-free survival were also similar between groups. Women who underwent FP were more likely to have a biological child after breast cancer treatment. CONCLUSIONS Women underwent FP at high rates independent of timing of chemotherapy and oncologic factors. FP is associated with having a biological child and does not compromise oncologic outcomes.
Collapse
Affiliation(s)
- Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | - Shirin Muhsen
- Clemenceau Medical Center/Johns Hopkins International, Beirut, Lebanon
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne Kelvin
- Survivorship Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shari B Goldfarb
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
7
|
Crown A, Gemignani ML. ASO Author Reflections: Oncologic Safety of Fertility Preservation. Ann Surg Oncol 2022; 29:5797-5798. [PMID: 35771371 DOI: 10.1245/s10434-022-11983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA.,Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
8
|
Mazo Canola M, Kaklamani VG. Anti-estrogen Therapy and Fertility Preservation in Premenopausal Breast Cancer Patients: a Review. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Kim B, Yoon H, Kim T, Lee S. Role of Klotho as a Modulator of Oxidative Stress Associated with Ovarian Tissue Cryopreservation. Int J Mol Sci 2021; 22:ijms222413547. [PMID: 34948343 PMCID: PMC8707502 DOI: 10.3390/ijms222413547] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Ovarian tissue cryopreservation is the only option for preserving fertility in adult and prepubertal cancer patients who require immediate chemotherapy or do not want ovarian stimulation. However, whether ovarian tissue cryopreservation can ameliorate follicular damage and inhibit the production of reactive oxygen species in cryopreserved ovarian tissue remains unclear. Oxidative stress is caused by several factors, such as UV exposure, obesity, age, oxygen, and cryopreservation, which affect many of the physiological processes involved in reproduction, from maturation to fertilization, embryonic development, and pregnancy. Here, freezing and thawing solutions were pre-treated with N-acetylcysteine (NAC) and klotho protein upon the freezing of ovarian tissue. While both NAC and klotho protein suppressed DNA fragmentation by scavenging reactive oxygen species, NAC induced apoptosis and tissue damage in mouse ovarian tissue. Klotho protein inhibited NAC-induced apoptosis and restored cellular tissue damage, suggesting that klotho protein may be an effective antioxidant for the cryopreservation of ovarian tissue.
Collapse
Affiliation(s)
- Boram Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea; (B.K.); (T.K.)
| | - Hyunho Yoon
- Department of Medical and Biological Sciences, The Catholic University of Korea, Bucheon 14662, Korea;
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea; (B.K.); (T.K.)
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea; (B.K.); (T.K.)
- Correspondence:
| |
Collapse
|
10
|
Moragón S, Di Liello R, Bermejo B, Hernando C, Olcina E, Chirivella I, Lluch A, Cejalvo JM, Martínez MT. Fertility and breast cancer: A literature review of counseling, preservation options and outcomes. Crit Rev Oncol Hematol 2021; 166:103461. [PMID: 34461268 DOI: 10.1016/j.critrevonc.2021.103461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/17/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023] Open
Abstract
Fertility preservation is an important issue in breast cancer patients undergoing oncological treatment. Fertility counseling is a crucial need given the physical and psychological stress experienced by patients. Cryopreservation of mature oocytes is currently the standard fertility-preserving procedure. Other options such as ovarian tissue preservation or gonadal protection during chemotherapy are still experimental, but have proven effectiveness. Prompt referral to a fertility unit is highly recommended in order to ensure quality of care. In this article, we focus on the different strategies to preserve fertility in breast cancer patients, assessing also the safety of pregnancy and breastfeeding after cancer. A systemic literature review was performed for research articles published in English in PubMed, or as abstracts from the European Society for Medical Oncology (ESMO), San Antonio Breast Cancer Symposium (SABCS) and American Society of Clinical Oncology (ASCO) annual meetings, using the search terms "breast cancer" and "fertility".
Collapse
Affiliation(s)
- Santiago Moragón
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain
| | - Raimondo Di Liello
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain; Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ''Luigi Vanvitelli'', Naples, Italy
| | - Begoña Bermejo
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain; Center for Biomedical Network Research on Cancer (CIBERONC), Spain
| | - Cristina Hernando
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain
| | - Ernesto Olcina
- Hematology and Oncology Department, University Medical Center Freiburg, Freiburg, Germany
| | - Isabel Chirivella
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain
| | - Ana Lluch
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain; Center for Biomedical Network Research on Cancer (CIBERONC), Spain
| | - Juan Miguel Cejalvo
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain; Center for Biomedical Network Research on Cancer (CIBERONC), Spain.
| | - María Teresa Martínez
- Medical Oncology Department. INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain.
| |
Collapse
|
11
|
Mgboji GE, Cordeiro Mitchell CN, Bedrick BS, Vaidya D, Tao X, Liu Y, Maher JY, Christianson MS. Predictive factors for fertility preservation in pediatric and adolescent girls with planned gonadotoxic treatment. J Assist Reprod Genet 2021; 38:2713-2721. [PMID: 34370210 DOI: 10.1007/s10815-021-02286-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To characterize female pediatric and adolescent patients seen for fertility preservation consultation at an academic medical center and to describe the association between demographic or clinical factors and the use of fertility preservation treatment (FPT). METHODS This is a retrospective chart analysis of female pediatric and adolescent patients seen for fertility preservation consultation at an academic fertility center over a 14-year period from 2005 to 2019. RESULTS One hundred six females aged 3-21 years were seen for fertility preservation consultation with a mean age of 16.6 years. Diagnoses included hematologic malignancies (41.5%), gynecologic malignancies (9.4%), other malignancies (31.1%), non-malignant hematologic disease (14.2%), and non-malignant conditions (3.8%). Overall, 64.2% of subjects pursued fertility preservation, including oocyte cryopreservation (35.8%) and ovarian tissue cryopreservation (23.6%). Overall, age, minority race, diagnosis, time since diagnosis, and median household income were not significantly associated with odds of completing an FPT procedure. Among all patients, those who underwent gonadotoxic therapy prior to consultation had a lower odds of receiving FPT (OR= 0.24, 95% CI 0.10-0.55). Among patients without chemotherapy exposure, no factors were associated with FPT. CONCLUSIONS Among pediatric and adolescent patients at an academic center undergoing a fertility preservation consultation, there were no socioeconomic or clinical barriers to FPT use in those who had not yet undergone gonadotoxic therapy. The only factor that was negatively associated with odds of pursuing FPT was prior chemotherapy exposure.
Collapse
Affiliation(s)
- Glory E Mgboji
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Christina N Cordeiro Mitchell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,RADfertility, Newark, DE, USA.,Department of Obstetrics and Gynecology, ChristianaCare, Newark, DE, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dhananjay Vaidya
- Department of Internal Medicine/Biostatistics, Epidemiology, and Data Management, Johns Hopkins University School of Medicine/Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xueting Tao
- Department of Biostatistics, Epidemiology, and Data Management, Johns Hopkins University School of Medicine/Bloomberg School of Public Health, Baltimore, MD, USA.,Biostatistics Department, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Yisi Liu
- Department of Biostatistics, Epidemiology, and Data Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacqueline Y Maher
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.,Pediatric Gynecology Program, Children's National Hospital, Washington D.C., USA
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
12
|
Kim S, Kim SW, Han SJ, Lee S, Park HT, Song JY, Kim T. Molecular Mechanism and Prevention Strategy of Chemotherapy- and Radiotherapy-Induced Ovarian Damage. Int J Mol Sci 2021; 22:ijms22147484. [PMID: 34299104 PMCID: PMC8305189 DOI: 10.3390/ijms22147484] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Fertility preservation is an emerging discipline, which is of substantial clinical value in the care of young patients with cancer. Chemotherapy and radiation may induce ovarian damage in prepubertal girls and young women. Although many studies have explored the mechanisms implicated in ovarian toxicity during cancer treatment, its molecular pathophysiology is not fully understood. Chemotherapy may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions. Oxidative stress and the radiosensitivity of oocytes are the main causes of gonadal damage after radiation treatment. Fertility preservation options can be differentiated by patient age, desire for conception, treatment regimen, socioeconomic status, and treatment duration. This review will help highlight the importance of multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.
Collapse
Affiliation(s)
- Seongmin Kim
- Gynecologic Cancer Center, CHA Ilsan Medical Center, CHA University College of Medicine, 1205 Jungang-ro, Ilsandong-gu, Goyang-si 10414, Korea;
| | - Sung-Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-W.K.); (S.-J.H.)
| | - Soo-Jin Han
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; (S.-W.K.); (S.-J.H.)
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
- Correspondence: ; Tel.: +82-2-920-6773
| | - Hyun-Tae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Jae-Yun Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea; (H.-T.P.); (J.-Y.S.); (T.K.)
| |
Collapse
|
13
|
Villarreal-Garza C, Mesa-Chavez F, Plata de la Mora A, Miaja-Avila M, Garcia-Garcia M, Fonseca A, de la Rosa-Pacheco S, Cruz-Ramos M, García Garza MR, Mohar A, Bargallo-Rocha E. Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico. J Natl Compr Canc Netw 2021; 19:1-8. [PMID: 34153944 DOI: 10.6004/jnccn.2020.7692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the risk of treatment-related infertility, implementation of fertility-preservation (FP) strategies among young patients with breast cancer is often suboptimal in resource-constrained settings such as Mexico. The "Joven & Fuerte: Program for Young Women With Breast Cancer" strives to enhance patient access to supportive care services, including FP measures through alliances with assisted-reproduction units and procurement of coverage of some of these strategies. This study describes patients from Joven & Fuerte who have preserved fertility, and assesses which characteristics were associated with the likelihood of undergoing FP. METHODS Women aged ≤40 years with recently diagnosed breast cancer were prospectively accrued. Sociodemographic and clinicopathologic data were collected from patient-reported and provider-recorded information at diagnosis and 1-year follow-up. Descriptive statistics, chi-square test, and simple logistic regression were used to compare patients who preserved fertility with those who did not. RESULTS In total, 447 patients were included, among which 53 (12%) preserved fertility, representing 38% of the 140 women who desired future biologic children. Oocyte/embryo cryopreservation was the most frequently used method for FP (59%), followed by temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy (26%), and use of both GnRHa and oocyte/embryo cryopreservation (15%). Younger age, higher educational level, being employed, having private healthcare insurance, and having one or no children were associated with a significantly higher likelihood of preserving fertility. CONCLUSIONS By facilitating referral and seeking funds and special discounts for underserved patients, supportive care programs for young women with breast cancer can play a crucial role on enhancing access to oncofertility services that would otherwise be prohibitive because of their high costs, particularly in resource-constrained settings. For these efforts to be successful and widely applied in the long term, sustained and extended governmental coverage of FP options for this young group is warranted.
Collapse
Affiliation(s)
- Cynthia Villarreal-Garza
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Fernanda Mesa-Chavez
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Alejandra Plata de la Mora
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| | - Melina Miaja-Avila
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Marisol Garcia-Garcia
- 1Centro de Cancer de Mama, TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
| | - Alan Fonseca
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| | | | - Marlid Cruz-Ramos
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| | | | - Alejandro Mohar
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 6Unidad de Epidemiologia e Investigacion Biomedica en Cancer, Instituto Nacional de Cancerologia, and
- 7Instituto de Biomedicas, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, México
| | - Enrique Bargallo-Rocha
- 2Joven & Fuerte, Programa para la Atencion e Investigacion para Pacientes Jovenes con Cancer de Mama en Mexico, Ciudad de Mexico
- 3Departamento de Tumores Mamarios e Investigacion, Instituto Nacional de Cancerologia, Ciudad de Mexico
| |
Collapse
|
14
|
Di Mattei VE, Perego G, Rancoita PMV, Taranto P, Carnelli L, Mangili G, Sarais V, Bergamini A, Candiani M. Psychological Aspects Associated With Fertility Preservation in Oncology: An Exploratory Study. Front Psychol 2021; 11:608651. [PMID: 33414749 PMCID: PMC7783324 DOI: 10.3389/fpsyg.2020.608651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Gonadotoxicity is considered one of the most distressing side effects of cancer treatment. Although fertility preservation can be a valid solution, it also involves a challenging process. A clear understanding of the features of women who decide to pursue fertility preservation after cancer diagnosis is missing. The purpose of the present study was therefore to analyze the personality profile of female patients referred to oncofertility prior to gonadotoxic treatment. Methods Fifty-two female cancer patients took part in the study. The Temperament and Character Inventory-Revised (TCI-R), the Response Evaluation Measure-71 (REM-71), the Beck Depression Inventory (BDI-II), and the State-Trait Anxiety Inventory-Y Form (STAI-Y) were administered to examine personality characteristics, defense mechanisms, depression and anxiety symptoms. Results Compared with reference data of the Italian population, our sample reported significantly lower scores in Harm Avoidance and trait anxiety, and significantly higher levels of mature defense mechanisms. Most of the patients reported low scores in immature defense mechanisms, depression, and trait anxiety, and medium scores in state anxiety. Conclusions Our findings suggest that these women display functional personality traits and defensive style, in association with low levels of depression and trait anxiety. These features may enable a proactive attitude to cancer and the ability to make long-term plans. This may favor psychological adjustment to cancer and a projection toward the future.
Collapse
Affiliation(s)
- Valentina Elisabetta Di Mattei
- Division of Neuroscience, Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gaia Perego
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Paola Maria Vittoria Rancoita
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Taranto
- Division of Neuroscience, Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Carnelli
- Division of Neuroscience, Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Sarais
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
15
|
Crown A, Muhsen S, Zabor EC, Sevilimedu V, Kelvin J, Goldfarb SB, Gemignani ML. Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer? Ann Surg Oncol 2020; 27:4740-4749. [PMID: 32767225 PMCID: PMC7554118 DOI: 10.1245/s10434-020-08883-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/23/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The American Society of Clinical Oncology guidelines recommend early referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. Current practice patterns demonstrate an increased utilization of neoadjuvant chemotherapy (NAC). We evaluated premenopausal women with breast cancer after consultation with a Fertility Nurse Specialist (FNS) and determine factors associated with referral to REI specialists. METHODS This retrospective review included all premenopausal women diagnosed at our institution with stage 0-III unilateral breast cancers between 2009 and 2015 who completed an FNS consultation. Clinicopathologic features and factors associated with referral to REI after FNS consultation were analyzed. RESULTS A total of 334 women were identified. Median age was 35 years (interquartile range 32-38). The majority of women were single (n = 198, 59.3%) and nulliparous (n = 239, 71.6%). REI referrals were common (n = 237, 71.0%). The Breast Surgery service was the most frequent referring service (n = 194, 58.1%), with significantly more REI referrals compared to Breast Medicine and Genetics services (p = 0.002). Nulliparity was associated with REI referral (p < 0.0001). Adjuvant chemotherapy (p = 0.003) was associated with pursuing REI referral, whereas NAC (p < 0.001) was associated with declining REI referral. CONCLUSIONS Most women elected to consult with an REI specialist, confirming strong interest in fertility preservation among premenopausal women with breast cancer. However, women receiving NAC more frequently declined referral to REI, suggesting that the need to start NAC may influence decisions regarding fertility preservation. With increasing utilization of NAC, our study supports the need for further counseling and education regarding fertility preservation for women undergoing NAC.
Collapse
Affiliation(s)
- Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirin Muhsen
- Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon
| | - Emily C Zabor
- Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne Kelvin
- Department of Medicine, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shari B Goldfarb
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
16
|
Crown A, Gemignani ML. ASO Author Reflections: Impact of Neoadjuvant Chemotherapy on Exploration of Fertility Preservation. Ann Surg Oncol 2020; 27:699-700. [PMID: 32776189 DOI: 10.1245/s10434-020-08917-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
17
|
Rothwell E, Lamb B, Johnson E, Gurtcheff S, Riches N, Fagan M, Sabatello M, Johnstone E. Patient perspectives and experiences with in vitro fertilization and genetic testing options. Ther Adv Reprod Health 2020; 14:2633494119899942. [PMID: 32518912 PMCID: PMC7254585 DOI: 10.1177/2633494119899942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/31/2022] Open
Abstract
Objective: Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies. Methods: Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts. Results: Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results. Conclusion: The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.
Collapse
Affiliation(s)
- Erin Rothwell
- Associate Vice President for Research, Integrity and Compliance, The University of Utah, 75 South 2000 East, Salt Lake City, UT 84112, USA
| | - Brandy Lamb
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Erin Johnson
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | | | - Naomi Riches
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Melinda Fagan
- Department of Philosophy, The University of Utah, Salt Lake City, UT, USA
| | - Maya Sabatello
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Erica Johnstone
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
18
|
Sciorio R. Cryopreservation of human embryos and oocytes for fertility preservation in cancer and non cancer patients: a mini review. Gynecol Endocrinol 2020; 36:381-388. [PMID: 32003268 DOI: 10.1080/09513590.2020.1719402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The term 'cryopreservation' illustrates the process of freezing cells and storing at very low temperature in liquid nitrogen (-196 °C). Cooling is not a physiological condition for human cells especially due to the high concentration of water in the living matter, whose conversion to ice crystals may be associated with cell death. Human oocytes are particularly sensitive to the freezing process, primarily because of their large size and the presence of the meiotic spindle, which at low temperature can degenerate. In the last decade, the cryopreservation technology has become highly important as an option for fertility preservation (FP) in women with cancer. Anticancer therapy might promote premature ovarian failure and negatively affects the reproductive outcome. Over the years, scientists have proposed different cryopreservation strategies in the effort to maintain the physiological functions of oocytes and embryo. However, despite the first success obtained in the 1980s with frozen oocytes, it was not until recently that a new approach has been proposed: the 'Vitrification' which allowed a breakthrough in this procedure. FP is a major determinant for cancer survivor women in the reproductive age. This article describes the FP options currently available, focusing mainly on oocyte and embryo cryopreservation.
Collapse
Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| |
Collapse
|
19
|
Vriens IJH, Ter Welle-Butalid EM, de Boer M, de Die-Smulders CEM, Derhaag JG, Geurts SME, van Hellemond IEG, Luiten EJT, Dercksen MW, Lemaire BMD, van Haaren ERM, Vriens BEPJ, van de Wouw AJ, van Riel AMMGH, Janssen-Engelen SLE, van de Poel MHW, Schepers-van der Sterren EEM, van Golde RJT, Tjan-Heijnen VCG. Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience. Breast Cancer Res Treat 2020; 181:77-86. [PMID: 32236826 PMCID: PMC7182539 DOI: 10.1007/s10549-020-05598-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/12/2020] [Indexed: 12/31/2022]
Abstract
Purpose We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. Methods Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan–Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. Results Of 118 counseled women with a median age of 31 years (range 19–40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). Conclusions Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.
Collapse
Affiliation(s)
- Ingeborg J H Vriens
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Elena M Ter Welle-Butalid
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maaike de Boer
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Josien G Derhaag
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sandra M E Geurts
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Irene E G van Hellemond
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Wouter Dercksen
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
| | - Bea M D Lemaire
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - Els R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Birgit E P J Vriens
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Agnes J van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | | | | | | | | | - Ron J T van Golde
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
20
|
Hershlag A, Mullin C, Bristow SL. Is Fertility Preservation Feasible and Safe With Neoadjuvant Therapy for Breast Cancer? JCO Glob Oncol 2020; 6:356-359. [PMID: 35275744 PMCID: PMC9812502 DOI: 10.1200/go.22.00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Avner Hershlag
- Northwell Health, Manhasset, New Hyde, NY,Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY,Corresponding author: Avner Hershlag, MD, Northwell
Health Fertility, 300 Community Dr, Manhasset, NY 11030; e-mail:
| | - Christine Mullin
- Northwell Health, Manhasset, New Hyde, NY,Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
| | - Sara L. Bristow
- Northwell Health, Manhasset, New Hyde, NY,Donald and Barabara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
| |
Collapse
|
21
|
Hershlag A, Mullin C, Bristow SL. Is Fertility Preservation Feasible and Safe With Neoadjuvant Therapy for Breast Cancer? JCO Glob Oncol 2020; 6:1700213. [PMID: 32259161 PMCID: PMC7853872 DOI: 10.1200/jgo.17.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Avner Hershlag
- Northwell Health, Manhasset, New Hyde, NY.,Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Christine Mullin
- Northwell Health, Manhasset, New Hyde, NY.,Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Sara L Bristow
- Northwell Health, Manhasset, New Hyde, NY.,Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| |
Collapse
|
22
|
Sella T, Partridge AH. Fertility Counseling and Preservation in Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-019-00348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Fertility preservation and preimplantation genetic assessment for women with breast cancer. Cryobiology 2020; 92:1-8. [DOI: 10.1016/j.cryobiol.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
|
24
|
Oncofertility: Meeting the Fertility Goals of Adolescents and Young Adults With Cancer. ACTA ACUST UNITED AC 2019; 24:328-335. [PMID: 30480578 DOI: 10.1097/ppo.0000000000000344] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adolescents and young adults aged 15 to 39 years who are diagnosed with cancer (AYA survivors) undergo a range of therapies for cancer cure but subsequently may be at risk of treatment-related infertility, and for female AYA survivors, adverse pregnancy outcomes. Future fertility is important to AYA survivors. Meeting their fertility goals requires awareness of this importance, knowledge of cancer treatment-related fertility risks, appropriate fertility counseling on these risks, and access to fertility care. Epidemiologic and dissemination and implementation research are needed to estimate more precise risks of traditional and novel cancer therapies on fertility and pregnancy outcomes and improve the delivery of fertility care.
Collapse
|
25
|
Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers. Breast 2019; 47:85-92. [PMID: 31362134 DOI: 10.1016/j.breast.2019.07.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Most research addressing needs and concerns of young patients with breast cancer (≤40 years) is retrospective. The HOHO European protocol is a prospective multicenter cohort study of young women with newly diagnosed breast cancer, about fertility, psychosocial and quality of life concerns. Here we report the baseline data and focus on predictors of fertility concerns. MATERIALS AND METHODS Patient surveys and medical record review were used. The baseline survey included sociodemographic, medical and treatment data as well as questions on fertility concerns and preservation strategies. Subscales from the CAncer Rehabilitation Evaluation System-Short Form (CARES-SF) were administered to measure specific quality of life aspects. Uni- and multivariable modeling were used to investigate predictors of greater fertility concern. RESULTS Among 297 eligible respondents, 67% discussed fertility issues before starting therapy, 64% were concerned about becoming infertile after treatment, and 15% decided not to follow prescribed therapies. Fifty-four percent of women wished future children before diagnosis; of these, 71% still desired biologic children afterwards. In multivariable analysis, not having children was the only patient characteristic significantly associated with fertility concerns at diagnosis. Twenty-seven percent used fertility preservation strategies. Women who received chemotherapy reported greater physical (p = 0.021) and sexual difficulties (p = 0.039) than women who did not. Women who were married or had a partner reported less psychosocial problems than single women (p = 0.039). CONCLUSIONS Young women with newly diagnosed breast cancer have several concerns, including, but not limited to, fertility. The HOHO European study provides valuable information to develop targeted interventions.
Collapse
|
26
|
Lee S, Ryu KJ, Kim B, Kang D, Kim YY, Kim T. Comparison between Slow Freezing and Vitrification for Human Ovarian Tissue Cryopreservation and Xenotransplantation. Int J Mol Sci 2019; 20:ijms20133346. [PMID: 31288388 PMCID: PMC6651588 DOI: 10.3390/ijms20133346] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/16/2022] Open
Abstract
Two methods for the cryopreservation of human ovarian tissue were compared using a xenotransplantation model to establish a safe and effective cryopreservation method. Ovarian tissues were obtained from women who underwent benign ovarian surgery in the gynecology research unit of a university hospital. The tissues were transplanted into 112 ovariectomized female severe combined immunodeficient mice 4 weeks after slow freezing or vitrification cryopreservation. Tissues were retrieved 4 weeks later. Primordial follicular counts decreased after cryopreservation and xenotransplantation, and were significantly higher in the slow freezing group than in the vitrification group (p < 0.001). Immunohistochemistry and TUNEL assay showed that the Ki-67 and CD31 markers of follicular proliferation and angiogenesis were higher in the slow freezing group (p < 0.001 and p = 0.006, respectively) and DNA damage was greater in the vitrification group (p < 0.001). Western blotting showed that vitrification increased cellular apoptosis. Anti-Müllerian hormone expression was low in transplanted samples subjected to both cryopreservation techniques. Electron microscopy revealed primordial follicle deformation in the vitrification group. Slow freezing for ovarian tissue cryopreservation is superior to vitrification in terms of follicle survival and growth after xenotransplantation. These results will be useful for fertility preservation in female cancer patients.
Collapse
Affiliation(s)
- Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Boram Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Dahyeon Kang
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Yoon Young Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul 03080, Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea.
| |
Collapse
|
27
|
Hawkins Bressler L, Mersereau JE, Anderson C, Rodriguez JL, Hodgson ME, Weinberg CR, Sandler DP, Nichols HB. Fertility-related experiences after breast cancer diagnosis in the Sister and Two Sister Studies. Cancer 2019; 125:2675-2683. [PMID: 31012960 DOI: 10.1002/cncr.32126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Commonly used chemotherapies can be toxic to the ovaries. To the authors' knowledge, the majority of studies evaluating receipt of fertility counseling for women in their reproductive years have been performed in specific settings, thereby limiting generalizability. METHODS A nationwide sample of US women diagnosed with breast cancer before age 45 years completed a survey assessing the prevalence of fertility counseling. Age-adjusted log-binomial regression was used to estimate prevalence ratios (PRs) and 95% CIs for fertility counseling. RESULTS Among 432 survivors diagnosed between 2004 and 2011, 288 (67%) had not discussed the effects of treatment on fertility with a health care provider before or during treatment. Fertility discussion was associated with younger age (PR, 3.49 [95% CI, 2.66-4.58] for aged <35 years vs ≥40 years) and lower parity (PR, 1.81 [95% CI, 1.29-2.53] for parity 1 vs 2). Approximately 20% of respondents reported that they were interested in future fertility (87 of 432 respondents) at the time of their diagnosis, but not all of these individuals (66 of 87 respondents) received counseling regarding the impact of treatment on their fertility, and few (8 of 87 respondents) used fertility preservation strategies. Among 68 women with a fertility interest who provided reasons for not taking steps to preserve fertility, reasons cited included concern for an adverse impact on cancer treatment (56%), lack of knowledge (26%), decision to not have a child (24%), and cost (18%). CONCLUSIONS Across multiple treatment settings, the majority of women of reproductive age who are diagnosed with breast cancer did not discuss fertility with a health care provider or use fertility preservation strategies. Discussing the potential impact of cancer treatment on future fertility is an important aspect of patient education.
Collapse
Affiliation(s)
- Leah Hawkins Bressler
- Division of Reproductive Epidemiology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer E Mersereau
- Division of Reproductive Epidemiology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chelsea Anderson
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Services, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Services, Research Triangle Park, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
28
|
Melo C, Moura-Ramos M, Canavarro MC, Almeida-Santos T. The time is now: An exploratory study regarding the predictors of female cancer patients' decision to undergo fertility preservation. Eur J Cancer Care (Engl) 2019; 28:e13025. [PMID: 30809894 DOI: 10.1111/ecc.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/07/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This cross-sectional exploratory study aimed to examine the female cancer patients' personal and health care-related variables mostly associated with their decision whether to preserve or not their fertility, in order to know more about the influence of attitudinal and health care-related variables on this decision where fertility preservation (FP) is fully covered by the National Health System. METHODS Childbearing attitudes, health care-related information, FP motivations and childbearing motivations were assessed, in a clinical setting, to female cancer patients in childbearing age, who were undergoing the FP decision-making process. RESULTS This study included 89 participants (82% response rate). Those who decided to undergo FP attributed more value to the reasons for FP and less value to the reasons against FP than those who decided not to undergo FP. Not having children, strongly valuing pregnancy after cancer and attributing low value to the implications of the postponement of cancer treatments were significant and independently associated with deciding to preserve fertility. CONCLUSION The decision to pursue FP is mainly influenced by three factors: the absence of children, attributing high value to trying to ensure future pregnancy and attributing low value to the possible postponement of cancer therapy in order to have time to preserve fertility.
Collapse
Affiliation(s)
- Cláudia Melo
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Mariana Moura-Ramos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Unit of Psychological Intervention, Maternity Dr. Daniel de Matos, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Portuguese Centre for Fertility Preservation, Reproductive Medicine Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| |
Collapse
|
29
|
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]
|
30
|
Smith KL, Gracia C, Sokalska A, Moore H. Advances in Fertility Preservation for Young Women With Cancer. Am Soc Clin Oncol Educ Book 2018; 38:27-37. [PMID: 30231357 DOI: 10.1200/edbk_208301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.
Collapse
Affiliation(s)
- Karen Lisa Smith
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Clarisa Gracia
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Anna Sokalska
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Halle Moore
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| |
Collapse
|
31
|
Melan K, Amant F, Veronique-Baudin J, Joachim C, Janky E. Fertility preservation healthcare circuit and networks in cancer patients worldwide: what are the issues? BMC Cancer 2018; 18:192. [PMID: 29452595 PMCID: PMC5816557 DOI: 10.1186/s12885-018-4046-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022] Open
Abstract
Background Fertility preservation (FP) is a major determinant of quality of life after cancer remission for women who may not have achieved their ideal family size. This article describes the FP services and strategy currently available, highlighting issues of oncofertility worldwide. Main body of the abstract For these patients in complex situations, health networks are essential to improve coordination of care, and the strengthening of this coordination is a major challenge to improve the performance of the health system. Two international networks have been created in order to foster scientific exchange between countries and to standardize the oncofertility healthcare circuit. However, the paucity of referral nationwide networks lead to a structural gap in health care policies. Short conclusion Management strategies of oncofertility in the world are still fragile and uneven. To structure the oncofertility sector, a multidisciplinary project allowing teams to collaborate is of utmost importance particularly in low and middle-income countries.
Collapse
Affiliation(s)
- Kathleen Melan
- Laboratory CELTEC Cancer and Environment EA4546, University of the French West-Indies, Pointe-à-Pitre, Guadeloupe
| | - Frederic Amant
- Department of Obstetrics & Gynaecology, UZ Gasthuisberg / Katholieke Universiteit Leuven Herestraat 49, 3000, Leuven, Belgium
| | - Jacqueline Veronique-Baudin
- Oncology Haematology Urology Pathology Department, UF 1441 Cancer Research and Registry, University Hospital of Martinique, 127 Route de Redoute, Les jardins de la Mouïna, 97200, Fort-de-France, Martinique
| | - Clarisse Joachim
- Oncology Haematology Urology Pathology Department, UF 1441 Cancer Research and Registry, University Hospital of Martinique, 127 Route de Redoute, Les jardins de la Mouïna, 97200, Fort-de-France, Martinique.
| | - Eustase Janky
- Laboratory CELTEC Cancer and Environment EA4546, University of the French West-Indies, Pointe-à-Pitre, Guadeloupe.,Gynaecology, Obstetrics Department, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe
| |
Collapse
|
32
|
Constance ES, Moravek MB, Jeruss JS. Strategies to Maintain Fertility in Young Breast Cancer Patients. Cancer Treat Res 2018; 173:1-13. [PMID: 29349754 DOI: 10.1007/978-3-319-70197-4_1] [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]
Abstract
Breast cancer is the most frequently occurring cancer in women of reproductive age. Treatments for breast cancer may eliminate or diminish fertility, making discussions about fertility preservation essential prior to initiation of gonadotoxic therapies. Additionally, even in patients who do not require chemotherapy, the use of adjuvant endocrine therapy will often push patients out of the reproductive window before treatment is completed. The only established methods for fertility preservation are oocyte or embryo cryopreservation, but experimental methods, such as ovarian suppression with GnRH agonists and ovarian tissue cryopreservation, show great promise. Early referral to a fertility specialist for interested patients affords patients the most fertility preservation options, with only minimal delay to cancer treatment.
Collapse
Affiliation(s)
- Elizabeth S Constance
- Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Jacqueline S Jeruss
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA. .,Division of Surgical Oncology, 3303 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
33
|
Kim J, Kim SK, Hwang KJ, Kim SH. Fertility preservation during cancer treatment: The Korean Society for Fertility Preservation clinical guidelines. Clin Exp Reprod Med 2017; 44:171-174. [PMID: 29376012 PMCID: PMC5783912 DOI: 10.5653/cerm.2017.44.4.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/20/2017] [Accepted: 07/05/2017] [Indexed: 11/06/2022] Open
Abstract
While many fertility preservation (FP) options now exist for reproductive-aged cancer patients, access to these services continues to be limited. A comprehensive FP program should be organized to serve oncofertility patients effectively. Also, much effort is needed from various individuals—patients, specialists from various fields, and consultants—to facilitate FP in a timely manner. Various challenges still exist in improving access to FP programs. To improve access to FP treatment, it is important to educate oncologists and patients via electronic tools and to actively navigate patients through the system. Reproductive endocrinology practices that receive oncofertility referrals must be equipped to provide a full range of options on short notice. A multidisciplinary team approach is required, involving physicians, nurses, mental health professionals, office staff, and laboratory personnel. The bottom line of FP patient care is to understand the true nature of each patient's specific situation and to develop a patient flow system that will help build a successful FP program. Expanding the patient flow system to all comprehensive cancer centers will ensure that all patients are provided with adequate information regarding their fertility, regardless of geography.
Collapse
Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Cha Fertility Center at Seoul Station, CHA University, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Joo Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
34
|
Cain H, Macpherson I, Beresford M, Pinder S, Pong J, Dixon J. Neoadjuvant Therapy in Early Breast Cancer: Treatment Considerations and Common Debates in Practice. Clin Oncol (R Coll Radiol) 2017; 29:642-652. [DOI: 10.1016/j.clon.2017.06.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 01/16/2023]
|
35
|
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: 13] [Impact Index Per Article: 1.9] [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.
Collapse
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
| |
Collapse
|
36
|
Peavey M, Arian S, Gibbons W, Lu K, Gershenson D, Woodard T. On-Site Fertility Preservation Services for Adolescents and Young Adults in a Comprehensive Cancer Center. J Adolesc Young Adult Oncol 2016; 6:229-234. [PMID: 27845854 DOI: 10.1089/jayao.2016.0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Adolescents and young adults (AYAs) receiving cancer treatments that may impair fertility should receive counseling about risk of infertility and options for fertility preservation (FP) before treatment and/or during survivorship. Our objective was to define the AYA patient population referred to an on-site fertility consultation service within a comprehensive cancer center and determine factors associated with patients proceeding with FP treatment. METHODS We conducted a retrospective chart review of AYA women who completed a consultation at the MD Anderson Fertility Preservation and Family Building Service during the first year of service. Records of 154 referred AYA patients were reviewed for age, ethnicity, cancer type gravidity and parity, survivorship status, and decision to pursue FP treatment. RESULTS Patients (mean age 29.7) were Caucasian (55%), Hispanic (23%), and African American (10%). The majority of women (67%) were seen for FP before cancer treatment and the remaining sought options for family building while in survivorship. The most common cancer types were hematologic (29%), breast (25%), and gynecologic (23%). CONCLUSIONS Patients referred to an on-site fertility consultation service were medically and ethnically diverse. Interest in fertility counseling and treatment was apparent in both survivorship pre- and postcancer treatment. Although the referral group was ethnically diverse, Caucasian women were most likely to pursue FP treatment compared to women of other ethnicities.
Collapse
Affiliation(s)
- Mary Peavey
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas
| | - Sara Arian
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas
| | - William Gibbons
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas
| | - Karen Lu
- 2 Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center , Houston, Texas
| | - David Gershenson
- 2 Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center , Houston, Texas
| | - Terri Woodard
- 1 Reproductive Endocrinology and Infertility, Baylor College of Medicine , Houston, Texas.,2 Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center , Houston, Texas
| |
Collapse
|
37
|
Abstract
Breast cancer is the most common non-cutaneous malignancy among women, and there are over 3 million breast cancer survivors living in the United States today. Excellent cure rates with modern therapies are associated with substantial toxicities for many women; it is important that health care providers attend to the resulting symptoms and issues to optimize quality of life in this population. In this article, we review management options for potential long term toxicities in breast cancer survivors, with a particular focus on bone health, fertility preservation, premature menopause, cardiac dysfunction, and cognitive impairment.
Collapse
|
38
|
Warner E, Yee S, Kennedy E, Glass K, Foong S, Seminsky M, Quan ML. Oncofertility Knowledge, Attitudes, and Practices of Canadian Breast Surgeons. Ann Surg Oncol 2016; 23:3850-3859. [PMID: 27431414 DOI: 10.1245/s10434-016-5423-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guidelines recommend that oncologists discuss treatment-related fertility issues with young cancer patients as early as possible after diagnosis and, if appropriate, expedite referral for fertility preservation (FP). This study sought to determine the attitudes and practices of Canadian breast surgeons regarding fertility issues, as well as barriers to and facilitators of fertility discussion and referrals. METHODS Semistructured telephone interviews were conducted with 28 site lead surgeons (SLSs) at 28 (97 %) of 29 centers (25 % cancer centers, 64 % teaching hospitals) across Canada participating in RUBY, a pan-Canadian research program for young women with breast cancer. In addition, 56 (65 %) of 86 of their surgical colleagues (non-site lead surgeons [NSLSs]) completed an online survey of their oncofertility knowledge, attitudes, and practices. RESULTS Of the 28 SLSs (43 % male, 36 % in practice <10 years), 46 % had inadequate oncofertility knowledge, 25 % discussed fertility only if mentioned by the patient, 21 % believed fertility discussion and referral were the mandate of the medical oncologist, and 45 % did not know of an FP center in their area. More than 80 % of the NSLSs (54 % male, 30 % in practice <10 years) were unfamiliar with oocyte or embryo cryopreservation; 36 % never or rarely discussed fertility issues; and 51 % thought referral to a fertility specialist was not their responsibility. CONCLUSIONS Oncofertility knowledge was low among the SLSs, especially the NSLSs, and barriers to referral were identified. An oncofertility knowledge translation intervention specifically for breast surgeons is being developed to increase surgeon knowledge and awareness of oncofertility issues and referral.
Collapse
Affiliation(s)
- Ellen Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada. .,University of Toronto, Toronto, ON, Canada.
| | | | - Erin Kennedy
- University of Toronto, Toronto, ON, Canada.,Mount Sinai Hospital, Toronto, ON, Canada
| | - Karen Glass
- University of Toronto, Toronto, ON, Canada.,CReATe Fertility Centre, Toronto, ON, Canada
| | - Shu Foong
- Regional Fertility Program, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | - Maureen Seminsky
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - May Lynn Quan
- University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| |
Collapse
|
39
|
Kim J, Turan V, Oktay K. Long-Term Safety of Letrozole and Gonadotropin Stimulation for Fertility Preservation in Women With Breast Cancer. J Clin Endocrinol Metab 2016; 101:1364-71. [PMID: 26751194 PMCID: PMC4880171 DOI: 10.1210/jc.2015-3878] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT AND OBJECTIVE There has been increased attention to the issue of fertility preservation (FP). We aimed to investigate the long-term safety of FP via controlled ovarian stimulation with letrozole supplementation (COSTLES) prior to breast cancer treatment. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, nonrandomized, controlled study conducted between the years 2002 and 2014. A total of 337 women diagnosed with stage 3 or less invasive breast cancer were enrolled during a FP consultation before chemotherapy. Of those, 120 elected to undergo COSTLES for FP prior to chemotherapy (FP group). The remaining 217 patients did not undergo any FP procedure and served as the controls. MAIN OUTCOME MEASURE The primary end point was cancer recurrence defined as the detection of locoregional tumor (chest wall, regional nodal disease), distant metastases, or contralateral invasive breast cancer. RESULTS The baseline characteristics at enrollment were similar between the FP and control groups except for the less frequent lymph node involvement (P = .02) in the former. The mean follow-up after diagnosis was 5.0 years in the FP group and 6.9 years in the control group. In the FP group, the hazard ratio for recurrence after ovarian stimulation was 0.77 (95% confidence interval 0.28–2.13), and the survival was not compromised compared with controls (P = .61). Neither BRCA gene mutation status (P = .57) nor undergoing FP before or after breast surgery (P = .44) affected survival outcomes in the FP group. Likewise, none of the tumor characteristics including the estrogen receptor status affected the survival rates after the COSTLES. CONCLUSIONS COSTLES is unlikely to cause a substantially increased recurrence risk in breast cancer during the 5 years after diagnosis.
Collapse
Affiliation(s)
- Jayeon Kim
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| | - Volkan Turan
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| | - Kutluk Oktay
- Division of Reproductive Medicine, Fertility Preservation, and Infertility (J.K., V.T., K.O.), Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595; Innovation Institute for Fertility Preservation (J.K., V.T., K.O.), New York, New York 10570; Department of Obstetrics and Gynecology (V.T.), Yeni Yuzyil University School of Medicine, GOP Hospital, Istanbul, Turkey; and Department of Obstetrics and Gynecology (J.K.), Cha Gangnam Hospital, Cha University, Seoul 135-081, Korea
| |
Collapse
|
40
|
Argyle CE, Harper JC, Davies MC. Oocyte cryopreservation: where are we now? Hum Reprod Update 2016; 22:440-9. [DOI: 10.1093/humupd/dmw007] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/15/2016] [Indexed: 11/15/2022] Open
|
41
|
Kim J, Mersereau JE, Su HI, Whitcomb BW, Malcarne VL, Gorman JR. Young female cancer survivors' use of fertility care after completing cancer treatment. Support Care Cancer 2016; 24:3191-9. [PMID: 26939923 DOI: 10.1007/s00520-016-3138-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study is to investigate factors associated with female young adult cancer survivors' (YCSs) use of fertility care (FC), including consultation or fertility treatment, after completing their cancer treatment. METHODS In this cross-sectional study, females between that ages of 18 and 35 years who had been diagnosed with childhood, adolescent, or young adult cancers completed a 20-min web-based survey that included demographics, reproductive history, use of FC, fertility-related informational needs, and reproductive concerns. RESULTS A total of 204 participants completed the survey. Participants' mean age was 28.3 ± 4.5 years. Thirty (15 %) participants reported using FC after cancer treatment. The majority of participants recalled not receiving enough information about fertility preservation options at the time of cancer diagnosis (73 %). In multivariable analysis, those with higher concerns about having children because of perceived risk to their personal health (P = 0.003) were less likely to report use of FC after cancer treatment. Those who had used FC before cancer treatment (P = 0.003) and who felt less fertile than age-matched women (P = 0.02) were more likely to use FC after their cancer treatment. CONCLUSIONS While most YCSs in this cohort believed that they did not receive enough information about fertility and most wanted to have children, the vast majority did not seek FC. The findings of this study offer further evidence of the need for improved education and emotional support regarding reproductive options after cancer treatment is completed. Targeted discussions with YCSs about appropriate post-treatment FC options may improve providers' capacity to help YCSs meet their parenthood goals.
Collapse
Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
- Department of Obstetrics and Gynecology, CHA Seoul Fertility Center, CHA University, Seoul, South Korea
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
| | - H Irene Su
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, 92182, USA
| | - Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 2250 SW Jefferson Way, Corvallis, OR, 97331-6406, USA.
| |
Collapse
|
42
|
von Wolff M, Giesecke D, Germeyer A, Lawrenz B, Henes M, Nawroth F, Friebel S, Rohde A, Giesecke P, Denschlag D. Characteristics and attitudes of women in relation to chosen fertility preservation techniques: a prospective, multicenter questionnaire-based study with 144 participants. Eur J Obstet Gynecol Reprod Biol 2016; 201:12-7. [PMID: 27039248 DOI: 10.1016/j.ejogrb.2016.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/28/2015] [Accepted: 01/29/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE What are the patients attitudes about their fertility and about the counselling process at the time when fertility preservation counselling is performed? STUDY DESIGN A survey regarding fertility concerns and counselling performance in relation to the chosen fertility preservation procedure such as no treatment, GnRH agonists, and freezing of ovarian tissue or oocytes/zygotes was prospectively conducted in four university centres and one private centre, all belonging to the network FertiPROTEKT in Germany and Switzerland. RESULTS All women (n=145) received a questionnaire at the first counselling appointment. The mean age of the patients was 30 years (±5.8, range 17-43 years). 91% were referred by their treating oncologists. Single patients preferred invasive strategies, such as freezing of oocytes/zygotes (44.3%) or freezing of ovarian tissue (36%), whereas only 19.7% opted for no treatment/GnRH agonists. In married couples, the proportions were 28.9%, 31.1% and 40.0% respectively. Women without children also opted more frequently for invasive strategies, such as freezing of oocytes/zygotes (84.5%) or freezing of ovarian tissue (74.1%), and less frequently for no treatment/GnRH agonists (63.3%). Physical and psychological status, current and future fertility concerns and satisfaction with the counselling process were equal in all treatment groups. CONCLUSION As fertility concerns and attitudes about the counselling process were independent from the fertility preservation procedure chosen, the preferred treatment can hardly be predicted and therefore all women should be counselled about all possible fertility preservation techniques.
Collapse
Affiliation(s)
- Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Berne, Switzerland.
| | - Dagmar Giesecke
- Hochtaunus-Kliniken Bad Homburg, Women's Hospital, Bad Homburg, Germany
| | - Ariane Germeyer
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, University of Heidelberg, Heidelberg, Germany
| | - Barbara Lawrenz
- University Women's Hospital, University of Tübingen, Tübingen, Germany
| | - Melanie Henes
- University Women's Hospital, University of Tübingen, Tübingen, Germany
| | - Frank Nawroth
- Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Hamburg, Germany
| | - Stefanie Friebel
- University Women's Hospital, University of Freiburg, Freiburg, Germany
| | - Anke Rohde
- University Women's Hospital, University of Bonn, Division of Psychosomatic Medicine, Gynaecological Psychosomatics, Bonn, Germany
| | - Peter Giesecke
- Hochtaunus-Kliniken Bad Homburg, Women's Hospital, Bad Homburg, Germany
| | - Dominik Denschlag
- Hochtaunus-Kliniken Bad Homburg, Women's Hospital, Bad Homburg, Germany
| |
Collapse
|
43
|
Panagiotopoulou N, Ghuman N, Sandher R, Herbert M, Stewart J. Barriers and facilitators towards fertility preservation care for cancer patients: a meta-synthesis. Eur J Cancer Care (Engl) 2015; 27. [DOI: 10.1111/ecc.12428] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Affiliation(s)
- N. Panagiotopoulou
- Newcastle Fertility Centre; International Centre for Life; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - N. Ghuman
- Obstetrics and Gynaecology Department; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - R. Sandher
- Institute of Human Genetics, International Centre for Life; Newcastle University; Newcastle upon Tyne UK
| | - M. Herbert
- Institute of Human Genetics, International Centre for Life; Newcastle University; Newcastle upon Tyne UK
| | - J.A. Stewart
- Newcastle Fertility Centre; International Centre for Life; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| |
Collapse
|
44
|
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.
Collapse
Affiliation(s)
- Angela K Lawson
- a Department of Obstetrics and Gynecology, Northwestern University , Chicago , IL , USA
| | | | | | | | | | | |
Collapse
|
45
|
Furui T, Takenaka M, Makino H, Terazawa K, Yamamoto A, Morishige KI. An evaluation of the Gifu Model in a trial for a new regional oncofertility network in Japan, focusing on its necessity and effects. Reprod Med Biol 2015; 15:107-113. [PMID: 29259426 DOI: 10.1007/s12522-015-0219-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/29/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose We evaluated our 2-year experience of the regional oncofertility network in Gifu Prefecture (GPOFS) in order to establish a more sophisticated regional oncofertility networking model in Japan. Methods Questionnaires were distributed twice in January 2013 to 57 departments in 35 hospitals that provide cancer treatment in Gifu Prefecture, before the establishment of the regional oncofertility network. The number and type of disease of the referred adolescent and young adult (AYA) cancer patients who visited the oncofertility clinic in Gifu University Hospital via the GPOFS were analyzed. Results The majority of regional oncologists are aware of the need to provide information about oncofertility to their patients, but they cannot provide sufficient information due to their lack of knowledge about reproductive medicine. Eighty-one AYA patients were referred to our clinic for oncofertility counseling in the first 2 years after the establishment of the GPOFS. Conclusions The GPOFS as the first regional oncofertility network in Japan has just started and may be working to help both AYA cancer patients and their oncologists. The nationwide establishment of the regional oncofertility network model could help both AYA cancer patients and oncologists.
Collapse
Affiliation(s)
- Tatsuro Furui
- Department of Obstetrics and Gynecology Gifu University Graduate School of Medicine 1-6-1 Yanagido 501-1194 Gifu Gifu Japan
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Motoki Takenaka
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Hiroshi Makino
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Keiko Terazawa
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Akio Yamamoto
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| | - Ken-Ichiro Morishige
- Department of Obstetrics and Gynecology Gifu University Graduate School of Medicine 1-6-1 Yanagido 501-1194 Gifu Gifu Japan
- Department of Obstetrics and Gynecology Gifu University Hospital Gifu Japan
| |
Collapse
|
46
|
Banerjee R, Tsiapali E. Occurrence and recall rates of fertility discussions with young breast cancer patients. Support Care Cancer 2015; 24:163-171. [PMID: 25967235 DOI: 10.1007/s00520-015-2758-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Fertility preservation is an important issue for premenopausal cancer patients; however, not all patients receive counseling about chemotherapy-induced infertility and potential mitigation strategies. We aimed to identify characteristics of premenopausal breast cancer patients less likely to receive fertility counseling. We also investigated patient recall of chart-documented fertility discussions and patient attitudes toward fertility preservation. METHODS The study was approved by our institution's Institutional Review Board. All female patients with invasive primary breast cancer of any type, aged 40 or younger at the time of diagnosis, who were diagnosed during or up to 5 years prior to the study period were eligible. The study was conducted between February 2012 and October 2013. Enrolled patients completed an anonymous survey, and their medical charts were subsequently reviewed to identify provider documentation of fertility discussions, referral to fertility specialists, or implementation of fertility preservation. Patient comments regarding their fertility were solicited and examined thematically. RESULTS Forty-nine patients consented to participate. Fertility discussions were documented by providers in 55% of patients. Patients aged over 35 and multiparous patients were significantly less likely than their counterparts (p < 0.01 in both cases) to have had chart-documented fertility discussions. Only 52% of patients with chart-documented discussions recalled having had such a conversation. Patient comments highlighted the difficulty of considering fertility at the time of diagnosis and also the risks and obstacles facing fertility preservation. CONCLUSIONS Despite increasing awareness, fertility is not universally discussed with premenopausal breast cancer patients at the time of diagnosis; older and multiparous patients are at particular risk of not receiving fertility counseling. Even when such discussions are documented, only about half of patients recall the conversation. Patient-reported barriers to fertility preservation include lack of education combined with the stress of diagnosis, financial costs, and perceived treatment toxicities.
Collapse
Affiliation(s)
- Rahul Banerjee
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ekaterini Tsiapali
- Medstar Regional Breast Health Program at Medstar Southern Maryland Hospital Center, Department of Surgery, Georgetown University, Washington, DC, USA. .,, 7501 Surratts Road, Suite 303, Clinton, MD, 20735, USA.
| |
Collapse
|
47
|
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
|
48
|
Kim J, Mersereau JE. Early referral makes the decision-making about fertility preservation easier: a pilot survey study of young female cancer survivors. Support Care Cancer 2014; 23:1663-7. [PMID: 25421445 DOI: 10.1007/s00520-014-2526-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/14/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of the study was to investigate the association between patients' decision-making about fertility preservation (FP) and time between cancer diagnosis and FP consultation in young female cancer survivors. METHODS This is a pilot survey study of women aged 18-43 years seen for FP consultation between April 2009 and December 2010. RESULTS Among 52 women who completed the survey, 15 (29 %) had their FP consultation more than 2 weeks after their cancer diagnosis (late referral group) and 37 (71 %) were within 2 weeks of their cancer diagnosis (early referral group). In univariate analysis, the only difference between the late referral and early referral groups was a higher decisional conflict scale (DCS) in late referral group (p = 0.04). In multivariable analysis, late referral group was more likely to have high DCS (>35) compared to early referral group (odds ratio 4.8, 95 % confidence interval 1.5, 21.6) after adjusting for age, center, and type of cancer. CONCLUSION Early referral to a fertility specialist can help patients make better decision about FP. This is the first study to suggest that early referral is important in patients' decision-making process about FP treatment. Our finding supports the benefit of early referral in patients who are interested in FP which is consistent with prior studies about FP referral patterns.
Collapse
Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599-7570, USA
| | | |
Collapse
|
49
|
Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR. Prospective study of depression and anxiety in female fertility preservation and infertility patients. Fertil Steril 2014; 102:1377-84. [PMID: 25154674 DOI: 10.1016/j.fertnstert.2014.07.765] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To prospectively assess anxiety, depression, coping, and appraisal in female fertility preservation (FP) patients compared with infertile patients. DESIGN Prospective pre- and post-treatment survey. SETTING Academic medical center. PATIENT(S) Forty-seven women with cancer (FP patients) and 91 age-matched infertile patients. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Depression, anxiety, coping, infertility-related stress, appraisal of treatment, and medical outcomes. RESULT(S) FP patients reported more symptoms of anxiety and depression than infertile patients, but infertile patients' symptoms worsened over time; 44% of FP and 14% of infertile patients' scores exceeded the clinical cutoff for depression before treatment. The interval between surveys and medical treatment data did not predict changes in mood symptoms. Coping strategies and infertility-related stress did not differ between groups, and avoidant coping predicted higher depression and anxiety scores. CONCLUSION(S) FP patients reported more anxiety and depression than infertile patients at enrollment in treatment, with more than one-third of FP patients reporting clinically significant depressive symptoms. However, infertile patients' anxiety and depressive symptoms increased across treatment. This increase was not related to time between registration for IVF and oocyte retrieval or the medical aspects of treatment. FP and infertile patients should be provided psychologic consultation before treatment to identify mood and anxiety symptoms and to refer patients for counseling as needed to prevent worsening of symptoms.
Collapse
|
50
|
Kim J, Skrzynia C, Mersereau JE. A pilot study of BRCA mutation carriers' knowledge about the clinical impact of prophylactic-oophorectomy and views on fertility consultation: a single-center pilot study. J Genet Couns 2014; 24:149-57. [PMID: 25120035 DOI: 10.1007/s10897-014-9747-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
BRCA mutation carriers will experience early surgically induced menopause following prophylactic bilateral salpingo-oophorectomy (PBSO). This pilot study aimed to investigate their (1) knowledge about the clinical impact of PBSO; (2) views on fertility consultation (FC)/fertility preservation (FP) treatment; and (3) difficulties in conceiving compared to non-carriers. A cross-sectional, single institution web-survey was performed at a university-based IVF center. Women aged 18-50 years who were screened for BRCA gene mutations from 2005 to 2013 were recruited via mail. Forty-one BRCA-positive and 110 BRCA-negative women completed the survey (response rate: 50 %). The knowledge about the reproductive impact of PBSO was limited, with the majority of women in this highly educated sample only identifying the correct response 64 % of the time. Among BRCA mutation carriers, 24 (59 %) had positive views about FC/FP treatments. A larger proportion of women with no children at the time of BRCA testing, and those who were non-white tended to have positive views toward FP. Women with, versus without, BRCA mutations were more likely to have difficulty in conceiving (p = 0.08). This well-educated group had limited knowledge about the reproductive clinical impact of PBSO, or the benefit of a FP before PBSO. Most women with BRCA mutations were interested in FC/FP treatment if they had not completed childbearing at the time of screening. Targeted referrals for FC at the time of BRCA screening may help women improve knowledge and allow improved decision-making about reproductive options.
Collapse
Affiliation(s)
- J Kim
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
| | | | | |
Collapse
|