Support or stressor? The community as a predictor of perceptions of infertility

Semen Cryopreservation to Expand Male Fertility in Cancer Patients: Intracase Evaluation of Semen Quality

To preserve male fertility after diagnosis of any kind of cancer, a prompt assessment of the semen quality and an appropriate semen cryopreservation must be performed before radio-chemotherapy starts. The present work aims to evaluate the semen parameters at diagnosis of different cancer patients before cryopreservation and after thawing. Testicular tumors and lymphomas are among the most common cancers in younger patients, and while chemotherapy significantly increases patients' survival, it can epigenetically alter the semen fluid, resulting in temporary or permanent infertility. We analyzed data from the database of the Gamete Cryopreservation Center (Annunziata Hospital, CS; Italy) in the period of 2011-2020 from a cohort of 254 cancer patients aged 18-56 years. The evaluation was performed in a blind manner and anonymously recovered; the main parameters referring to semen quality were assessed in accordance with the WHO guidelines and decision limits (6th edition; 2021). The cancer types were as follows: testis cancers (TC; n = 135; 53.1%), hematological cancers (HC; n = 76; 29.9%), and other types of cancer (OC; n = 43; 17%). Comparing TC vs. HC (P1) and vs. OC (P2), TC had the worst semen quality: sperm number/mL (P1 = 0.0014; P2 = 0.004), total motility (P1 = 0.02; P2 = 0.07), progressive motility (P1 = 0.04; P2 = 0.05), viability (P1 = 0.01; P2 = 0.02), and percentage of atypical morphology (P1 = 0.05; P2 = 0.03). After semen thawing, viability and progressive motility recovery lowered, accounting for 46.82% and 16.75%, respectively, in the whole cohort; similarly, in the subgroups ascribed to TC, they showed the lowest recovery. Strong correlation existed between pre- and post-cryopreservation viability and progressive motility in the whole cohort (p < 0.001) and in the TC subgroup (p < 0.05). All cancer subgroups, to significantly different extents, had semen findings below the WHO reference values, suggesting diverse sperm susceptibilities to different cancers and cryodamage. Cancer and associated treatments epigenetically affect patients' semen quality, meaning cryopreservation should be considered a useful personalized prerogative for any kind of cancer in a timely manner.

Separate but Related: Dimensions of Healthcare Provider Social Support in Day-Treatment Oncology Units

Social support by healthcare providers has been increasingly investigated during the past decade, but studies have made different choices concerning its measurement. To evaluate how social support from a healthcare provider impacts the perceived quality of care and patient outcomes, reliable and valid instruments capable of measuring specific aspects of the construct are needed. In study 1, we tested the factor structure and the psychometric properties of a new Healthcare Provider Social Support measure (HPSS) for oncology settings. One-hundred-sixty-two patients (89 females; M age = 58.97, SD age = 13.28) from religious and government-operated hospitals completed the HPSS during day treatment. We modeled the HPSS factor structure to represent four related aspects: Emotional, Informational, Appraisal, and Instrumental social support. Study 2 preliminarily assessed the concurrent validity of the HPSS with patient perceptions of the patient-doctor relationship. Sixty-nine patients (40 females; M age = 53.67, SD age = 13.74) completed the HPPS with scales assessing perceived doctor-patient communication and patient trust in the healthcare provider. Study 1, using Exploratory Structural Equation Modeling, showed that a bifactor model had an excellent fit. The analysis supported the use of subscale scores, which were more tenable than a single total score in terms of bifactor model indices. This conclusion was also supported by greater scalability of the subscales in a Mokken Scale Analysis. Oncology patients treated in the religious hospital perceived greater Emotional, Informational, and Instrumental social support from their healthcare provider than those treated in government-operated. Study 2 showed that patient ratings of healthcare provider social support, except Instrumental, were positively correlated with better doctor communication skills and greater trust in the physician. Multiple regression analyses showed that Informational and Emotional support provided a unique contribution to building trust in the physician, controlling for the doctor's communication skills. The study results showed that the four social support ratings were reliable and valid, sharpening the distinction between functional components in the formal healthcare system.