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Sandheinrich T, Chase JA, Armer J. Examining Factors in the Decision to Sperm Bank by Adolescent and Young Adult Males Diagnosed With Cancer: A Review of the Literature. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024:27527530241267299. [PMID: 39257019 DOI: 10.1177/27527530241267299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Background: Despite American Society of Clinical Oncology and Children's Oncology Group recommendations, the rate of sperm-banking for newly diagnosed adolescent and young adult males with cancer remains between 18% and 35%. The purpose of this study was to examine recent literature regarding decision-making and fertility preservation prior to the initiation of therapy for adolescents and young adults diagnosed with cancer. Method: A search of multiple online databases was undertaken for peer-reviewed studies between the years of 2010 and 2022. The databases CINAHL, PubMed, PsycInfo, Scopus, Google Scholar, and forward citation search was employed using the same Boolean search phrases in each database. Some 402 articles were then screened for relevance by title, abstract, and full review based on inclusion/exclusion criteria for synthesis. Results: Ten articles met criteria to be included in this review. Three themes were identified as impacting the decision to cryopreserve sperm prior to the initiation of therapy. Provider recommendation, parent recommendation, and referral for fertility specialist consult emerged as statistically significant factors in the decision to attempt sperm banking. Discussion: While the most significant factor impacting the decision to preserve fertility, parents reported they were more likely to recommend this to their child if they received clear recommendations from the medical team. Pediatric oncology physicians and nurses are in a unique position to positively impact quality of life and psychosocial outcomes in survivors of pediatric cancer by providing up-to-date evidence-based information, risk assessment, recommendations, and/or referral to fertility preservation specialists to families and patients.
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Affiliation(s)
- Taryn Sandheinrich
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- Siteman Kids Pediatric Oncology Program, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jo-Ana Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Jane Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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2
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Figueroa Gray MS, Shapiro L, Dorsey CN, Randall S, Casperson M, Chawla N, Zebrack B, Fujii MM, Hahn EE, Keegan THM, Kirchhoff AC, Kushi LH, Nichols HB, Wernli KJ, Sauder CAM, Chubak J. A Patient-Centered Conceptual Model of AYA Cancer Survivorship Care Informed by a Qualitative Interview Study. Cancers (Basel) 2024; 16:3073. [PMID: 39272931 PMCID: PMC11394144 DOI: 10.3390/cancers16173073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/24/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024] Open
Abstract
Purpose: Conceptual models provide frameworks to illustrate relationships among patient-, provider-, system-, and community-level factors that inform care delivery and research. Existing models of cancer survivorship care focus largely on pediatric or adult populations whose needs differ from adolescents and young adults (AYAs). We developed a patient-centered conceptual model of AYA survivorship care. Methods: We conducted a narrative literature review of current conceptual and theoretical models of care. We engaged AYA cancer survivors (n = 25) in semi-structured one-hour telephone interviews. Most participants were in their 20s and 30s, and the majority (84%) were women. Recruitment was stratified by age and time since cancer diagnosis. We conducted a thematic analysis of interview transcripts to identify themes that exemplified patient-centered care. Results: Most participants identified as white and female. Leukemia and breast cancer were the most common cancer types. Main themes included the need for (1) care coordination, (2) ongoing mental health support, (3) connection to AYA peer support, (4) support during fertility preservation efforts, (5) support with financial burden, (6) support for quality of life, (7) information about and support with side effects and late effects, and (8) attention to the unique needs of young adults. Conclusions: We present a patient-centered conceptual model of AYA survivorship care needs that can inform future cancer care delivery and research.
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Affiliation(s)
- Marlaine S Figueroa Gray
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Lily Shapiro
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Sarah Randall
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | | | - Neetu Chawla
- Veterans Affairs Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer Street (152), North Hills, CA 91343, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA
| | - Monica M Fujii
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, Pasadena, CA 91101, USA
| | - Theresa H M Keegan
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, 4501 X Street Suite 3016, Sacramento, CA 95817, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Office 4715, Salt Lake City, UT 84112, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Hazel B Nichols
- Gillings School of Global Public Health, University of North Carolina, 2104F Mcgavran-Greenberg Hall CB #7435, Chapel Hill, NC 27599, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis Comprehensive Cancer Center, 4501 X Street Suite 3010, Sacramento, CA 95817, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
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3
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Stalls JM, Dorfman CS, Divakaran S, Acharya K, Sperling J, Woodward JT, Plumb Vilardaga J, Corbett C, Oeffinger K, Shelby RA. Unmet Reproductive Health Care Information Needs of Female Young Adult Survivors of Childhood Cancer: Oncology Providers' Perspectives. J Adolesc Young Adult Oncol 2024. [PMID: 39158351 DOI: 10.1089/jayao.2024.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
This study aimed to characterize unmet reproductive health needs of female young adult survivors of childhood cancer (YASCC), as understood by oncology providers (N = 10) caring for this patient population. Providers completed brief online questionnaires and a one-time semi-structured interview. Descriptive statistics characterized quantitative data, and rapid qualitative analysis identified themes in interview data. In survey data, providers rated fertility as a top concern among YASCC. Qualitative data identified specific under-addressed reproductive and sexual health information needs for patients and also for their providers. The results provide preliminary knowledge to inform the development of behavioral interventions to address patients' unmet needs.
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Affiliation(s)
- Juliann M Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Supportive Care and Survivorship Center, Durham, North Carolina, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Supportive Care and Survivorship Center, Durham, North Carolina, USA
| | - Smrithi Divakaran
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly Acharya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica Sperling
- Duke Sanford School of Public Policy, Duke University's Social Science Research Institute, Duke University, Durham, North Carolina, USA
| | - Julia T Woodward
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Plumb Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cheyenne Corbett
- Duke Cancer Institute, Supportive Care and Survivorship Center, Durham, North Carolina, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Supportive Care and Survivorship Center, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Supportive Care and Survivorship Center, Durham, North Carolina, USA
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Schioppo DA, Greenwood JPH, Miller KA, Vig HS. A Qualitative Exploration of Oncology Clinician's Needs for PGT-M Discussions in Clinical Practice. J Adolesc Young Adult Oncol 2024; 13:646-651. [PMID: 38629661 DOI: 10.1089/jayao.2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
Purpose: Oncology clinicians are appropriately positioned to facilitate discussions of assisted reproductive technologies including preimplantation genetic testing for monogenic disease (PGT-M), in the context of cancer treatment or surveillance. Yet, reproductive services, including PGT-M, remain one of the least implemented services in oncology. No studies to date have explored which practice resources the clinicians need to increase knowledge of PGT-M. The objective of this study was to explore the specific needs of oncology clinicians to help maximize the reproductive potential of young adult patients with hereditary cancers. Methods: Participants were recruited through notices circulated on social media platforms and snowball sampling. Participants completed a brief online survey to confirm eligibility. Eligible participants completed a virtual, semi-structured interview. Interviews focused on clinician experiences with PGT-M and initiating referrals to fertility specialists. Thematic analysis was conducted using a constant comparative approach to identify current clinical practices. Results: This study found that PGT-M discussions are not necessarily within the scope of responsibilities for oncology clinicians owing to prioritization of cancer treatment and overall lack of knowledge. Participants need accessible resources and timely support for reproductive planning in the context of cancer treatment. Participants desire a streamlined referral pathway to professionals trained in oncofertility to help address their patient's reproductive needs. Conclusion: Our study identified that educational and referral resources to reproductive specialists are needed to maximize reproductive potential across the cancer continuum. These findings provide a foundation for larger studies that can inform standard-of-care recommendations in the emerging field of oncofertility.
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Affiliation(s)
- Davia A Schioppo
- Masters of Science in Genetic Counseling, Brandeis University, Waltham, Massachusetts, USA
| | | | - Kristen A Miller
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hetal S Vig
- Masters of Science in Genetic Counseling, Brandeis University, Waltham, Massachusetts, USA
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Dorfman CS, Stalls JM, Arrato NA, Shelby RA, Woodward JT, Acharya K, Davidson B, Wagner L, Corbett C, Greenup RA. Adoption as an Alternative Family-Building Strategy: Perceptions of Female, Young Adult Cancer Survivors Receiving Gonadotoxic Treatments. J Adolesc Young Adult Oncol 2024; 13:708-713. [PMID: 38588577 PMCID: PMC11322616 DOI: 10.1089/jayao.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Female survivors of young adult (YA) cancers are at risk of fertility impacts following cancer treatment. For these women, fertility-related distress is both prevalent and persistent. Yet there is little research regarding survivors' perspectives on alternative family-building options, particularly adoption. This exploratory secondary data analysis analyzed semistructured interviews and explored survivors' views of adoption. Overall, female YA survivors reported openness to adoption as a possible substitute for biological conception and an alternative to fertility preservation. It is imperative that this population receives support in decision-making around and consideration of the unique barriers to adoption for cancer survivors.
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Affiliation(s)
- Caroline S. Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Juliann M. Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Nicole A. Arrato
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A. Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Julia T. Woodward
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly Acharya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brittany Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lars Wagner
- Division of Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cheyenne Corbett
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Rachel A. Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Nyeko R, Okello N, Abeja CJ, Adyanga P, Apio B, Nabasirye CK, Mwa PA, Angom R, Geriga F, Buser J. Reproductive Concerns and Associated Factors Among Adolescent and Young Adult Cancer Survivors in Uganda: A Hospital-Based Cross-Sectional Study. J Adolesc Young Adult Oncol 2024; 13:629-636. [PMID: 38578003 DOI: 10.1089/jayao.2023.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: Reproductive health (RH) is a critical issue among cancer survivors worldwide. However, in developing countries where RH services for patients with cancer are often lacking, reproductive concerns among adolescent and young adult (AYA) survivors remain uncertain. In this study, we assessed the reproductive concerns of AYA cancer survivors in a resource-limited context of Uganda. Methods: We collected data from AYA cancer survivors at two facilities in Uganda using an interviewer-administered questionnaire. Descriptive statistics were calculated, one-way analysis of variance was used for intergroup comparisons, and multiple regressions were used to test for predictors of reproductive concerns. Results: A total of 110 AYA cancer survivors, with a median age of 20 years (interquartile range [IQR], 18-22), were interviewed. More than half (53.6%) of the respondents were males. The median time since cancer diagnosis was 19 months (IQR, 13.0-35.0). Almost all (91.8%) respondents had a future desire to have children, but only 15.5% received reproductive counseling. The mean total score for the reproductive concern subscales was highest for the fertility concern, followed by the information-seeking and health-related concerns. Reproductive counseling, desire to have children, and respondents' age were the factors influencing reproductive concern. Conclusions: The study shows a strong desire for biological parenthood with very low reproductive counseling among AYA cancer survivors, who remain concerned about their fertility, information needs, and health. This outcome underscores the need to integrate RH services into resource-limited cancer care settings.
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Affiliation(s)
- Richard Nyeko
- Department of Paediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda
- Paediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda
| | - Nelson Okello
- Department of Paediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda
| | | | - Proscovia Adyanga
- Department of Paediatric and Child Health, Faculty of Medicine, Lira University, Lira, Uganda
| | - Betty Apio
- Lira Regional Referral Hospital, Lira, Uganda
| | | | - Pamella Aol Mwa
- Department of Paediatrics and Child Health, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Racheal Angom
- Paediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda
| | - Fadhil Geriga
- Paediatric Oncology Service, Uganda Cancer Institute, Kampala, Uganda
| | - Julie Buser
- University of Michigan, Ann Arbor, Michigan, USA
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7
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Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist 2024:oyae141. [PMID: 38906705 DOI: 10.1093/oncolo/oyae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/14/2024] [Indexed: 06/23/2024] Open
Abstract
Although the overall incidence and mortality of colorectal cancer have declined, diagnosed cases of young-onset colorectal cancer have increased significantly. Concerns about future fertility are second only to concerns about survival and may significantly affect the quality of life of young cancer survivors. Fertility preservation is an important issue in young-onset colorectal patients with cancer undergoing oncotherapy. Here, we discussed the effects of different treatments on fertility, common options for fertility preservation, factors affecting fertility preservation and improvement measures, and the relationship between fertility and pregnancy outcomes in young-onset colorectal patients with cancer.
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Affiliation(s)
- Qiuping Jiang
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou, Zhejiang, People's Republic of China
| | - Hongmei Hua
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou, Zhejiang, People's Republic of China
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Bjornard K, Close A, Burns K, Chavez J, Chow EJ, Meacham LR. Fertility preservation in pediatric solid tumors: A report from the Children's Oncology Group. Pediatr Blood Cancer 2024; 71:e30960. [PMID: 38532279 PMCID: PMC11104288 DOI: 10.1002/pbc.30960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
Treatment for childhood solid tumors may lead to an increased risk for gonadal dysfunction/infertility. Discussion of risk should occur at diagnosis, any changes in therapy, and during survivorship. Gonadotoxic therapies were abstracted from 32 Children's Oncology Group (COG) phase III, frontline solid tumor protocols, in use from 2000 to 2022. Risk for gonadal dysfunction/infertility was assessed based on gonadotoxic therapies, sex, and pubertal status and assigned as minimal, significant, and high following the Oncofertility Consortium Pediatric Initiative Network (PIN) risk stratification. Most protocols (65.6%, 21/32) contained at least one therapeutic arm with a high level of increased risk. Solid tumor therapies present challenges in risk stratification due to response-adjusted therapy and the need to account for radiation field in the risk assessment. This guide hopes to serve as a tool to assist in standardizing gonadotoxic risk assessments across disciplines and improve referral for fertility services and reproductive health counseling for patients receiving COG-based solid tumor therapy. Internationally, many solid tumor therapies follow similar paradigms to COG studies, and risk stratifications may be generalizable to similar styles of therapy. In addition, this model may be applied to other international groups with the goal of standardizing fertility assessments.
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Affiliation(s)
- Kari Bjornard
- Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Allison Close
- Helen DeVos Children’s Hospital, Division of Hematology/Oncology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Karen Burns
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Josuah Chavez
- Helen DeVos Children’s Hospital, Division of Hematology/Oncology, Grand Rapids, MI, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, Seattle Children’s Hospital, Seattle, WA, USA
| | - Lillian R. Meacham
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Pediatric Hematology/Oncology/BMT, Emory University Atlanta, GA USA
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Baliga S, Patel S, Naqa IE, Li XA, Cohen LE, Howell RM, Hoppe BS, Constine LS, Palmer JD, Hamstra D, Olch AJ. Testicular Dysfunction in Male Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:610-624. [PMID: 37791936 DOI: 10.1016/j.ijrobp.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The male reproductive task force of the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative performed a comprehensive review that included a meta-analysis of publications reporting radiation dose-volume effects for risk of impaired fertility and hormonal function after radiation therapy for pediatric malignancies. METHODS AND MATERIALS The PENTEC task force conducted a comprehensive literature search to identify published data evaluating the effect of testicular radiation dose on reproductive complications in male childhood cancer survivors. Thirty-one studies were analyzed, of which 4 had testicular dose data to generate descriptive scatter plots. Two cohorts were identified. Cohort 1 consisted of pediatric and young adult patients with cancer who received scatter radiation therapy to the testes. Cohort 2 consisted of pediatric and young adult patients with cancer who received direct testicular radiation therapy as part of their cancer therapy. Descriptive scatter plots were used to delineate the relationship between the effect of mean testicular dose on sperm count reduction, testosterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH) levels. RESULTS Descriptive scatter plots demonstrated a 44% to 80% risk of oligospermia when the mean testicular dose was <1 Gy, but this was recovered by >12 months in 75% to 100% of patients. At doses >1 Gy, the rate of oligospermia increased to >90% at 12 months. Testosterone levels were generally not affected when the mean testicular dose was <0.2 Gy but were abnormal in up to 25% of patients receiving between 0.2 and 12 Gy. Doses between 12 and 19 Gy may be associated with abnormal testosterone in 40% of patients, whereas doses >20 Gy to the testes were associated with a steep increase in abnormal testosterone in at least 68% of patients. FSH levels were unaffected by a mean testicular dose <0.2 Gy, whereas at doses >0.5 Gy, the risk was between 40% and 100%. LH levels were affected at doses >0.5 Gy in 33% to 75% of patients between 10 and 24 months after radiation. Although dose modeling could not be performed in cohort 2, the risk of reproductive toxicities was escalated with doses >10 Gy. CONCLUSIONS This PENTEC comprehensive review demonstrates important relationships between scatter or direct radiation dose on male reproductive endpoints including semen analysis and levels of FSH, LH, and testosterone.
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Affiliation(s)
- Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Samir Patel
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Issam El Naqa
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laurie E Cohen
- Division of Endocrinology, Children's Hospital at Montefiore, Bronx, New York
| | - Rebecca M Howell
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Hamstra
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | - Arthur J Olch
- Department of Radiation Oncology, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California
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Yoshida K, Hashimoto T, Koizumi T, Suzuki N. Psychosocial experiences regarding potential fertility loss and pregnancy failure after treatment in cancer survivors of reproductive age to identify psychosocial care needs: a systematic review. Support Care Cancer 2024; 32:337. [PMID: 38727728 DOI: 10.1007/s00520-024-08544-w] [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: 11/03/2023] [Accepted: 05/03/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The challenges of fertility loss owing to cancer treatment persist long after treatment. However, psychosocial care for fertility among cancer survivors who have completed cancer treatment is insufficient. This systematic review examined psychosocial experiences related to the potential loss of fertility and unsuccessful pregnancy after treatment in cancer survivors of reproductive age to identify psychosocial care needs. METHODS A systematic review was conducted using the online databases PubMed, Cochrane Library, PsycINFO, CINAHL, and Ichushi-Web between August and December 2022 to identify studies that addressed psychosocial experiences after fertility loss or failure to conceive among young cancer survivors. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS Forty studies were included, revealing psychosocial experiences across five categories: subjective fear of (potential) fertility loss, impact on romantic relationships, alternative methods for family building, reliance on social support, and specialized care. Only one study addressed the psychosocial aspects after complete loss of fertility in young cancer survivors. CONCLUSIONS The possibility and uncertainty of fertility loss led to stress and depression, loss of identity, decreased opportunities to meet a new partner, and damaged relationships established before diagnosis. The needs encompass fertility preservation, sexuality, approaches to building a family, partner communication, and other diverse needs.
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Affiliation(s)
- Kanako Yoshida
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo, Tokyo, Japan.
| | - Tomoko Hashimoto
- Division of Integrated Medicine, IVF Namba Clinic, 1-17-28 Minamihorie Nishi-Ku, Osaka, Japan
| | - Tomoe Koizumi
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, Japan
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11
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Rashidian P. An update on oncofertility in prepubertal females. J Gynecol Obstet Hum Reprod 2024; 53:102742. [PMID: 38341083 DOI: 10.1016/j.jogoh.2024.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
Cancer is a life-threatening event for pediatric patients. Treatment advancements in pediatric cancer have improved prognosis, but some of these treatments have gonadotoxic potential and may affect fertility in different ways. Due to the growing interest of the research community in the life prospects of young cancer survivors, there has been a demand to intersect reproductive medicine and oncology, which is referred to as "oncofertility". There are various fertility preservation options according to gender and pubertal status, and shared decisions must take place at the time of diagnosis. This study aims to provide a critical review of current and emerging strategies for preserving and restoring fertility in prepubertal females, ranging from established methods to experimental approaches that can be offered before, during, and after anticancer therapies. Additionally, the author aims to review how clinicians' awareness of oncofertility options and the latest advancements in this field, timely referral, and proper consultations with patients and their families are vital in addressing their concerns, providing emotional support, and guiding them through the decision-making process, as well as potential barriers that may hinder the fertility preservation process.
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Affiliation(s)
- Pegah Rashidian
- Reproductive Health Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Klobodu C, Vitolins MZ, Deutsch JM, Fisher K, Nasser JA, Stott D, Murray MJ, Curtis L, Milliron BJ. Examining the Role of Nutrition in Cancer Survivorship and Female Fertility: A Narrative Review. Curr Dev Nutr 2024; 8:102134. [PMID: 38584676 PMCID: PMC10997918 DOI: 10.1016/j.cdnut.2024.102134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Female cancer survivors have a higher chance of experiencing infertility than females without a history of cancer diagnosis. This risk remains high despite advances in fertility treatments. There is a need to augment fertility treatments with cost-effective methods such as nutritional guidance to improve fertility chances. The aim of this review article is to connect the current literature on cancer survivorship nutrition and fertility nutrition, focusing on the importance of integrating nutritional guidance into fertility counseling, assessment, and treatment for female cancer survivors. Consuming a healthful diet comprising whole grains, soy, fruits, vegetables, seafood, and unsaturated fats has improved both female fertility and cancer survivorship. Similarly, maintaining a healthy body weight also improves female fertility and cancer survivorship. Therefore, dietary interventions to support female cancer survivors with fertility challenges are of immense importance. The period of follow-up fertility counseling and assessment after cancer treatment may provide a unique opportunity for implementing nutritional guidance for female cancer survivors. Dietary interventions are a promising strategy to improve pregnancy chances and overall quality of life among female cancer survivors; thus, researchers should investigate perceptions regarding fertility, barriers, and challenges to changing nutrition-related behaviors, and preferences for nutritional guidance to support fertility treatments in this population.
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Affiliation(s)
- Cynthia Klobodu
- Department of Nutrition and Food Science, California State University, Chico, College of Natural Sciences, CA, United States
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jonathan M Deutsch
- Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Kathleen Fisher
- Department of Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Jennifer A Nasser
- Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Dahlia Stott
- Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Michael J Murray
- Northern California Fertility Medical Center, Sacramento, CA, United States
| | - Laura Curtis
- Department of Nutrition and Food Science, California State University, Chico, College of Natural Sciences, CA, United States
| | - Brandy-Joe Milliron
- Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
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Benedict C, Ford JS, Schapira L, Davis A, Simon P, Spiegel D, Diefenbach M. Preliminary testing of "roadmap to parenthood" decision aid and planning tool for family building after cancer: Results of a single-arm pilot study. Psychooncology 2024; 33:e6323. [PMID: 38629761 PMCID: PMC11182040 DOI: 10.1002/pon.6323] [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: 08/18/2023] [Revised: 02/01/2024] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Many young adult female cancer survivors need to use reproductive medicine, surrogacy, or adoption to have a child. This study pilot tested Roadmap to Parenthood, a web-based, self-guided decision aid and planning tool for family building after cancer (disease agnostic). METHODS A single-arm pilot study tested feasibility, acceptability, and obtained effect size estimates of the Roadmap tool. Participants, recruited via hospital-based and social media strategies, completed a baseline survey (T1), accessed the Roadmap tool (website), then completed surveys at one- and 3-months (T2 and T3, respectively). Feasibility and acceptability were evaluated with rates of eligibility, enrollment, and survey completion, and feedback. Pairwise t-tests and repeated measures ANOVA evaluated usage effects. Effect size estimates were calculated. RESULTS Participants (N = 98) averaged 31 years old (SD = 5.61); 71% were nulliparous. Enrollment rate was 73%, T1-T2 completion rate was 80%, and 93% accessed the website. From T1-T2, participants reported improvements in decisional conflict (p < 0.001; Cohen's d = 0.85), unmet information needs (p < 0.001; Cohen's d = 0.70), self-efficacy (p = 0.003; Cohen's d = 0.40), and self-efficacy for managing negative emotions (p = 0.03; Cohen's d = 0.29); effects were sustained at T3. There was no change in reproductive distress (p = 0.22). By T3, 94% reported increased consideration of preparatory actions and 20%-61% completed such actions. CONCLUSIONS The Roadmap intervention was feasible to conduct, acceptable to users, and led to improvements in key psychosocial outcomes. Future directions will test intervention efficacy in a randomized controlled trial with a larger sample and over a longer period. A web-based tool may help women make decisions about family building after cancer and prepare for potential challenges.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Stanford, CA
- Stanford Cancer Institute, Stanford, CA
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, NY
| | | | - Alexandra Davis
- Stanford University School of Medicine, Stanford, CA
- Department of Clinical Psychology, Palo Alto University, Palo Alto, CA
| | - Pamela Simon
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA
| | - David Spiegel
- Stanford University School of Medicine, Stanford, CA
- Stanford Cancer Institute, Stanford, CA
| | - Michael Diefenbach
- Center for Health Innovation and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY
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Yoshida K, Matsui Y. An Examination of the Association Between Psychosocial Aspects of Fertility Issues and Demographic Characteristics of Unmarried Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2024; 13:293-299. [PMID: 37902972 DOI: 10.1089/jayao.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Purpose: The purpose of this study was to examine the association between fertility issues and demographic characteristics of unmarried adolescent and young adult cancer survivors. Methods: We conducted a survey among cancer survivors who were 15-39 years old and unmarried at the time of cancer diagnosis and 20-45 years old at the time of the survey. Views on fertility issues, originally developed based on the results of a qualitative study conducted with the same inclusion criteria, were used to assess thoughts and feelings regarding fertility issues. Results: Through exploratory factor analysis of the 128 respondents who either had children or desired children, two factors related to fertility issues were identified: "anxiety related to the possibility of not being able to have children" and "pressure from others to have children." Multiple regression analysis was performed to examine the association between these factors and demographic characteristics. The analysis revealed that being male and having a partner were significant predictors for both factors for views on fertility issues. Additionally, younger age at the time of diagnosis was a significant predictor for the first factor. Conclusions: Greater fertility issues among unmarried cancer survivors were associated with younger age at diagnosis, having a partner, and being male. Surprisingly, contrary to previous findings, male cancer survivors experienced more significant fertility problems than women. This result may be attributed to the well-established gender roles in Japan, where men are predominantly considered the heirs and inheritors of the family.
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Affiliation(s)
- Kanako Yoshida
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yutaka Matsui
- Institute of Human Sciences, University of Tsukuba, Tokyo, Japan
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15
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Kuiper ST, Zweers D, Suelmann BBM, Meijer RP, Vervoort SCJM. Perspectives and Concerns on Late Effects Regarding Sexuality among Adolescents and Young Adults Treated for Testicular Germ Cell Tumor: The PRICELESS-Study-A Qualitative Study. Cancers (Basel) 2024; 16:715. [PMID: 38398106 PMCID: PMC10886665 DOI: 10.3390/cancers16040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to explore perspectives and concerns regarding sexuality among adolescents and young adults (AYAs) possibly experiencing late effects after testicular germ cell tumor (TGCT) treatment. A qualitative study was performed in which semi-structured interviews were held with thirteen AYAs from a center of expertise for TGCT in the Netherlands. Data were analyzed using Braun and Clark's thematic analysis method. Seven interacting and interconnected themes were found: desire to have children, rediscovering sexuality, insecurity about sexual performance, acceptance of physical change, loss of masculinity, burden on relationship, and openness in discussing sexuality. Concerns about the desire to have children seem to play a significant role. In conclusion, TGCT patients face multiple changes (physical, emotional, relational, and sexual), followed by a difficult period of acceptance, after which a new phase of rediscovering sexuality appeared. These findings can help to make healthcare professionals aware of the underlying mechanisms and concerns about sexuality. Furthermore, insights can help to develop sexuality-themed items for a broader monitoring tool to structurally assess the late effects to support discussing sexuality.
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Affiliation(s)
- Stefan T. Kuiper
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Daniëlle Zweers
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Britt B. M. Suelmann
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Richard P. Meijer
- Oncological Urology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sigrid C. J. M. Vervoort
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
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16
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Lehmann V, Vlooswijk C, van der Graaf WTA, Bijlsma R, Kaal SEJ, Kerst JM, Tromp JM, Bos MEMM, van der Hulle T, Lalisang RI, Nuver J, Kouwenhoven MCM, Lok CAR, Beerendonk CCM, Dinkelman-Smit M, Husson O. Pre-treatment fertility preservation and post-treatment reproduction in long-term survivors of adolescent and young adult (AYA) cancer. J Cancer Surviv 2024:10.1007/s11764-024-01538-x. [PMID: 38316726 DOI: 10.1007/s11764-024-01538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To describe recall of fertility-related consultations and cryopreservation and to examine reproductive goals and reproduction post-treatment in long-term survivors of adolescent and young adult (AYA) (age, 18-39 years) cancer. METHODS This study included n = 1457 male and n = 2112 female long-term survivors (Mage = 43-45 years; 5-22 years from diagnosis) who provided self-report. Clinical data were supplied by the Netherlands Cancer Registry. RESULTS Most male survivors (72.7%) recalled fertility-related consultations and 22.6% completed sperm cryopreservation. Younger age (OR = 2.8; 95%CI [2.2-3.6]), not having children (OR = 5.0; 95%CI [3.2-7.7]), testicular cancer or lymphoma/leukemia (OR = 2.8/2.5 relative to "others"), and more intense treatments (OR = 1.5; 95%CI [1.1-2.0]) were associated with higher cryopreservation rates. Time since diagnosis had no effect. Of men who cryopreserved, 12.1% utilized assisted reproductive technologies (ART). Most men (88.5%) felt their diagnosis did not affect their reproductive goals, but 7.6% wanted no (additional) children due to cancer. Half of female survivors (55.4%; n = 1171) recalled fertility-related consultations. Rates of cryopreservation were very low (3.6%), but increased after 2013 when oocyte cryopreservation became non-experimental. Of women who cryopreserved, 13.2% successfully utilized ART. Most women (74.8%) experienced no effects of cancer on reproductive goals, but 17.8% wanted no (additional) children due to cancer. CONCLUSIONS Cryopreservation in men varied by patient/clinical factors and was very low in women, but data of more recently treated females are needed. Utilizing cryopreserved material through ART was rare, which questions its cost-effectiveness, but it may enhance survivors' well-being. IMPLICATIONS FOR CANCER SURVIVORS The extent to which cryopreservation positively affects survivors' well-being remains to be tested. Moreover, effects of cancer on reproductive goals require further attention, especially in women who refrain from having children due to cancer.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands.
| | - Carla Vlooswijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rhodé Bijlsma
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Suzanne E J Kaal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jacqueline M Tromp
- Department of Medical Oncology, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Monique E M M Bos
- Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roy I Lalisang
- Department of Internal Medicine, GROW-School of Oncology and Reproduction, Maastricht UMC, Maastricht, The Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathilde C M Kouwenhoven
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Center Gynaecologic Oncology Amsterdam, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marij Dinkelman-Smit
- Department of Urology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Marino JL, Peate M, McNeil R, Orme LM, McCarthy MC, Glackin A, Sawyer SM. Experiences of Family and Partner Support in Fertility Decision-Making Among Adolescents and Young Adults with Cancer: A National Australian Study. J Adolesc Young Adult Oncol 2024; 13:180-188. [PMID: 37339458 DOI: 10.1089/jayao.2023.0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Purpose: To understand how adolescents and young adults (AYAs) with cancer experience family and partner involvement in fertility preservation (FP) decision-making. Methods: As part of a nationally representative Australian cross-sectional study of 15-25-year olds with cancer, 196 participants (mean age 19.9 [standard deviation 3.2] years at diagnosis; 51% male) were surveyed regarding FP decision-making. Results: One hundred sixty-one (83%) participants reported discussion of potential effects of cancer and its treatment on fertility, of whom 57 (35%) did not undertake FP (51% of females; 19% of males). Parental involvement (mothers 62%, fathers 45%) in decision-making was considered helpful, including for 73% of 20-25-year olds with partners. Sisters and brothers were involved less often, yet rated helpful in 48% and 41% of cases, respectively. Older participants were more likely than younger ones to have involved partners (47% vs. 22%, p = 0.001) and less likely to have involved mothers (56% vs. 71%, p = 0.04) or fathers (39% vs. 55%, p = 0.04). Conclusion: This is the first quantitative study to explore family and partner involvement in AYA FP decision-making in both females and males in a nationally representative sample. Parents are important resources who commonly assist AYAs with these complex decisions. Although many AYAs will be the main decision-makers when it comes to FP, particularly as AYAs mature, these data suggest that resources and support should be available for and inclusive of parents, partners, and siblings.
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Affiliation(s)
- Jennifer L Marino
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Westmead, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Lisa M Orme
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- ONTrac at Peter Mac, Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Aoife Glackin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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18
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Glackin A, Marino JL, Peate M, McNeil R, Orme LM, McCarthy MC, Sawyer SM. Experiences of Oncofertility Decision-Making and Care in a National Sample of Adolescent and Young Adult Cancer Patients and Parents. J Adolesc Young Adult Oncol 2024; 13:170-179. [PMID: 37535814 DOI: 10.1089/jayao.2023.0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Purpose: Cancer and its treatments are known to compromise fertility in adolescents and young adults (AYAs). The emotional burden of possible infertility is reduced in those who receive supportive oncofertility care. In legal minors, provision of health care must consider the legal context and desire that AYAs have for autonomous decision-making, together with their competence to make health decisions. This has important implications for how oncofertility discussions may, or may not, involve parents. The aim of this study was to explore oncofertility decision-making and care experiences in a national Australian sample of AYA cancer patients and their parents. Methods: AYAs aged 15-25 years and parents were recruited from 17 cancer care sites and CanTeen Australia as part of a national AYA cancer care study. The cross-sectional survey included open-ended questions regarding oncofertility care experiences. We used reflexive thematic analysis to identify themes. Results: Data were available for 99 AYAs and 111 parents. Four themes were identified: emotional care needs; parent-AYA dynamics including AYA autonomy and agency; decision-making considerations including values and practicalities; and reflections on oncofertility care and follow-up. Both AYAs and parents placed importance on AYA autonomy in fertility decision-making, but many AYAs appreciated the role of parents in providing support and guidance throughout the process. Conclusion: Health care professionals are encouraged to autonomously engage AYAs around fertility decision-making, while concurrently offering opportunities that promote parental support. Better psychological support and follow-up oncofertility care are also needed.
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Affiliation(s)
- Aoife Glackin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa M Orme
- ONTrac at Peter Mac, Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Rae CS, Costa A, Seow H, Barr RD. Factors Associated With Adolescent and Young Adult Females Attending a Fertility Consultation Within 30 Days of a Cancer Diagnosis in Ontario, Canada. J Adolesc Young Adult Oncol 2024; 13:189-196. [PMID: 37279019 DOI: 10.1089/jayao.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Purpose: To examine the factors associated with females attending a fertility consultation within 30 days of cancer diagnosis. Methods: This is a retrospective cohort study, including females, 15 to 39 years of age, diagnosed with cancer in Ontario, Canada. Administrative data were used from the Institute of Clinical and Evaluative Sciences for the period 2006 to 2019. A backward selection multivariate logistic regression was performed, with a primary outcome of fertility consultation within 30 days of diagnosis. Results: A total of 20,556 females were included in the study, with 7% having attended a fertility visit within 30 days of diagnosis. Factors associated with being more likely to attend included: not currently having children (odds ratio [OR] = 4.3; confidence interval [95% CI 3.6-5.1]), later years of diagnosis (OR = 3.2; 95% CI [2.8-3.8]), having undergone chemotherapy (OR = 3.6; 95% CI [3.0-4.3]) or radiation therapy (OR = 1.9; 95% CI [1.6-2.2]), and less marginalization within dependency quintiles (OR 1.4; 95% CI [1.1-1.7]). Having a cancer with lower risk to fertility (OR = 0.3; 95% CI [0.2-0.3]), death within a year of diagnosis (OR = 0.4; 95% CI [0.3-0.6]), and residing in a northern region of Ontario (OR = 0.3; 95% CI [0.2-0.4]) were associated with being less likely to attend. For sociodemographic factors, lower levels of income (OR = 0.5; 95% CI [0.4-0.6]) and marginalization with residential instability (OR = 0.6; 95% CI [0.5-0.8]) were associated with being less likely to attend a fertility consultation. Conclusions: Rates for attendance of female fertility consultations after a cancer diagnosis remain low, with disparities by both clinical and demographic factors.
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Affiliation(s)
- Charlene S Rae
- Department of Pediatrics and Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Andrew Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Hsien Seow
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ronald D Barr
- Department of Pediatrics and Evidence, and Impact, McMaster University, Hamilton, Canada
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20
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Suhag A, Sharma KK, Tiwari SK, Joshi P, Rastogi S, Kaur S. Health-related quality of life, psychological issues and concerns among sarcoma survivors: a mixed method study. Ecancermedicalscience 2024; 18:1657. [PMID: 38425760 PMCID: PMC10901627 DOI: 10.3332/ecancer.2024.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Indexed: 03/02/2024] Open
Abstract
Purpose We aimed to explore the health-related quality of life (HRQoL), psychological issues and concerns among sarcoma survivors in India and assess their satisfaction with nursing care. Methods This study employed a sequential mixed-methods design, enrolling 100 sarcoma survivors from July to December 2021, with data collected using standardised questionnaires for HRQoL, depression, anxiety, stress, cognitive impairment and self-structured satisfaction with nursing care. Qualitative data were gathered through focused group discussions. Results The mean global health score among sarcoma survivors was 79.48 ± 16.26. A significant number of survivors had symptoms of mild-to-moderate depression (30%), severe anxiety (12%), stress (16%) and mild cognitive impairment (5%). Significant mean rank differences were observed between anxiety and financial difficulty (p < 0.05), emotional functioning (p < 0.001), cognitive functioning (p < 0.001), pain (<0.05), insomnia (p < 0.001), fatigue (p < 0.001), anorexia (p < 0.05) and nausea/vomiting (p < 0.001). Educational qualification had a significant association with depression and anxiety while family history of cancer emerged as a significant factor associated with anxiety and stress among survivors. Qualitative analysis revealed themes related to body image, societal discrimination, socio-economic impact, marriage concerns and fertility issues. Survivor satisfaction with nursing care was good. Conclusion A substantial number of sarcoma survivors had an average HRQoL and experienced depression, anxiety and stress. Our study emphasizes the importance of holistic survivorship care, involving nurses in post-treatment support, and addressing societal discrimination and psychosocial concerns to enhance their quality of life. Implications for cancer survivors Our study calls for a holistic approach to sarcoma survivor care and emphasizes the importance of personalised survivorship care plans led by nurses to address the diverse needs of sarcoma survivors in India. Such plans should encompass strategies for managing depression, anxiety and stress, along with addressing body image concerns and social support.
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Affiliation(s)
- Arti Suhag
- College of Nursing, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Kamlesh Kumari Sharma
- College of Nursing, All India Institute of Medical Sciences, Bathinda, Punjab 151001, India
| | - Surya Kant Tiwari
- College of Nursing, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh 229405, India
- https://orcid.org/0000-0003-4718-0398
| | - Poonam Joshi
- College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal 741250, India
- https://orcid.org/0000-0002-7016-8437
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Simran Kaur
- Department of Medical Physiology, All India Institute of Medical Sciences, New Delhi 110608, India
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21
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Tan CY, Francis-Levin N, Stelmak D, Iannarino NT, Zhang A, Herrel L, Ellman E, Walling E, Moravek MB, Chugh R, Zebrack B. Differentiating gender-based reproductive concerns among adolescent and young adult cancer patients: A mixed methods study. J Psychosoc Oncol 2024; 42:526-542. [PMID: 38164962 DOI: 10.1080/07347332.2023.2291798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Few studies have examined the distinct reproductive concerns (RC) of men and women in the adolescent and young adult (AYA) cancer patient population. The purpose of this mixed-methods study was to explore and differentiate the RC of AYAs. METHODS Participants completed the Reproductive Concerns After Cancer (RCAC) scale and participated in a semistructured interview. Interviews were deductively coded based on an analytic schema derived from the RCAC. RESULTS After identifying participants through the electronic health record, 27 younger AYAs, ages 12-25, enrolled in the study. Four inductive themes emerged and differed by gender. These include differential temporality, acceptance, and openness to alternatives, partner influence, and parental/guardian influence. AYA men reported fewer RC (M = 49.4, SD = 9.6) compared to AYA women (M = 56.8, SD = 8.4). CONCLUSIONS Oncofertility care providers are advised to account for short- and long-ranging concerns based on AYAs' gender. Future evaluations of patient-reported outcome measures specific to AYA RC are recommended.
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Affiliation(s)
- Chiu Yi Tan
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nina Francis-Levin
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas T Iannarino
- Department of Language, Culture, and the Arts, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B Moravek
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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22
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Klees C, Alexandri C, Demeestere I, Lybaert P. The Role of microRNA in Spermatogenesis: Is There a Place for Fertility Preservation Innovation? Int J Mol Sci 2023; 25:460. [PMID: 38203631 PMCID: PMC10778981 DOI: 10.3390/ijms25010460] [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: 11/15/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Oncological treatments have dramatically improved over the last decade, and as a result, survival rates for cancer patients have also improved. Quality of life, including concerns about fertility, has become a major focus for both oncologists and patients. While oncologic treatments are often highly effective at suppressing neoplastic growth, they are frequently associated with severe gonadotoxicity, leading to infertility. For male patients, the therapeutic option to preserve fertility is semen cryopreservation. In prepubertal patients, immature testicular tissue can be sampled and stored to allow post-cure transplantation of the tissue, immature germ cells, or in vitro spermatogenesis. However, experimental techniques have not yet been proven effective for restoring sperm production for these patients. MicroRNAs (miRNAs) have emerged as promising molecular markers and therapeutic tools in various diseases. These small regulatory RNAs possess the unique characteristic of having multiple gene targets. MiRNA-based therapeutics can, therefore, be used to modulate the expression of different genes involved in signaling pathways dysregulated by changes in the physiological environment (disease, temperature, ex vivo culture, pharmacological agents). This review discusses the possible role of miRNA as an innovative treatment option in male fertility preservation-restoration strategies and describes the diverse applications where these new therapeutic tools could serve as fertility protection agents.
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Affiliation(s)
- Charlotte Klees
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
| | - Chrysanthi Alexandri
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
- Fertility Clinic, HUB-Erasme Hospital, 1070 Brussels, Belgium
| | - Pascale Lybaert
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
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23
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Hsieh MC, Lai CY, Lin LT, Chou D, Yeh CM, Cheng JK, Wang HH, Lin KH, Lin TB, Peng HY. Melatonin Relieves Paclitaxel-Induced Neuropathic Pain by Regulating pNEK2-Dependent Epigenetic Pathways in DRG Neurons. ACS Chem Neurosci 2023; 14:4227-4239. [PMID: 37978917 DOI: 10.1021/acschemneuro.3c00616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The neurohormone melatonin (MLT) demonstrates promising potential in ameliorating neuropathic pain induced by paclitaxel (PTX) chemotherapy. However, little is known about its protective effect on dorsal root ganglion (DRG) neurons in neuropathic pain resulting from the chemotherapeutic drug PTX. Here, PTX-treated rats revealed that intrathecal administration of MLT dose-dependently elevated hind paw withdrawal thresholds and latency, indicating that MLT significantly reversed PTX-induced neuropathic pain. Mechanistically, the analgesic effects of MLT were found to be mediated via melatonin receptor 2 (MT2), as pretreatment with an MT2 receptor antagonist inhibited these effects. Moreover, intrathecal MLT injection reversed the pNEK2-dependent epigenetic program induced by PTX. All of the effects caused by MLT were blocked by pretreatment with an MT2 receptor-selective antagonist, 4P-PDOT. Remarkably, multiple MLT administered during PTX treatment (PTX+MLTs) exhibited not only rapid but also lasting reversal of allodynia/hyperalgesia compared to single-bolus MLT administered after PTX treatment (PTX+MLT). In addition, PTX+MLTs exhibited greater efficacy in reversing PTX-induced alterations in pRSK2, pNEK2, JMJD3, H3K27me3, and TRPV1 expression and interaction in DRG neurons than PTX+MLT. These results indicated that MLT administered during PTX treatment reduced the incidence and/or severity of neuropathy and had a better inhibitory effect on the pNEK2-dependent epigenetic program compared to MLT administered after PTX treatment. In conclusion, MLT/MT2 is a promising therapy for the treatment of pNEK2-dependent painful neuropathy resulting from PTX treatment. MLT administered during PTX chemotherapy may be more effective in the prevention or reduction of PTX-induced neuropathy and maintaining quality.
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Affiliation(s)
- Ming-Chun Hsieh
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
| | - Cheng-Yuan Lai
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City 252, Taiwan
| | - Li-Ting Lin
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City 252, Taiwan
| | - Dylan Chou
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
| | - Chou-Ming Yeh
- Division of Thoracic Surgery, Department of Health, Taichung Hospital, Executive Yuan, Taichung 40343, Taiwan
- Central Taiwan University of Science and Technology, Taichung 40343, Taiwan
| | - Jen-Kun Cheng
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei104, Taiwan
| | - Hsueh-Hsiao Wang
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
| | - Kuan-Hung Lin
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City 252, Taiwan
- Traditional Herbal Medicine Research Center, Taipei Medical University Hospital, Taipei110, Taiwan
- Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 252, Taiwan
| | - Tzer-Bin Lin
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City 110, Taiwan
- Institute of New Drug Development, College of Medicine, China Medical University, Taichung 40604, Taiwan
| | - Hsien-Yu Peng
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City 252, Taiwan
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24
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Dong Y, Yue Z, Zhuang H, Zhang C, Fang Y, Jiang G. The experiences of reproductive concerns in cancer survivors: A systematic review and meta-synthesis of qualitative studies. Cancer Med 2023; 12:22224-22251. [PMID: 38069669 PMCID: PMC10757101 DOI: 10.1002/cam4.6531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 12/31/2023] Open
Abstract
AIM The aim of this study was to synthesize qualitative research evidence on cancer survivors' experiences with reproductive concerns (RC). METHODS We conducted a systematic search of qualitative studies and utilized the meta-aggregation approach. The database searches were extended up to May 14, 2023, encompassing 12 databases, specifically MEDLINE, CINAHL, PubMed, EMBASE, Scopus, Web of Science (Core Collection), AMED, PsycINFO, The Cochrane Library, CNKI, Wan Fang Data, and VIP. RESULTS Three overarching themes were synthesized from the analysis of 21 studies that explored cancer patients' awareness of reproductive concerns, their perceptions, needs, and coping styles. These themes encapsulate the multifaceted aspects of cancer patients' reproductive concerns: "Gender differences in fertility concerns among cancer patients: Perspectives from men and women"; "The influence of age: Experiences with fertility issues among cancer patients at different life stages"; "The impact of treatment stages on fertility concerns: The evolution of perception and coping strategies in the course of cancer treatment". CONCLUSION Our study presents an in-depth exploration of the reproductive concerns experienced by cancer patients from various perspectives. We found that the internal experiences of reproductive concerns, their perceptions, needs, and coping mechanisms differ based on their roles. This comprehensive understanding of the complex emotions and needs of cancer patients when confronted with fertility issues can guide clinicians in providing more effective medical assistance, psychological counseling, and fertility-related information services.
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Affiliation(s)
- Ying Dong
- LiaoNing Cancer Hospital & Institute, DaLian Medical University School of NursingShenyangChina
| | - Zhenyu Yue
- LiaoNing Cancer Hospital & InstituteShenyangChina
| | - Huan Zhuang
- Third Department of GynecologyLiaoNing Cancer Hospital & InstituteShenyangChina
| | - Chen Zhang
- DaLian Medical University School of NursingDalianChina
| | - Yu Fang
- DaLian Medical University School of NursingDalianChina
| | - Guichun Jiang
- Clinical Skills Training CenterLiaoNing Cancer Hospital & InstituteShenyangChina
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25
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Ledesma B, Campbell K, Muthigi A, Ila V, Nassau DE, Ibrahim E, Ramasamy R. Semen Cryopreservation in Men with Cancer: Identifying Patterns and Challenges. JOURNAL OF FERTILITY PRESERVATION 2023; 3:246156. [PMID: 38567027 PMCID: PMC10987015 DOI: 10.32371/jfp/246156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this study was to determine the proportion of male cancer patients who undergo semen cryopreservation before chemotherapy after referral was placed, identify factors associated with completing the procedure, and explore reasons for not moving forward with it. METHODS The electronic medical records of men with cancer who were referred to a reproductive urologist identified with an ICD-10 code for a fertility preservation procedure (Z31.62, Z31.84) between November 2021 and February 2023 were reviewed. Cancer type, semen cryopreservation rates, and reasons for opting out of the procedure were recorded. RESULTS Of the 128 men diagnosed with cancer who were referred for cryopreservation during the study period, n:67 (52%) underwent semen cryopreservation. Those who did not undergo the procedure tended to be older, with a median age of 38 years compared to those that did it (33 years) (p: 0.10). The most common reasons for non-compliance included financial burden, and lack of interest. CONCLUSION While it is recommended that patients consider fertility preservation prior to chemotherapy, our findings suggest that only half of male cancer patients completed the procedure despite referral. Further work is needed to determine barriers to access and increase awareness of fertility preservation prior to chemotherapy.
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Affiliation(s)
- Braian Ledesma
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Katherine Campbell
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Akhil Muthigi
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Vishal Ila
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | - Emad Ibrahim
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
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26
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Cherven B, Quast LF, Klosky JL, Gerhardt CA, Baust K, Calaminus G, Kaatsch P, Hagedoorn M, Tuinman MA, Lehmann V. Contraceptive methods and fertility testing in young adult survivors of childhood cancer. J Assist Reprod Genet 2023; 40:2391-2400. [PMID: 37584730 PMCID: PMC10504164 DOI: 10.1007/s10815-023-02908-7] [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: 06/29/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Reproductive health is important, but often neglected in cancer survivorship care. This study explored contraceptive use and factors associated with fertility testing among young adult survivors of childhood cancer in Germany. METHODS Young adult survivors of childhood cancer were identified through the German Childhood Cancer Registry and completed a mailed survey. Survivors were queried regarding contraceptive use, reproductive goals, uncertainty about fertility, and completion or interest in fertility testing. Multivariable stepwise logistic regression models were used to calculate Odds Ratios (OR) and 95% confidence intervals (CI) as a means of identifying factors associated with completion of and interest in fertility testing. RESULTS Survivors (N = 472; 57.8% female; aged 23.3 ± 1.5 years, and 14.9 ± 5.0 years from diagnosis), reported high rates of contraceptive use, including 61.2% using a single method, 30.6% dual methods, and 8.1% no/less effective methods. Few survivors had completed fertility testing (13.0%), although 58.8% were interested. Having been diagnosed during adolescence (OR = 2.66, 95%CI: 1.39-5.09), greater uncertainty about fertility (OR = 1.16, 95%CI: 1.03-1.31), and use of dual contraceptive methods (OR = 1.94, 95%CI: 1.02-3.69) were associated with having completed fertility testing. Factors associated with interest in fertility testing included goals of wanting to have children (OR = 7.76, 95%CI: 3.01-20.04) and greater uncertainty about fertility (OR = 1.19 95%CI: 1.06-1.33). CONCLUSION In this sample of young adults who survived childhood cancer, most reported contraceptive use. Few survivors had completed fertility testing, although more than half were interested. Interventions are needed to address potential barriers to fertility testing and help survivors manage fertility-related uncertainty.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren F Quast
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands.
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27
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Benedict C, Stal J, Davis A, Zeidman A, Pons D, Schapira L, Diefenbach M, Ford JS. Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors. Psychooncology 2023; 32:1606-1615. [PMID: 37695291 PMCID: PMC10591918 DOI: 10.1002/pon.6212] [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: 02/24/2023] [Revised: 07/28/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Many adolescent and young adult female (AYA-F) cancer survivors face decisions about family building using reproductive medicine or adoption to achieve parenthood. This study evaluated associations among reproductive distress, avoidance, and family-building decision making and identified sociodemographic and clinical characteristics related to high distress and avoidance. METHODS A cross-sectional survey assessed AYA-F survivors' oncofertility experiences. Measures included an investigator-designed Unmet Information Needs scale, Reproductive Concerns After Cancer Scale, Impact of Events Scale-Avoidance subscale, Decision Self-Efficacy scale, and Decision Conflict Scale. Two linear regression models evaluated correlates of decision self-efficacy and decisional conflict about family building after cancer. Bivariate analyses evaluated correlates of avoidance using Pearson's correlation, t-test, and ANOVA. RESULTS AYA-Fs (N = 111) averaged 31-years-old (SD = 5.49) and 3 years post-treatment (range: 1-23 years); 90% were nulliparous. Most common diagnoses were leukemia (24%) and breast cancer (22%). Average decisional conflict was 52.12 (SD = 23.87, range: 0-100); 74% of the sample reported DCS scores within the clinically significant range. Higher levels of reproductive distress (B = -0.23, p = 0.04) and avoidance (B = -0.24, p = 0.02) related to lower decision self-efficacy. Younger age (B = -0.18, p = 0.03), greater unmet information needs (B = 0.33, p < 0.001), and higher levels of reproductive distress (B = 0.34, p = 0.001) related to worse decisional conflict. Predictors of distress and avoidance were identified. CONCLUSIONS After cancer treatment, high fertility distress and avoidant coping were associated with poorer quality decision making about family building after cancer. Fertility counseling post-treatment should support self-efficacy and constructive coping skills to counteract high distress, maladaptive coping, and facilitate values-based decision making.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
- Stanford Cancer Institute, Stanford, CA
| | - Julia Stal
- Department off Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Ali Davis
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
- Department of Clinical Psychology, Palo Alto University, Palo Alto, CA
| | - Anna Zeidman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Devon Pons
- University of San Francisco, San Francisco, CA
| | | | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, NY
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28
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Kayiira A, Xiong S, Zaake D, Balagadde JK, Gomez-Lobo V, Wabinga H, Ghebre R. Shared Decision-Making About Future Fertility in Childhood Cancer Survivorship: Perspectives of Parents in Uganda. J Adolesc Young Adult Oncol 2023; 12:718-726. [PMID: 36787466 PMCID: PMC10611960 DOI: 10.1089/jayao.2022.0127] [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] [Indexed: 02/16/2023] Open
Abstract
Background: Despite a plethora of literature on barriers to addressing future fertility in childhood cancer survivors, the data are not representative of limited middle-income settings. Unique and context-specific factors may influence addressing future fertility care among childhood cancer survivors in Uganda. This study aimed to explore the experiences, attitudes, and perceptions of parents on their interactions with health providers about future fertility, as part of their child's cancer survivorship. Methods: Using grounded theory, semistructured interviews were conducted with parents of children diagnosed with cancer, <18 years of age, and not in the induction or consolidation phases of treatment. Transcripts were thematically analyzed. Results: A total of 20 participants were interviewed, with the majority identifying as female (n = 18). The global theme that arose was the importance of shared decision-making, and the key themes encompassing this were as follows: (1) importance of accurate information, (2) respect of autonomy, and (3) engagement and psychosocial support. Conclusion: In Uganda, parents of children with cancer value a multifaceted approach to satisfactory decision-making within the context of oncofertility.
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Affiliation(s)
- Anthony Kayiira
- Department of Obstetrics and Gynaecology, Uganda Martyrs University School of Medicine, Kampala, Uganda
- Department of Reproductive Endocrinology and Infertility, Mulago Specialized Women's and Neonatal Hospital, Kampala, Uganda
| | - Serena Xiong
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Daniel Zaake
- Department of Obstetrics and Gynaecology, Uganda Martyrs University School of Medicine, Kampala, Uganda
| | | | - Veronica Gomez-Lobo
- Department of Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Henry Wabinga
- Department of Pathology, Kampala Cancer Registry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
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29
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Shen J, Jiang H, Lin H, Fan S, Yu D, Yang L, Chen L. Fertility concerns in cancer patients: a bibliometric analysis via CiteSpace: A review. Medicine (Baltimore) 2023; 102:e35211. [PMID: 37746999 PMCID: PMC10519520 DOI: 10.1097/md.0000000000035211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Fertility concerns are a pervasive issue but very subtle in patients with cancer. Though various studies have focused on fertility concerns, limited research endeavor has been dedicated to bibliometric analysis. Given this, to visually analyze the hot frontier trends of research related to fertility concerns of patients with cancer using CiteSpace and provide new insights for future research in this field using the bibliometric method. We used CiteSpace software to retrieve the literature related to fertility concerns of patients with cancer in the Web of Science core collection database from the year of establishment to 2022 and conducted visual analysis in terms of authors, countries and regions, research institutions, and keywords. The search resulted in 201 valid articles, and the annual publication volume of literature related to fertility concerns in patients with cancer was generally on the rise; the country with the most publications was the United States, which also had the highest influence; the main research institution was Sloan Kettleson Cancer Research Center; the core research scholar was Jessica R. Gorman; the research hotspots mainly centered on quality of survival, women, survivorship, preservation, breast cancer, adolescence, and infertility. The results of this bibliometric study provide the current status and trends in the fertility concerns of patients with cancer and may help researchers identify the hotspots and frontier trends in this field.
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Affiliation(s)
- Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Siyue Fan
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Doudou Yu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liping Yang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
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30
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Rosimont M, Kariyawasam D, Samara-Boustani D, Giani E, Beltrand J, Bolle S, Fresneau B, Puget S, Sainte-Rose C, Alapetite C, Pinto G, Touraine P, Piketty ML, Brabant S, Abbou S, Aerts I, Beccaria K, Bourgeois M, Roujeau T, Blauwblomme T, Rocco FD, Thalassinos C, Rigaud C, James S, Busiah K, Simon A, Bourdeaut F, Lemelle L, Guerrini-Rousseau L, Orbach D, Doz F, Dufour C, Grill J, Polak M, Briceño LG. Assessment of Puberty and Hypothalamic-Pituitary-Gonadal Axis Function After Childhood Brain Tumor Treatment. J Clin Endocrinol Metab 2023; 108:e823-e831. [PMID: 36810692 DOI: 10.1210/clinem/dgad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Endocrine complications are common in pediatric brain tumor patients. OBJECTIVE To describe hypothalamic-pituitary-gonadal axis (HPGA) function in patients treated in childhood for a primary brain tumor more than 5 years earlier, in order to identify risk factors for HPGA impairment. METHODS We retrospectively included 204 patients diagnosed with a primary brain tumor before 18 years of age and monitored at the pediatric endocrinology unit of the Necker Enfants-Malades University Hospital (Paris, France) between January 2010 and December 2015. Patients with pituitary adenoma or untreated glioma were excluded. RESULTS Among patients with suprasellar glioma not treated by radiotherapy, the prevalence of advanced puberty was 65% overall and 70% when the diagnosis occurred before 5 years of age. Medulloblastoma chemotherapy caused gonadal toxicity in 70% of all patients and in 87.5% of those younger than 5 years at diagnosis. In the group with craniopharyngioma, 70% of patients had hypogonadotropic hypogonadism, which was consistently accompanied by growth hormone deficiency. CONCLUSION Tumor type, location, and treatment were the risk main factors for HPGA impairment. Awareness that onset can be delayed is essential to guide information of parents and patients, patient monitoring, and timely hormone replacement therapy.
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Affiliation(s)
- Manon Rosimont
- Endocrino-diabéto-pédiatrie, Centre hospitalier chrétien du Montlégia, 4000 Liège, Belgium
| | - Dulanjalee Kariyawasam
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Dinane Samara-Boustani
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Elisa Giani
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Jacques Beltrand
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
- Université Paris Cité, 75006 Paris, France
| | - Stephanie Bolle
- Département de radiothérapie-oncologie, Institut Gustave Roussy, 94805 Villejuif, France
| | - Brice Fresneau
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Stephanie Puget
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Christian Sainte-Rose
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Claire Alapetite
- Radiation Oncology Department and Proton Centre, Institut Curie, 75005 Paris, France
| | - Graziella Pinto
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Philippe Touraine
- Université Paris Cité, 75006 Paris, France
- Service Endocrinologie et Médecine de la Reproduction, Hôpital Universitaire La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 75005 Paris, France
| | - Marie-Liesse Piketty
- Explorations Fonctionnelles, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75013 Paris, France
| | - Séverine Brabant
- Explorations Fonctionnelles, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75013 Paris, France
| | - Samuel Abbou
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Isabelle Aerts
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Kevin Beccaria
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Marie Bourgeois
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Thomas Roujeau
- Unité de Neurochirurgie pédiatrique, Hôpital Gui de Chauliac, 34295 Montpellier, France
| | - Thomas Blauwblomme
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | | | - Caroline Thalassinos
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Charlotte Rigaud
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Syril James
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Kanetee Busiah
- Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Albane Simon
- Endocrinologie Pédiatrique, Centre Hospitalier de Versailles, 78157 Le Chesnay, France
| | - Franck Bourdeaut
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Lauriane Lemelle
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Léa Guerrini-Rousseau
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
- PSL Research University, 75006 Paris, France
| | - François Doz
- Université Paris Cité, 75006 Paris, France
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Christelle Dufour
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Jacques Grill
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Michel Polak
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
- Université Paris Cité, 75006 Paris, France
| | - Laura González Briceño
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
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Close A, Burns K, Bjornard K, Webb M, Chavez J, Chow EJ, Meacham L. Fertility preservation in pediatric leukemia and lymphoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2023; 70:e30407. [PMID: 37194406 PMCID: PMC10525075 DOI: 10.1002/pbc.30407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
Certain chemotherapy agents, radiation, and surgery can all negatively impact future fertility. Consults regarding treatment-related risk for infertility and gonadal late effects of these agents should occur at the time of diagnosis as well as during survivorship. Counseling on fertility risk has traditionally varied significantly across providers and institutions. We aim to provide a guide to standardize the assignment of gonadotoxic risk, which can be used in counseling patients both at the time of diagnosis and in survivorship. Gonadotoxic therapies were abstracted from 26 frontline Children's Oncology Group (COG) phase III protocols for leukemia/lymphoma, in use from 2000-2022. A stratification system based on gonadotoxic therapies, sex, and pubertal status was used to assign treatments into minimal, significant, and high level of increased risk for gonadal dysfunction/infertility. Risk levels were assigned to protocols and different treatment arms to aid oncologists and survivor care providers in counseling patients regarding treatment-related gonadotoxicity. Males were most commonly at high risk, with at least one high-risk arm in 14/26 protocols (54%), followed by pubertal females (23% of protocols) and prepubertal females (15% of protocols). All patients who received direct gonadal radiation or hematopoietic stem cell transplant (HSCT) were considered at high risk. Partnering with patients and their oncology/survivorship team is imperative for effective fertility counseling both prior to and post treatment, and this comprehensive guide can be used as a tool to standardize and improve reproductive health counseling in patients undergoing COG-based leukemia/lymphoma care.
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Affiliation(s)
- Allison Close
- Helen DeVos Children’s Hospital, Division of Hematology/Oncology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Karen Burns
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Kari Bjornard
- Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Martine Webb
- University of California, Los Angeles, Division of Internal Medicine, Los Angeles, CA, USA
| | - Josuah Chavez
- Helen DeVos Children’s Hospital, Division of Hematology/Oncology, Grand Rapids, MI, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, Seattle Children’s Hospital, Seattle, WA, USA
| | - Lillian Meacham
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Pediatric Hematology/Oncology/BMT, Emory University Atlanta, GA USA
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Kayiira A, Neda John J, Zaake D, Xiong S, Kambugu Balagadde J, Gomez-Lobo V, Wabinga H, Ghebre R. Understanding Fertility Attitudes and Outcomes Among Survivors of Adolescent and Young Adult Cancers in a Low-Resource Setting: A Registry-Based Computer-Assisted Telephone Interview Survey. J Adolesc Young Adult Oncol 2023; 12:520-528. [PMID: 36579945 PMCID: PMC10457622 DOI: 10.1089/jayao.2022.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: To establish the extent of self-reported reproductive failure associated with cancer treatment, and attitudes toward fertility among adolescent and young adult (AYA) cancer survivors in Uganda. Methods: A registry-based computer-assisted telephone interview survey was conducted in Uganda. The survey population were survivors of childhood, adolescent and early adulthood cancers diagnosed between 2007 and 2018. The survey explored fertility outcomes, experiences of oncofertility and fertility attitudes of AYA cancer survivors. Results: Thirty-four (female = 14 and male = 20) interviews were completed. Survivors were 18-35 years of age. The median age at cancer diagnosis was 23.5 for females and 17.5 for males. Kaposi's sarcoma contributed to 44% of primary cancer diagnoses. All the survivors had received chemotherapy alone or in combination with other modalities and 79% of survivors had not received satisfactory information about future fertility before cancer treatment. Twenty one percent of males and 46% females met the criteria for infertility and 60% of these had met this criterion after their cancer diagnosis. Eighty two percent wanted to raise a biologically related child. Forty seven percent would be dissatisfied with their lives if they were unable to have a child or additional children. Conclusion: AYA cancer survivors in this low-resource setting reported reproductive failure, despite a strong fertility desire. Information and counseling provided on therapy-related problems before cancer treatment was insufficient and reinforces the need to build capacity for oncofertility resources within the region.
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Affiliation(s)
- Anthony Kayiira
- Department of Obstetrics and Gynecology, Uganda Martyrs University School of Medicine, Kampala, Uganda
- Department of Reproductive Endocrinology and Infertility, Mulago Specialized Women's and Neonatal Hospital, Kampala, Uganda
| | | | - Daniel Zaake
- Department of Obstetrics and Gynecology, Uganda Martyrs University School of Medicine, Kampala, Uganda
| | - Serena Xiong
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis. Minnesota, USA
| | | | - Veronica Gomez-Lobo
- Department of Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Henry Wabinga
- Kampala Cancer Registry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
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Shati AA, Khalil MA. Acylated ghrelin suppresses doxorubicin-induced testicular damage and improves sperm parameters in rats via activation of Nrf2 and mammalian target of rapamycin. J Cancer Res Ther 2023; 19:1194-1205. [PMID: 37787283 DOI: 10.4103/jcrt.jcrt_1756_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Exogenous administration of acylated ghrelin (AG) afforded reproductive protective effect in several animal models but not in those treated with doxorubicin (DOX). This study evaluated the protective effect of AG against DOX-induced testicular damage and impairment in sperm parameters in rats and examined the potential mechanisms of action. Materials and Methods Adult male rats were divided into five groups (n = 8/each) as control, control + AG (40 nmol/kg/day; subcutaneous), DOX (10 mg/kg/day 1; intraperitoneal [i.p.]), DOX + AG, and DOX + AG + brusatol (an Nrf2 inhibitor) (2 mg/kg/every 3 days; i.p.). The treatment regimen continued for 65 days. Results AG prevented testicular damage and apoptosis; increased sperm count, motility, and viability; and reduced the number of abnormal sperms. It also increased their circulatory levels of AG, des-acylated ghrelin (DAG), and AG/DAG ratio and the testicular mRNA levels of ghrelin and growth hormone secretagogue receptor 1a Concomitantly, AG increased serum and testicular testosterone levels, reduced serum levels of the follicle-stimulating hormone and luteinizing hormone, and upregulated the testicular protein levels of the steroidogenic acute regulatory protein and 3β-hydroxysteroid dehydrogenase in DOX-treated rats. In the testes of the control and DOX-treated rats, AG increased the phosphorylation of mammalian target of rapamycin and stimulated the levels of glutathione and superoxide dismutase, as well as the nuclear activation of Nrf2. All these effects were completely prevented by co-treatment with brusatol. Conclusion AG replacement therapy could be a novel strategy to prevent reproductive toxicity in cancer patients.
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Affiliation(s)
- Ali A Shati
- Department of Biology, College of Science, King Khalid University, Abha, Saudi Arabia
| | - Mohammad A Khalil
- Department of Basic Medical Sciences, Division of Physiology, College of Medicine, King Fahad Medical City, Riyadh, KSA
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Tuerxun H, Zhao Y, Li Y, Liu X, Wen S, Cao J, Cui J, Zhao Y. Immune Checkpoint Inhibitors as A Threat to Reproductive Function: A Systematic Review. Crit Rev Oncol Hematol 2023:104064. [PMID: 37379960 DOI: 10.1016/j.critrevonc.2023.104064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023] Open
Abstract
In recent years, the indications for immunotherapy in cancer treatment have been expanding. The increased risk of cancer in young people, coupled with the fact that many women or men choose to delay childbearing, has made an increasing number of patients of childbearing age eligible for immunotherapy. Furthermore, with the improvements of various treatments, more young people and children are able to survive cancer. As a result, long-term sequelae of cancer treatments, such as reproductive dysfunction, are increasingly important for survivors. While many anti-cancer drugs are known to cause reproduction dysfunction, the effects of immune checkpoint inhibitors (ICIs) on reproduction function remain largely unknown. Through a retrospective analysis of previous reports and literature, this article aims to elucidate the causes of reproductive dysfunction induced by ICIs and focus on their specific mechanisms, in order to providing some guidance to clinicians and patients.
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Affiliation(s)
- Halahati Tuerxun
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yixin Zhao
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yawen Li
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xingyu Liu
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Shuhui Wen
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Jingjing Cao
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Jiuwei Cui
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yuguang Zhao
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, 130021, China.
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35
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Takizawa Y, Kizawa M, Niwa N, Komura Y, Takahashi M, Koda D, Kurita T, Nakajima T. Specific inhibitory effects of guanosine on breast cancer cell proliferation. Biochem Biophys Res Commun 2023; 673:67-72. [PMID: 37356147 DOI: 10.1016/j.bbrc.2023.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death. Drug therapy for breast cancer is currently selected based on the subtype classification; however, many anticancer drugs are highly cytotoxic. Since intracellular levels of GTP are elevated in many cancer cells that undergo a specific cell proliferation cycle, GTP has potential as a target for cancer therapy. The present study focused on nucleosides and nucleotides and examined intracellular GTP-dependent changes in cell proliferation rates in normal (MCF-12A) and cancer (MCF-7) breast cell lines. Decreased cell proliferation due to a reduction in intracellular GTP levels by mycophenolic acid (MPA), an inosine monophosphate dehydrogenase inhibitor, was observed in both cell lines. The inhibitory effects of MPA on cell proliferation were suppressed when it was applied in combination with Guanosine (Guo), a substrate for GTP salvage synthesis, while the single exposure to Guo suppressed the proliferation of MCF-7 cells only. Although the underlying mechanisms remain unclear, since the inhibitory effects of Guo on cell proliferation did not correlate with GTP or ATP intracellular levels or the GTP/ATP ratio, there may be another cause besides GTP metabolism. Guo inhibited the proliferation of MCF-7, a human breast cancer cell line, but not MCF-12A, a human normal breast cell line. Further studies are needed to investigate the potential of applying Guo as a target for the development of a novel cancer treatment system.
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Affiliation(s)
- Yusuke Takizawa
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan.
| | - Masayuki Kizawa
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Nobuyuki Niwa
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Yuya Komura
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Masato Takahashi
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Daiki Koda
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Takuro Kurita
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Takanori Nakajima
- Division of Clinical Pharmaceutics, Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, 10281 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan
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Benedict C, Thom B, Diefenbach M, Schapira L, Simon P, Ford JS. The Impact of Cancer-Related Financial Toxicity on Reproductive Concerns and Family-Building Decision-Making in Post-Treatment Survivorship. J Adolesc Young Adult Oncol 2023; 12:408-415. [PMID: 36169520 PMCID: PMC10282808 DOI: 10.1089/jayao.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors are at-risk for cancer-related financial difficulties (i.e., financial toxicity [FT]). Family building after cancer often requires reproductive medicine or adoption with high costs; AYAs experience financial barriers to family building. This study evaluated the relationships among cancer FT, reproductive concerns, and decision-making processes about family building after cancer. Methods: AYA female (AYA-F) cancer survivors completed a cross-sectional survey including measures of FT, reproductive concerns, decisional conflict about family building, and decision-making self-efficacy. Differences across FT subgroups (i.e., no/mild, moderate, and severe FT) were tested. Linear regression evaluated the relationships between FT and reproductive concerns and decision-making processes. Results: Participants (N = 111) averaged 31.0 years (standard deviation [SD] = 5.49), 90% were nulliparous, and 84% were employed full/part-time. The overall FT levels were in the "moderate" range (M = 20.44, SD = 9.83); 48% worried quite a bit or very much about financial problems because of cancer. AYA-Fs reporting severe FT (24% of sample) experienced higher levels of reproductive concerns compared with those reporting no/mild and moderate FT. Those reporting moderate FT (46% of sample) reported greater decisional conflict about family-building options, compared with the no/mild FT subgroup. Both moderate and severe FT subgroups reported lower decision-making self-efficacy compared with the no/mild FT subgroup. In separate models controlling for covariates, greater FT related to higher levels of reproductive concerns (B = -0.39, p < 0.001), greater decisional conflict about family building (B = -0.56, p = 0.02), and lower decision-making self-efficacy (B = 0.60, p = 0.01). Conclusions: Given the high costs of reproductive medicine and adoption, fertility counseling pre- and post-treatment must address survivors' financial concerns and barriers.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Stanford Cancer Institute, Stanford, California, USA
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | | | - Pam Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, New York, USA
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37
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Beauchemin MP, Roth ME, Parsons SK. Reducing Adolescent and Young Adult Cancer Outcome Disparities Through Optimized Care Delivery: A Blueprint from the Children's Oncology Group. J Adolesc Young Adult Oncol 2023; 12:314-323. [PMID: 36716260 PMCID: PMC10282820 DOI: 10.1089/jayao.2022.0136] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Achieving equitable, high-quality cancer care delivery across socioeconomically and biologically diverse populations requires multilevel interventions, including those at the patient, provider, institution, and policy levels that influence cost, quality, and access to care. For adolescent and young adults (AYAs), who experience suboptimal health outcomes compared with younger and older people with cancer, cancer care delivery is influenced by additional contextual factors unique to the patients' developmental stage, psychosocial and economic status, and cancer subtype. In this review, we highlight the most pressing research needs in AYA cancer care delivery and opportunities to improve outcomes for this population.
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Affiliation(s)
- Melissa P. Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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38
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Dean M, Hintz EA, Baker J, Reblin M, Quinn GP, Haskins C, Vadaparampil ST. Shared Decision-Making Experiences of Couples with Inherited Cancer Risk Regarding Family Building. JOURNAL OF HEALTH COMMUNICATION 2023:1-10. [PMID: 37078713 DOI: 10.1080/10810730.2023.2202630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Patients with hereditary cancer predisposition syndromes have a high likelihood of passing germline mutations to future offspring. Patients at risk for inherited cancer may not have started and/or completed building their families; thus, they must decide about having children and consider the possibility of passing on their germline mutation. Utilizing the Shared Decision Making (SDM) Model, this study explores family building decision-making communication processes in opposite-sex couples with inherited cancer risk (ICR). Fifteen couples completed two recorded, analogue discussions and dyadic interviews at two time points. Participants were recruited through social media and snowball sampling. The constant comparison method was utilized to thematically analyze the data. When couples discussed family building options (FBOs), several themes were identified: FBO risks, FBO considerations, genetic-related FBO logistics, and life FBOs logistics. When deliberating family building decisions, couples shared easy conversational topics (e.g. FBO options and potential child's cancer risk due to a genetic variant) and difficult/conflict-inducing topics (e.g. preparing for possibilities, parenting, emotions, finances, and timing). Last, couples self-reported primary and secondary FBOs. The findings of this study capture couples' decision-making communication process while considering their experiences. Clinicians and practitioners can utilize these findings to support couples' family building decisions considering their ICR.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Elizabeth A Hintz
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Jonathan Baker
- Department of Communication, University of South Florida, Tampa, Florida, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
| | - Gwendolyn P Quinn
- Department of OB-GYN, Grossman School of Medicine, New York University, New York, USA
| | - Carolyn Haskins
- Department of Genetic Counseling, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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39
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Yumura Y, Takeshima T, Komeya M, Karibe J, Kuroda S, Saito T. Long-Term Fertility Function Sequelae in Young Male Cancer Survivors. World J Mens Health 2023; 41:255-271. [PMID: 36593712 PMCID: PMC10042651 DOI: 10.5534/wjmh.220102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023] Open
Abstract
With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.
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Affiliation(s)
- Yasushi Yumura
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
| | - Teppei Takeshima
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Mitsuru Komeya
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Jurii Karibe
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shinnosuke Kuroda
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tomoki Saito
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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Longpré SM, Rader NC, Dougherty KJ, Motai Y, Leinhauser KC. Factors That Influence Occupational Engagement of Young Adults Who Are Cancer Survivors: A Pilot Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:218-227. [PMID: 36245400 DOI: 10.1177/15394492221128779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer and its treatment can impact occupational engagement. However, occupational therapy-specific research studying young adult cancer survivors remains limited. The objective of this study to identify the type of occupations that young adult cancer survivors choose to engage in and to understand their decision-making process when choosing these occupations. A mixed-methods explanatory sequential design was used. Eleven participants, nine females and two males, between the ages of 18 and 35, were included. Several occupations were identified for engagement such as activities of daily living, leisure, work, sleep and rest, and health management. The predominant factor that influenced why occupations were chosen was that individuals purposefully selected occupations that allowed them to choose a path toward a more meaningful life. Information gained from this pilot study can be used to inform occupational therapy practitioners regarding services and interventions that promote occupational engagement for young adult cancer survivors.
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Affiliation(s)
| | - Nadeya C Rader
- Blanchfield Army Community Hospital, Fort Campbell, KY, USA
| | | | - Yael Motai
- Wellness Beyond Rehab, LLC, Oldsmar, FL, USA
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El Alaoui-Lasmaili K, Nguyen-Thi PL, Demogeot N, Lighezzolo-Alnot J, Gross MJ, Mansuy L, Chastagner P, Koscinski I. Fertility discussions and concerns in childhood cancer survivors, a systematic review for updated practice. Cancer Med 2023; 12:6023-6039. [PMID: 36224740 PMCID: PMC10028046 DOI: 10.1002/cam4.5339] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To provide ways to improve the clinical practice of fertility preservation (FP) for children, adolescents, and young adults (AYA) with cancer. DESIGN A systematic research of online databases was undertaken in March 2020 following the PRISMA criteria, including Medline and Web of Science. RESULTS Fifty-nine articles were included. Surveys, interviews, and focus groups were used to collect data from patients, parents, and health care providers (HCPs). Four themes worth exploring emerged: (a) what do patients and professionals think of and know about FP? (b) what makes the fertility discussion happen or not? (c) what, retrospectively, led to FP being pursued or not? and (d) how do patients and HCPs feel about fertility issues? CONCLUSION A minority of AYAs preserve their fertility (banking assay for 45% of boys and 23% of girls). Yet fertility concerns have a significant impact on the quality of life of young cancer survivors. Although recommendations and guidelines regarding FP are available internationally, there are no specific guidelines as to how to conduct fertility counseling for children and adolescents. Some barriers are not removable, such as a poor prognosis of an obvious severe disease, time constraints for starting treatment, and cultural and religious beliefs. In response to aspects hindering patients and families to be receptive to any discussion at the time of diagnosis, psychological support could reduce the level of emotional distress and help restore a degree of open-mindedness to open a window for discussion. Moreover, as the lack of knowledge of professionals about fertility is frequently pointed out as a limiting factor for fertility discussion, reinforcing professional training regarding FP could be proposed to promote fertility discussion and eventually referral for FP.
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Affiliation(s)
| | - Phi Linh Nguyen-Thi
- Unité d'évaluation médicale, Unité de Méthodologie, Data management et Statistique - UMDS, CHRU de Nancy
| | - Nadine Demogeot
- Interpsy Laboratory (UR4432), University of Lorraine, Nancy, France
| | | | | | - Ludovic Mansuy
- Department of Pediatric Hematology and Oncology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Isabelle Koscinski
- Laboratory of Biology of Reproduction-CECOS Lorraine, University Hospital of Nancy, Nancy, France
- INSERM U1256, NGERE, Université de Lorraine, Nancy, France
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Hovén E, Ljungman L, Sveen J, Skoglund C, Ljungman G, Ljung R, Wikman A. Losing a child to adolescent cancer: A register-based cohort study of psychotropic medication use in bereaved parents. Cancer Med 2023; 12:6148-6160. [PMID: 36218005 PMCID: PMC10028064 DOI: 10.1002/cam4.5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the short- and long-term risk of psychotropic medication use in parents who lose a child to cancer diagnosed in adolescence. METHODS This is a Swedish nationwide register-based study including 184 bereaved mothers and 184 bereaved fathers of 184 children diagnosed with cancer in adolescence. Logistic regression analyses, adjusted for sociodemographic characteristics and history of mental health problems, were performed to estimate risk of a prescription of psychotropic medication (anxiolytics, hypnotics/sedatives, antidepressants) in cancer-bereaved parents from 1 year before to 5 years after the child's death, with a general population sample of non-bereaved parents (n = 3291) as referents. RESULTS At the year of the child's death, 28%-36% of mothers and 11%-20% of fathers had a prescription of anxiolytics, hypnotics/sedatives or antidepressants. The corresponding percentages for non-bereaved mothers and fathers were 7%-12% and 4%-7%, respectively. Compared to non-bereaved mothers, bereaved mothers showed higher odds of prescriptions from 1 year before up to four (anxiolytics) and 5 years (hypnotics/sedatives and antidepressants) after the child's death. Bereaved fathers showed higher odds than non-bereaved fathers of prescriptions from 1 year before up to the year of (anxiolytics and hypnotics/sedatives) and 1 year after (antidepressants) the child's death. No differences in odds between bereaved and non-bereaved fathers were found at 2 years after the child's death. Being unmarried, born outside Sweden, and having a history of mental health problems were associated with higher odds of prescribed medications. CONCLUSIONS Indicative of mental health problems of clinical importance, cancer-bereaved parents had a higher prevalence of use of psychotropic medication. A decrease in medication use was evident with time, but still at 5 years after the child's death mothers displayed a higher use while fathers showed no difference to non-bereaved fathers after 2 years.
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Affiliation(s)
- Emma Hovén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Childhood Cancer Research Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Lisa Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Josefin Sveen
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Crisis PsychologyUniversity of BergenBergenNorway
| | | | - Gustaf Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Pediatric OncologyUppsala University HospitalUppsalaSweden
| | - Rickard Ljung
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Anna Wikman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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Drechsel KCE, Pilon MCF, Stoutjesdijk F, Meivis S, Schoonmade LJ, Wallace WHB, van Dulmen-den Broeder E, Beishuizen A, Kaspers GJL, Broer SL, Veening MA. Reproductive ability in survivors of childhood, adolescent, and young adult Hodgkin lymphoma: a review. Hum Reprod Update 2023:7034966. [PMID: 36779325 DOI: 10.1093/humupd/dmad002] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/21/2022] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Owing to a growing number of young and adolescent Hodgkin lymphoma (HL) survivors, awareness of (long-term) adverse effects of anticancer treatment increases. The risk of impaired reproductive ability is of great concern given its impact on quality of life. There is currently no review available on fertility after childhood HL treatment. OBJECTIVE AND RATIONALE The aim of this narrative review was to summarize existing literature on different aspects of reproductive function in male and female childhood, adolescent, and young adult HL survivors. SEARCH METHODS PubMed and EMBASE were searched for articles evaluating fertility in both male and female HL survivors aged <25 years at diagnosis. In females, anti-Müllerian hormone (AMH), antral follicle count, premature ovarian insufficiency (POI), acute ovarian failure, menstrual cycle, FSH, and pregnancy/live births were evaluated. In males, semen-analysis, serum FSH, inhibin B, LH, testosterone, and reports on pregnancy/live births were included. There was profound heterogeneity among studies and a lack of control groups; therefore, no meta-analyses could be performed. Results were presented descriptively and the quality of studies was not assessed individually. OUTCOMES After screening, 75 articles reporting on reproductive markers in childhood or adolescent HL survivors were included. Forty-one papers reported on 5057 female HL survivors. The incidence of POI was 6-34% (median 9%; seven studies). Signs of diminished ovarian reserve or impaired ovarian function were frequently seen (low AMH 55-59%; median 57%; two studies. elevated FSH 17-100%; median 53%; seven studies). Most survivors had regular menstrual cycles. Fifty-one studies assessed fertility in 1903 male HL survivors. Post-treatment azoospermia was highly prevalent (33-100%; median 75%; 29 studies). Long-term follow-up data were limited, but reports on recovery of semen up to 12 years post-treatment exist. FSH levels were often elevated with low inhibin B (elevated FSH 0-100%; median 51.5%; 26 studies. low inhibin B 19-50%; median 45%; three studies). LH and testosterone levels were less evidently affected (elevated LH 0-57%, median 17%; 21 studies and low testosterone 0-43%; median 6%; 15 studies). In both sexes, impaired reproductive ability was associated with a higher dose of cumulative chemotherapeutic agents and pelvic radiotherapy. The presence of abnormal markers before treatment indicated that the disease itself may also negatively affect reproductive function (Females: AMH<p10 9%; one study and Males: azoospermia 0-50%; median 10%; six studies). Reports on chance to achieve pregnancy during survivorship are reassuring, although studies had their limitations and the results are difficult to evaluate. In the end, a diminished ovarian reserve does not exclude the chance of a live birth, and males with aberrant markers may still be able to conceive. WIDER IMPLICATIONS This review substantiates the negative effect of HL treatment on gonadal function and therefore young HL survivors should be counseled regarding their future reproductive life, and fertility preservation should be considered. The current level of evidence is insufficient and additional trials on the effects of HL and (current) treatment regimens on reproductive function are needed. In this review, we make a recommendation on reproductive markers that could be assessed and the timing of (repeated) measurements.
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Affiliation(s)
- Katja C E Drechsel
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Cancer Center Amsterdam, Amsterdam UMC, Location VUmc, VU Amsterdam, Amsterdam, The Netherlands
| | - Maxime C F Pilon
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Francis Stoutjesdijk
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Salena Meivis
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Eline van Dulmen-den Broeder
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Haematology/Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gertjan J L Kaspers
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Simone L Broer
- Department of Reproductive Medicine & Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margreet A Veening
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Abstract
PURPOSE OF REVIEW There is a growing population of adolescent and young adult (AYA, ages 15-39 years) cancer patients and survivors, and the field of AYA oncology is rapidly evolving. Despite an increased focus on survival and quality of life for AYAs, gaps in knowledge remain. The current review focuses on what is known across several domains unique to AYA cancer care as well as areas of improvement and future directions in research and intervention. RECENT FINDINGS Due to the developmental stages included in the AYA age range, a cancer diagnosis and treatment can affect relationships, education and employment, finances, and long-term health differently than diagnoses in younger or older populations. Recent studies that have focused on these unique aspects of AYA cancer care, including health-related quality of life (HRQoL), fertility, financial toxicity, barriers to clinical trial enrollment, genetic predisposition, and survivorship care are included in the current review. SUMMARY Although studies have described many of the challenges faced by AYAs across the cancer continuum from diagnosis to survivorship, more work is needed, particularly in systematically measuring HRQoL, eliminating barriers to clinical trial enrollment, addressing financial toxicity, and increasing access to fertility preservation and high-quality survivorship care.
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45
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Simon PJ, Pyke-Grimm KA, Nasr AS. Assessing the Needs of Adolescents and Young Adults Receiving Cancer Treatment: A Mixed Methods Study. J Adolesc Young Adult Oncol 2023; 12:43-52. [PMID: 35575715 DOI: 10.1089/jayao.2021.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study was designed to assess the most salient health care needs of adolescents and young adults (AYAs) who undergo cancer treatment. Understanding their age-related needs helps providers offer appropriate support when support is vital: as they accept diagnosis and undergo treatment. Methods: A mixed methods design was used to obtain quantitative and qualitative data on the overall needs of AYA cancer patients. Participants, aged 16-29, who enrolled early in their cancer treatment, completed the Stanford Adolescent and Young Adult Cancer (SAYAC) Program survey and a subsequent one-on-one semistructured interview. Results: The quantitative and qualitative data were analyzed separately. The data revealed that AYAs adjusted and adapted to their cancer diagnosis to meet their health care needs. Three themes emerged from the data: acquisition of knowledge and experience, participation in decision-making and self-management behaviors, and gaining perspectives on life inside and outside of the hospital. The quantitative data revealed that the participants agreed or strongly agreed on the importance of being involved in the decision-making process, incorporating hopes and dreams into their treatment, and feeling supported by their family. Conclusion: Understanding the needs of AYAs who undergo cancer treatment is vital to their overall well-being. Using different data collection methods, including interviews, can clarify AYA needs and lead to improved individualized care.
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Affiliation(s)
- Pamela J Simon
- Stanford Adolescent and Young Adult Cancer Program, Stanford Children's Health, Palo Alto, California, USA
| | - Kimberly A Pyke-Grimm
- Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health, Palo Alto, California, USA.,Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Annette S Nasr
- Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health, Palo Alto, California, USA.,Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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46
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Allison KR, Patterson P, Ussher JM, McDonald FEJ, Perz J. Evaluating Maybe Later Baby, a Fertility Information Resource for Adolescents and Young Adults Diagnosed with Cancer: A Randomized, Controlled Pilot Study. J Adolesc Young Adult Oncol 2023; 12:101-109. [PMID: 35333618 DOI: 10.1089/jayao.2021.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Fertility is a major concern for adolescents and young adults (AYAs, 15-30 years) diagnosed with cancer, yet they often report a lack of information and understanding about fertility impacts and preservation options. This study aimed to evaluate the acceptability and preliminary efficacy of Maybe Later Baby (MLB), an oncofertility information resource for AYAs diagnosed with cancer. Methods: In a randomized controlled trial, 13 participants received MLB alone and 10 received an augmented intervention involving an additional consultation with a health care professional (HCP). Pre- and postintervention surveys and interviews explored participants' well-being, fertility knowledge, health literacy, and experiences using the resource. Results: Participants indicated that the resource was accessible and understandable and provided valuable information without increasing distress. When averaged across conditions, functional health literacy (p = 0.006) and oncofertility knowledge (p = 0.002) increased, although there were no significant changes in fertility-related emotions (p > 0.05), and quality of life decreased (p = 0.014). While qualitative accounts suggested that HCP consultations were useful and validated participants' experiences and concerns, participants receiving the augmented intervention became more nervous/fearful about fertility treatment (p = 0.005). There were no other differences in outcomes between conditions. Conclusions: Young people diagnosed with cancer want and value information about oncofertility and resources such as MLB are acceptable and useful means of providing this information. This could be supplemented by clinical discussion to ensure that tailored situation-specific information is provided and understood and patient distress is appropriately managed. Clinical Trial Registration number: 12615000624583.
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Affiliation(s)
- Kimberley R Allison
- Research and Youth Cancer Services, Canteen Australia, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Pandora Patterson
- Research and Youth Cancer Services, Canteen Australia, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Fiona E J McDonald
- Research and Youth Cancer Services, Canteen Australia, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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Mimoun E, Margalit D. Disclosing an Invisible Disability During a Romantic Relationship: Schizophrenia and Epilepsy. SEXUALITY AND DISABILITY 2023. [DOI: 10.1007/s11195-023-09774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Klobodu C, Deutsch J, Vitolins MZ, Fisher K, Nasser JA, Stott D, Milliron BJ. Optimizing Fertility Treatment With Nutrition Guidance: Exploring Barriers and Facilitators to Healthful Nutrition Among Female Cancer Survivors With Fertility Challenges. Integr Cancer Ther 2023; 22:15347354231191984. [PMID: 37559460 PMCID: PMC10416655 DOI: 10.1177/15347354231191984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Young women diagnosed with cancer are at an increased risk for infertility compared to women without a cancer diagnosis. Consuming a healthful diet comprised of whole grains, fruits, vegetables, and unsaturated fats has been found to improve both fertility and cancer survivorship. Given this reason, dietary interventions tailored to support female cancer survivors with fertility challenges are of immense importance. Therefore, the aim of this study was to explore barriers and facilitators to healthful nutrition among female cancer survivors with fertility challenges, to inform the development of dietary interventions for this population. METHODS Using a formative research design, interview, survey, and dietary intake data were collected from 20 female cancer survivors of reproductive age. Participant-check focus group discussions were conducted to validate findings. All interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a thematic analysis approach. Quantitative data were analyzed using means, standard deviations, ranges, frequencies, and percentages. RESULTS The average age of respondents was 31.47 ± 3.5 years and the average BMI was 24.78 ± 4.1 kg/m2. All participants were college educated, 45% identified as White, 50% as Black, and 10% as Hispanic or Latinx. Cancer diagnoses included breast, thyroid, ovarian, leukemia, and gastrointestinal cancers. The following themes were identified: (1) Lack of nutrition-related resources and detailed guidance, (2) Work-life balance, (3) Perceived rigidity of dietary guidance, (4) Treatment-related fatigue, (5) Having trust in healthcare providers, (6) Higher motivation to change nutrition behavior, and (7) Recognizing the additional benefits of nutrition. CONCLUSION These findings indicate a sought-after yet unmet need for post-cancer treatment fertility nutrition recommendations. Interventions should be tailored to women's needs and focus on improving their self-efficacy to make healthful dietary choices.
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Affiliation(s)
- Cynthia Klobodu
- Drexel University, Philadelphia, PA, USA
- California State University Chico, Chico, CA, USA
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Cherven B, Kelling E, Lewis RW, Pruett M, Meacham L, Klosky JL. Fertility-related worry among emerging adult cancer survivors. J Assist Reprod Genet 2022; 39:2857-2864. [PMID: 36447078 PMCID: PMC9790831 DOI: 10.1007/s10815-022-02663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Cancer survivors with a history of gonadotoxic treatment are at risk for future infertility and reproductive concerns, including worry about infertility. The purpose of this study was to describe factors associated with fertility-related worry among emerging adult survivors of childhood cancer. METHODS This chart review included patients aged 18.00-25.99 years and > 1 year from cancer treatment completion with a history of gonadotoxic treatment. Survivors were offered structured fertility-focused discussions at age ≥ 18 years, which assessed worry about future infertility. Data from this discussion (i.e., reported fertility-related worry (yes/no), sociodemographic, and clinical characteristics were abstracted from the medical record. Multivariable logistic regression with backwards elimination was used to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with fertility-related worry. RESULTS Survivors (N = 249) were a mean age of 19.1 ± 1.2 years at initial fertility discussion; 55.8% were male, 58.2% non-Hispanic White, and 27.3% were at high risk for future treatment-related infertility. Fertility-related worry was reported by 66.3% of survivors. Factors related to worry on multivariable analysis included female sex (OR: 2.64, 95%CI: 1.44-4.96, p = .002), solid tumor diagnosis (OR: 2.31, 95%CI: 1.15-4.71, p = .019), moderate and high risk of infertility (OR: 2.94, 95%CI: 1.23-7.64, p = .02; OR: 3.25, 95%CI: 1.55-7.17, p = .002), and ≥ 2 fertility discussions during survivorship care OR: 2.71, 95%CI: 1.46-5.20, p = .002). CONCLUSIONS Two-thirds of emerging adult cancer survivors expressed worry about future infertility, which has been linked to a variety of adverse quality of life outcomes. Survivors who are worried about infertility may benefit from psychological interventions.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Erin Kelling
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca Williamson Lewis
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
| | - Megan Pruett
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
| | - Lillian Meacham
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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50
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Ahmed Y, Khan AMH, Rao UJ, Shaukat F, Jamil A, Hasan SM, Abrar S, Qureshi BM, Abbasi AN. Fertility preservation is an imperative goal in the clinical practice of radiation oncology: a narrative review. Ecancermedicalscience 2022; 16:1461. [PMID: 36819826 PMCID: PMC9934885 DOI: 10.3332/ecancer.2022.1461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Indexed: 02/24/2023] Open
Abstract
With reduced cancer mortality in recent years, increased efforts must be put into safeguarding cancer survivors' long-term quality of life (QOL). Fertility preservation is recognised as a key component of QOL in survivorship. Concerns about fertility have been seen to significantly impact cancer patients' emotional and mental health as, generally, both malignancy and its treatment may cause a temporary or permanent reduction in infertility. This article reviews the primary effects of radiation therapy on male and female gonads and has further highlighted procedures through which the functioning of these organs can be protected before or during radiation treatment. We have also emphasised the importance of the establishment of multidisciplinary tumour boards and patient education regarding future reproductive function which is an important component of the care of individuals with cancer. This article highlights that infertility is a persistent and major concern that can add to long-term stress in cancer survivors, and education about fertility preservation before the initiation of any treatment is especially important.
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Affiliation(s)
- Yumna Ahmed
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | | | | | - Fatima Shaukat
- Department of Radiation Oncology, Cyberknife and Tomotherapy Centre, JPMC, Karachi 75510, Pakistan
| | - Arhum Jamil
- Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Sehrish Abrar
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Bilal Mazhar Qureshi
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ahmed Nadeem Abbasi
- Department of Radiation Oncology, Aga Khan University Hospital, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
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