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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study. Eur J Oncol Nurs 2024; 72:102648. [PMID: 39106587 DOI: 10.1016/j.ejon.2024.102648] [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: 10/02/2023] [Revised: 05/28/2024] [Accepted: 06/22/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE Guided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England. METHODS Secondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors. RESULTS Poorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65-74 years, younger respondents were less likely to rate their care favourably (16-34 years old ORadj. = 0.55 (0.36-0.84). Compared to White British, Asian (ORadj. = 0.51 (0.39-0.66)) and Black African women (ORadj. = 0.53 (0.33-0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (ORadj. = 0.79 (0.64-0.97)). CONCLUSION There is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
| | - Katriina L Whitaker
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
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Sun M, Liu C, Zhang P, Song Y, Bian Y, Ke S, Lu Y, Lu Q. Perspectives and needs for fertility preservation decision-making in childbearing-age patients with breast cancer: A qualitative study. Asia Pac J Oncol Nurs 2024; 11:100548. [PMID: 39170761 PMCID: PMC11338125 DOI: 10.1016/j.apjon.2024.100548] [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: 05/01/2024] [Accepted: 06/25/2024] [Indexed: 08/23/2024] Open
Abstract
Objective To explore the perspectives and needs related to fertility preservation decision-making in patients of childbearing age with breast cancer. Methods Semistructured face-to-face interviews were conducted in a tertiary hospital in Baoding, China from July to October 2023. Purposive sampling was used to ensure the diversity of samples. The interview guide is based on the literature review and the discussions within the research team. A traditional content analysis approach was used for data analysis. Results A total of 18 participants were interviewed. Three themes emerged from the data: conflicts between subjective desires and concerns, coexistence of objective benefits and challenges, and decision-making support needs. The conflicts between subjective desires and concerns included five sub-themes, the coexistence of objective benefits and challenges also included five sub-themes, and the decision-making support needs included two sub-themes. Conclusions Patients faced a difficult trade-off between desires and concerns, benefits, and challenges regarding fertility preservation decisions, with numerous unmet needs. Healthcare professionals should prioritize patients' fertility desires, providing timely fertility preservation information and adequate counseling after a cancer diagnosis. This approach can help alleviate unnecessary concerns, facilitate satisfactory decision-making, and improve patients' quality of life.
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Affiliation(s)
- Mengying Sun
- School of Nursing, Hebei University, Baoding, Hebei Province, China
| | - Chunlei Liu
- School of Nursing, Hebei University, Baoding, Hebei Province, China
| | - Peng Zhang
- Department of Breast Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Yanru Song
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Ying Bian
- Department of Breast Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Sangsang Ke
- School of Nursing, Hebei University, Baoding, Hebei Province, China
| | - Yanjuan Lu
- School of Nursing, Hebei University, Baoding, Hebei Province, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
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Taniskidou AM, Voultsos P, Tarlatzis V, Timotheadou E. Perceptions and experiences of fertility preservation in female patients with cancer in Greece. BMC Womens Health 2024; 24:108. [PMID: 38336757 PMCID: PMC10858603 DOI: 10.1186/s12905-024-02955-x] [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: 07/06/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND As advances in oncology have led to remarkable and steady improvements in the survival rates of patients with cancer and anticancer treatment can cause premature ovarian failure in women, fertility preservation (FP) has become a global public health concern and an integral part of the care for women diagnosed with cancer during reproductive age. However, for various reasons, FP remains underutilized for patients with cancer. There are substantial gaps in our knowledge about women's experiences and perceptions of the issue. This study aims to contribute to bridging that gap. METHODS This prospective qualitative study was conducted from March 2018 to February 2023. A combination of purposive and snowball sampling was used. Data were collected by semistructured interviews with nineteen reproductive-age women who had been recently diagnosed with cancer. Data were classified and analysed with a thematic analysis approach. RESULTS A variety of distinct themes and subthemes emerged from the analysis of the interview data. The cancer diagnosis emerged as a factor that considerably affects the women's attitudes towards biological parenthood: It can further increase their (strong) previous desire or decrease their previous (weak) desire. Women with a recent cancer diagnosis had not received adequate and multidisciplinary counselling, including clear and sufficient information. However, participants felt satisfied with the information they received because they either received the information they requested or remained in denial about the need to be informed (i.e., because they felt overwhelmed after the cancer diagnosis). Embryo cryopreservation emerged as a less desirable FP option for women with cancer. Participants showed respect for human embryos, not always for religious reasons. Surrogacy emerged as the last resort for most participants. Religious, social or financial factors did play a secondary (if any) role in women's decision-making about FP. Finally, male partners' opinions played a secondary role in most participants' decision-making about FP. If embryo cryopreservation was the selected option, partners would have a say because they were contributing their genetic material. CONCLUSIONS The findings that emerged from the data analysis were partly consistent with prior studies. However, we identified some interesting nuances that are of clinical importance. The results of this study may serve as a starting point for future research.
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Affiliation(s)
- Anna-Maria Taniskidou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR, 54124, Greece
| | - Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR, 54124, Greece.
| | - Vasileios Tarlatzis
- 1st Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR, 54124, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Klijn NF, ter Kuile MM, Lashley EELO. Patient-Reported Outcomes (PROs) and Patient Experiences in Fertility Preservation: A Systematic Review of the Literature on Adolescents and Young Adults (AYAs) with Cancer. Cancers (Basel) 2023; 15:5828. [PMID: 38136372 PMCID: PMC10741741 DOI: 10.3390/cancers15245828] [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: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
With better survival rates for patients diagnosed with cancer, more attention has been focused on future risks, like fertility decline due to gonadotoxic treatment. In this regard, the emphasis during counselling regarding possible preservation options is often on the treatment itself, meaning that the medical and emotional needs of patients regarding counselling, treatment, and future fertility are often overlooked. This review focuses on patient-reported outcomes (PROs) and patient experiences regarding fertility preservation (FP)-among adolescents and young adults (AYAs) with cancer. A systematic review of the literature, with a systematic search of online databases, was performed, resulting in 61 selected articles. A quality assessment was performed by a mixed methods appraisal tool (MMAT). Based on this search, three important topics emerged: initiating discussion about the risk of fertility decline, acknowledging the importance of future fertility, and recognizing the need for more verbal and written patient-specific information. In addition, patients value follow-up care and the opportunity to rediscuss FP and their concerns about future fertility and use of stored material. A clear FP healthcare pathway can prevent delays in receiving a referral to a fertility specialist to discuss FP options and initiating FP treatment. This patient-centered approach will optimize FP experiences and help to establish a process to achieve long-term follow up after FP treatment.
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Affiliation(s)
- Nicole F. Klijn
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Ko JKY, Cheung CSY, Cheng HHY, Yung SSF, Ng TY, Tin WWY, Yuen HY, Lam MHC, Chan ASY, Fung SWW, Man VCM, Kwong A, Ng EHY. Knowledge, attitudes and intention on fertility preservation among breast cancer patients. Sci Rep 2023; 13:9645. [PMID: 37316503 PMCID: PMC10267122 DOI: 10.1038/s41598-023-36377-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
Breast cancer is the most common cancer in reproductive age women. The aim of this study is to assess the knowledge, attitude and intention on fertility preservation among women diagnosed to have breast cancer. This is a multi-centre cross-sectional questionnaire study. Reproductive age women diagnosed with breast cancer attending Oncology, Breast Surgery and Gynaecology Clinics and support groups were invited to participate. Women filled in paper or electronic form of the questionnaire. 461 women were recruited and 421 women returned the questionnaire. Overall, 181/410 (44.1%) women had heard of fertility preservation. Younger age and higher education level were significantly associated with increased awareness of fertility preservation. Awareness and acceptance of the different fertility preservation methods in reproductive age women with breast cancer was suboptimal. However, 46.1% women felt that their fertility concerns affected their decision for cancer treatment in some way.
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Affiliation(s)
- Jennifer K Y Ko
- Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong, Hong Kong
| | - Charleen S Y Cheung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong, Hong Kong
| | - Heidi H Y Cheng
- Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong, Hong Kong
| | - Sofie S F Yung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong, Hong Kong
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Winnie W Y Tin
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ho Yan Yuen
- Department of Surgery, Pok Oi Hospital, Hong Kong, Hong Kong
| | - Martin H C Lam
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Ann S Y Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Sara W W Fung
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Vivian C M Man
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ava Kwong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ernest H Y Ng
- Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong, Hong Kong.
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Xu Z. Autophagy phenomenon in mice ovaries following transplantation. Theriogenology 2023; 195:40-45. [DOI: 10.1016/j.theriogenology.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
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del Valle L, Corchón S, Palop J, Rubio JM, Celda L. The experience of female oncological patients and fertility preservation: A phenomenology study. Eur J Cancer Care (Engl) 2022; 31:e13757. [PMID: 36354130 PMCID: PMC9787558 DOI: 10.1111/ecc.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 09/07/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study is to analyse the experience of fertility preservation among female oncological patients. METHODS A phenomenological study was conducted in an Assisted Human Reproduction Unit. The sample was composed of 14 females of reproductive age diagnosed with a cancer that may affect reproductive function, who had undergone a fertility preservation procedure. In-depth interviews were carried out, and the transcripts were entred into the Atlas.ti.v.8.2.3 qualitative analysis software package. The steps proposed by Taylor-Bogdan were followed in the analysis of the data. RESULTS Four thematic categories emerged in relation to the experience with the fertility preservation process: interruption of life plans and changes in the person; knowledge about fertility preservation options, reproductive capacity and impact because of the possible loss; dyadic relationshipsand social representations of fertility. CONCLUSIONS Patients suffer from difficulties when making decisions about fertility whilst dealing with a cancer diagnosis. They need adequate information and support from health professionals. Despite increasing awareness of fertility preservation, there is a lack of knowledge regarding patients' experiences and needs related to this process.
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Affiliation(s)
- Lara del Valle
- Nursing DepartmentFaculty of Nursing and Podiatry, University of ValenciaValenciaSpain
| | | | - Josefa Palop
- Nursing DepartmentFaculty of Nursing and Podiatry, University of ValenciaValenciaSpain
| | - Jose María Rubio
- Department of Assisted Human ReproductionAssisted Human Reproduction Unit of La Fe (AHRU)ValenciaSpain
| | - Luis Celda
- Nursing DepartmentFaculty of Nursing and Podiatry, University of ValenciaValenciaSpain
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Hamilton AC, Donnelly DW, Fitzpatrick D, Coleman HG. Early-Onset Cancers in Adults: A Review of Epidemiology, Supportive Care Needs and Future Research Priorities. Cancers (Basel) 2022; 14:4021. [PMID: 36011014 PMCID: PMC9406462 DOI: 10.3390/cancers14164021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Rising incidence of specific types of early-age onset cancers in adults aged 18-49 years has been reported in high-income countries. In this review, we summarise the epidemiology of early-onset cancers using exemplar data from a high-income UK region, discuss supportive care needs for young patients and outline future research directions. The incidence rate of early-onset cancers increased by 20.5% from 1993 to 2019 in Northern Ireland. Differences in types of cancer were observed between sexes and across age groups of 18-29, 30-39 and 40-49 years. One and five-year net survival was mostly better in 18-29-year-olds for all cancers combined compared to older age groups for both sexes, but there were variations in specific cancer types. Poorer survival was observed for patients with brain/central nervous system, connective and soft tissue or lung cancers. Patients with early-onset cancers face unique supportive care needs and require holistic care. The impact of cancer treatment on fertility and fertility preservation treatments is an important consideration. Social media can be used for patient support, information, fundraising, advocacy work and recruitment to research studies. We also outline suggested future research priorities for early-onset cancers, spanning prevention, diagnosis, treatment and supportive care needs.
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Affiliation(s)
| | - David W. Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast BT12 6DP, UK
| | - Deirdre Fitzpatrick
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast BT12 6DP, UK
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast BT12 6DP, UK
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK
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Zhu H, Shi L, Wang R, Cui L, Wang J, Tang M, Qian H, Wei M, Wang L, Zhou H, Xu W. Global Research Trends on Infertility and Psychology From the Past Two Decades: A Bibliometric and Visualized Study. Front Endocrinol (Lausanne) 2022; 13:889845. [PMID: 35903282 PMCID: PMC9317298 DOI: 10.3389/fendo.2022.889845] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study was to evaluate the global scientific output of research on infertility and psychology; explore the current status and trends in this field through the cooperation of authors, countries, and institutions; shed light on the direction of clinical infertility research in the future, and provide inspiration for targeted diagnosis and treatment of infertility. Methods Research publications on infertility and psychology from the past two decades were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using VOSviewer software and the bibliometrix R package. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords. Results A total of 151 articles related to the study of infertility and psychology were identified. We observed a gradual increase in the number of publications from 2001 to 2021, and the trend has been relatively stable in the past eight years. Human Reproduction (England), as the leading journal publishing the most papers (29 articles), was cited in the most journals (1208 times). Boivin J was the most prolific author (16 articles), with the largest number of citations (890 times) and the highest h-index (14) during the past decades. Boivin J was also the leader with the highest publication frequency and more active cooperation with other top authors. The United Kingdom (34 papers) and Cardiff University (25 articles) contributed the most publications and were the leading contributors in this field. Active cooperation between countries and between institutions was observed, and analyses of articles and references were also shown. The main hot topics included matters related to women (39 times), in-vitro salt (31 times), infertility (30 times), couples (25 times), and impact (24 times). Conclusion Our study results provide a comprehensive overview of the development of scientific literature, allowing relevant authors and research teams to recognize the current research status in this field. At the same time, infertility and psychology may soon become hotspots and should be closely monitored.
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Affiliation(s)
- Hongkun Zhu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingli Shi
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Rong Wang
- Department of Laboratory Medicine, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Lijuan Cui
- Department of Pathology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jiahui Wang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Mengyu Tang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Haiqing Qian
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Minggang Wei
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lihong Wang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Huifang Zhou
- Department of Gynaecology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenting Xu
- Nanjing University of Chinese Medicine, Nanjing, China
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
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