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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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2
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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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Pérez-Hernández Y. Exploring Medical Egg Freezing as a Disease Management Strategy. Med Anthropol 2023; 42:136-148. [PMID: 36745574 DOI: 10.1080/01459740.2023.2174022] [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: 02/07/2023]
Abstract
Medical egg freezing (MEF) allows women with fertility-threatening diseases to have their oocytes cryopreserved and stored for later use. Endometriosis is a common gynecological disease that might cause infertility. Qualitative research on endometriosis patients' experiences with MEF is minimal. I report on in-depth interviews among French endometriosis patients undertaking MEF. Their experiences are profoundly shaped by endometriosis-related pain. Egg freezing was described as a disease management strategy to cope with potential future infertility integral to their commitment to motherhood. Singlehood was a determining element for agreeing to undertake a physically and psychologically costly "additional" medical intervention.
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Boding S, Russell H, Knoetze R, Wilson V, Stafford L. 'Sometimes I can't look in the mirror': Recognising the importance of the sociocultural context in patient experiences of sexuality, relationships and body image after ovarian cancer. Eur J Cancer Care (Engl) 2022; 31:e13645. [PMID: 35790894 PMCID: PMC9787468 DOI: 10.1111/ecc.13645] [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: 11/08/2021] [Revised: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ovarian cancer (OC) can significantly change the way women feel about their body. However, personal accounts regarding these changes are lacking in the literature. Therefore, the aim of this study was to gain an understanding of the ways in which OC can affect relationships, sexuality, womanhood and body image. METHODS Ninety-eight Australian women aged 18 and over diagnosed with OC completed an online survey that invited narrative responses to open-ended questions about relationships, sexuality, body image and womanhood following OC treatment. Responses were analysed thematically while applying a sociocultural lens. RESULTS Three themes and two subthemes were identified: Failure and Loss of Femininity and Womanhood, Internalising Public Perception of Body and Illness and Altered Relationships which comprised two subthemes, Loss of the Sexual Self and Relationship Burden. These themes suggest women view themselves and their relationships in comparison with sociocultural understandings of body normalcy. Women often questioned their self-worth, their relationships and place within society due to changes in fertility, sexuality and bodily functioning. CONCLUSION These results highlight a need for health care professionals to open dialogue with women about sexuality and ensure information and support is given to reduce stigma and positively influence self-perception and increase body acceptance.
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Affiliation(s)
- Sally‐Anne Boding
- University of South Australia, Justice and SocietyAdelaideSAAustralia
| | | | - Ricki Knoetze
- University of South Australia, Justice and SocietyAdelaideSAAustralia
| | - Victoria Wilson
- University of South Australia, Justice and SocietyAdelaideSAAustralia
| | - Lesley Stafford
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVICAustralia
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Jones GL, Moss RH, Darby F, Mahmoodi N, Phillips B, Hughes J, Vogt KS, Greenfield DM, Brauten-Smith G, Gath J, Campbell T, Stark D, Velikova G, Snowden JA, Baskind E, Mascerenhas M, Yeomanson D, Skull J, Lane S, Bekker HL, Anderson RA. Cancer, Fertility and Me: Developing and Testing a Novel Fertility Preservation Patient Decision Aid to Support Women at Risk of Losing Their Fertility Because of Cancer Treatment. Front Oncol 2022; 12:896939. [PMID: 35847858 PMCID: PMC9280471 DOI: 10.3389/fonc.2022.896939] [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: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Women with a new cancer diagnosis face complex decisions about interventions aiming to preserve their fertility. Decision aids are more effective in supporting decision making than traditional information provision. We describe the development and field testing of a novel patient decision aid designed to support women to make fertility preservation treatment decisions around cancer diagnosis. Methods A prospective, mixed-method, three stage study involving: 1) co-development of the resource in collaboration with a multi-disciplinary group of key stakeholders including oncology and fertility healthcare professionals and patient partners (n=24), 2) alpha testing with a group of cancer patients who had faced a fertility preservation treatment decision in the past (n=11), and oncology and fertility healthcare professionals and stakeholders (n=14) and, 3) beta testing with women in routine care who had received a recent diagnosis of cancer and were facing a fertility preservation treatment decision (n=41) and their oncology and fertility healthcare professionals (n=3). Ten service users recruited from a closed Breast Cancer Now Facebook group and the support group Cancer and Fertility UK also provided feedback on CFM via an online survey. Results A 60-page paper prototype of the Cancer, Fertility and Me patient decision aid was initially developed. Alpha testing of the resource found that overall, it was acceptable to cancer patients, healthcare professionals and key stakeholders and it was considered a useful resource to support fertility preservation treatment decision-making. However, the healthcare professionals felt that the length of the patient decision aid, and elements of its content may be a barrier to its use. Subsequently, the prototype was reduced to 40 pages. During beta testing of the shortened version in routine care, women who received the resource described its positive impact on their ability to make fertility preservation decisions and support them at a stressful time. However, practical difficulties emerged which impacted upon its wider dissemination in clinical practice and limited some elements of the evaluation planned. Discussion Women receiving the decision aid within the cancer treatment pathway found it helped them engage with decisions about fertility preservation, and make better informed, values-based care plans with oncology and fertility teams. More work is needed to address access and implementation of this resource as part of routine oncology care pathways.
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Affiliation(s)
- Georgina L. Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Rachael H. Moss
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Frances Darby
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Neda Mahmoodi
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Bob Phillips
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Jane Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Katharina S. Vogt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Diana M. Greenfield
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | | | - Jacqui Gath
- Independent Cancer Patients’ Voice, London, United Kingdom
| | | | - Daniel Stark
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - John A. Snowden
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Ellissa Baskind
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Daniel Yeomanson
- Haematology and Oncology, Sheffield Children’s Hospital, Sheffield, United Kingdom
| | - Jonathan Skull
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Sheila Lane
- Department of Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development (LUCID), School of Medicine, University of Leeds, Leeds, United Kingdom
- Research Centre for Patient Involvement (ResCenPI) Central Region Denmark, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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6
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Linnane S, Quinn A, Riordan A, Dowling M. Women's fertility decision-making with a diagnosis of breast cancer: A qualitative evidence synthesis. Int J Nurs Pract 2022; 28:e13036. [PMID: 35088478 DOI: 10.1111/ijn.13036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/18/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
AIM To synthesize qualitative evidence of premenopausal women's experiences of fertility decision-making with a diagnosis of breast cancer. BACKGROUND Breast cancer is increasingly more common in premenopausal women who may have not yet considered starting a family or have completed their families. DESIGN Qualitative evidence synthesis guided by Thomas and Harden's three-stage approach to thematic analysis. DATA SOURCES Twelve electronic databases were searched: CINAHL, Embase, Pubmed, Proquest, PsychINFO, Lenus, Scopus, Web of Science, Rian.ie, Medline, EThOS e-theses online and DART Europe. No year limit was set. REVIEW METHODS The 'Enhancing transparency in reporting the synthesis of qualitative research guidelines' (ENTREQ) statement was followed. RESULTS Fifteen qualitative studies were included in the synthesis. Seven review findings under four major themes were identified: (1) first comes survival, (2) making decisions 'under the gun', (3) health-care professionals should not make assumptions and (4) we want accurate, detailed information and we want it early. High confidence in six of the review findings was agreed. CONCLUSION Most women experienced rushed fertility preservation decision-making at a time when they also faced cancer treatment decisions. Women want detailed, clear information on fertility preservation early after their diagnosis.
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Affiliation(s)
- Sharon Linnane
- Public Health Nurse, Mervue Health Centre, Galway, Ireland
| | - Aoife Quinn
- Clinical Nurse Specialist (Oncology), Galway University Hospitals, Galway, Ireland
| | - Anne Riordan
- National Health Library and Knowledge Service, Merlin Park University Hospital, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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7
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Martino ML, Lemmo D, Gargiulo A. A review of psychological impact of breast cancer in women below 50 years old. Health Care Women Int 2021; 42:1066-1085. [PMID: 34357855 DOI: 10.1080/07399332.2021.1901901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.
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Affiliation(s)
- Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Gargiulo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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8
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Sobota A, Ozakinci G. "Will It Affect Our Chances of Having Children?" and Feeling "Like a Ticking Bomb" -The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer. Front Psychol 2021; 12:632162. [PMID: 34149518 PMCID: PMC8206503 DOI: 10.3389/fpsyg.2021.632162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence. Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses. Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important. Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.
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Affiliation(s)
- Aleksandra Sobota
- University of St Andrews, School of Medicine, St Andrews, United Kingdom
| | - Gozde Ozakinci
- University of St Andrews, School of Medicine, St Andrews, United Kingdom
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9
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Possick C, Kestler-Peleg M. BRCA and Motherhood: A Matter of Time and Timing. QUALITATIVE HEALTH RESEARCH 2020; 30:825-835. [PMID: 31814509 DOI: 10.1177/1049732319885113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The threat of cancer and the effects of risk-reducing surgery can have a significant impact on family planning and family life. In this qualitative study, we examine intersecting experiences of BRCA carrier status, subsequent risk-reducing surgery, and motherhood by analyzing in-depth interviews with 16 Jewish, Israeli mothers (ages 36-57) who underwent risk-reducing mastectomies and/or oophorectomies. Time emerged as a prism through which the BRCA motherhood experience could be viewed. In the "Findings" section, we present concepts of BRCA time and maternal time through three subthemes: (a) objective and subjective fertility clocks and BRCA: the child who won't be born; (b) synchronizing the clocks: the "correct" tempo and chronology; and (c) back to the future: intergenerational coalescence of time. We discuss the notions of time and existential health threats and subjective time in the primary mother-infant relational system within the context of the cultural ideal of the "motherhood myth."
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10
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Martino ML, Gargiulo A, Lemmo D, Dolce P, Barberio D, Abate V, Avino F, Tortoriello R. Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer. Health Psychol Open 2019; 6:2055102919844501. [PMID: 31037219 PMCID: PMC6475855 DOI: 10.1177/2055102919844501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Franca Avino
- National Cancer Institute 'G. Pascale Fondazione', Italy
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11
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Hopwood P, Hopwood N. New challenges in psycho-oncology: An embodied approach to body image. Psychooncology 2019; 28:211-218. [PMID: 30488572 DOI: 10.1002/pon.4936] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Penelope Hopwood
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - Nick Hopwood
- School of Education, University of Technology Sydney, Ultimo, Australia
- Department of Curriculum Studies, University of Stellenbosch, Stellenbosch, South Africa
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12
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Women's stories of living with breast cancer: A systematic review and meta-synthesis of qualitative evidence. Soc Sci Med 2019; 222:231-245. [PMID: 30665063 DOI: 10.1016/j.socscimed.2019.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/07/2018] [Accepted: 01/13/2019] [Indexed: 02/08/2023]
Abstract
RATIONALE Globally, breast cancer is by far the most frequently occurring cancer amongst women. Whilst the physical consequences of the disease and associated treatments are well documented, a comprehensive picture of how breast cancer is experienced at all stages of disease progression is lacking. OBJECTIVE This systematic review aimed to synthesize qualitative studies documenting women's breast cancer narratives into an empirically based explanatory framework. METHODS Two investigators independently searched Academic Search Premiere, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, PubMed, Science Direct, SCOPUS, Web of Science and three international dissertation repositories using a pre-specified search strategy to identify qualitative studies on women's breast cancer narratives across all geographic and income-level settings. Of the 7840 studies that were screened for eligibility, included in the review were 180 studies, which were assessed using the Critical Appraisal Skills Programme. Using a 'meta-study' approach, an explanatory model of the breast cancer experience was formulated. Finally, we assessed the confidence in the review findings using the 'Confidence in the Evidence from Reviews of Qualitative Research' (CERQual) guidelines. RESULTS Eight core themes were identified: the burden of breast cancer, existential ordeal, illness appraisal, sources of support, being in the healthcare system, the self in relation to others, changes in self-image, and survivor identity. Together, these form the proposed Trajectory of Breast Cancer (TBC) framework. CONCLUSION The Trajectory of Breast Cancer explanatory framework offers a theoretically defensible synthesis of women's experiences of breast cancer. This framework provides an empirical basis for future reviewers conducting qualitative and narrative breast cancer research.
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13
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Milosevic E, Brunet J, Campbell KL. Exploring tensions within young breast cancer survivors' physical activity, nutrition and weight management beliefs and practices. Disabil Rehabil 2019; 42:685-691. [PMID: 30616419 DOI: 10.1080/09638288.2018.1506512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Although the benefits of physical activity, healthy eating, and weight management for breast cancer survivors are well established, little is known about how best to promote these practices among women diagnosed before age 40 years. We conducted a qualitative study to explore young breast cancer survivors' beliefs and practices regarding physical activity, nutrition, and weight management.Methods: Semi-structured interviews were conducted with 12 women (Mage=36 years, SD=3.4) who were within 5 years of breast cancer diagnosis. Data were analyzed using thematic analysis.Results: Participants' accounts revealed several tensions between the factors motivating them to engage in physical activity, healthy eating, and weight management and those deterring them. Tensions were captured within three themes: (1) prolonging life with a healthy lifestyle versus enjoying living; (2) perceiving benefits versus barriers, and; (3) seeking social connection versus protecting the self from social threats. Participants also noted preferences, which if considered could help them maintain healthy lifestyle practices.Conclusions: Although young breast cancer survivors value physical activity, healthy eating, and weight management, they are constantly weighing the benefits of these practices against their perceived drawbacks. To facilitate long-term participation among young breast cancer survivors, future programing must address their conflicting beliefs and priorities.Implications for RehabilitationPhysical activity, healthy eating, and weight management can play an important role in the health and wellbeing of breast cancer survivors.Young breast cancer survivors experience a 'tug-of-war' between the factors motivating them to be active and eat healthy and those deterring them.Following treatment for breast cancer, young women would benefit from tailored lifestyle-based programing that addresses their conflicting beliefs and priorities.Tailored programing might involve strategically scheduled program times or flexible programs designed to include the participation of family and friends.
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Affiliation(s)
- Elizabeth Milosevic
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Jennifer Brunet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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14
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Young K, Kirkman M, Holton S, Rowe H, Fisher J. Fertility experiences in women reporting endometriosis: findings from the Understanding Fertility Management in Contemporary Australia survey. EUR J CONTRACEP REPR 2018; 23:434-440. [DOI: 10.1080/13625187.2018.1539163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kate Young
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sara Holton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Heather Rowe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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15
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Daly C, Micic S, Facey M, Speller B, Yee S, Kennedy ED, Corter AL, Baxter NN. A review of factors affecting patient fertility preservation discussions & decision-making from the perspectives of patients and providers. Eur J Cancer Care (Engl) 2018; 28:e12945. [PMID: 30375696 DOI: 10.1111/ecc.12945] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/17/2018] [Accepted: 09/08/2018] [Indexed: 11/30/2022]
Abstract
Women undergoing cancer treatments and their healthcare providers encounter challenges in fertility preservation (FP) discussions and decision-making. A systematic review of qualitative research was conducted to gain in-depth understanding of factors influencing FP discussions and decision-making. Major bibliographic databases and grey literature in English from 1994 to 2016 were searched for qualitative research exploring patient/provider perspectives on barriers and facilitators to FP decision-making. Two researchers screened article titles, abstracts and full-texts. Verbatim data on research questions, study methodology, participants, findings and discussions of findings were extracted. Quality assessment and thematic analysis were conducted. The search yielded 74 studies dating from 2007 onwards; 29 met the inclusion criteria. Analysis revealed three types of barriers: (a) FP knowledge, skills and information deficits contributed to discomfort for providers and discontent for patients; (b) psychosocial factors and clinical issues influenced providers' practices around FP discussions and patients' decision-making; and (c) material, social and structural factors (e.g., lack of resources and accessibility) posed challenges to FP discussions. Potential facilitators to FP discussions and decision-making were also identified. A discussion of ways to improve physician's knowledge and facilitate women's decision-making and access to FP is presented, along with areas for policy development and further research.
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Affiliation(s)
- Corinne Daly
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Selena Micic
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcia Facey
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Speller
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samantha Yee
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arden L Corter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kuswanto CN, Stafford L, Sharp J, Schofield P. Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review. Psychooncology 2018; 27:2700-2708. [PMID: 30289196 DOI: 10.1002/pon.4904] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/15/2018] [Accepted: 09/24/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To systematically review findings of the impact of cancer diagnosis and treatment on mothers' psychological well-being, roles, and identity and to explore the psychosocial factors that contribute to mothers' psychological well-being. METHODS Six databases were searched for research articles and theses exploring the association between the impact of cancer diagnosis and treatment on mothers' psychological well-being, identity, and role, and the psychosocial factors contributing to mothers' psychological distress regardless of their cancer type and stage. The Mixed-Method Appraisal Bias Tool was used to assess the selected studies' methodological quality. RESULTS A total of 30 qualitative, quantitative, and mixed-method studies were deemed eligible for inclusion. Most studies reported that mothers experienced significant psychological distress, changes to or loss of parenting efficacy, maternal identity, and role. Psychosocial factors that contributed to mothers' distress included mothers' young age, presence of metastases, lower parenting efficacy, fear of cancer recurrence, higher illness intrusiveness, and lack of appropriate support. Four main themes emerged from the qualitative studies: psychological impact of cancer on mothers, changes in maternal identity and role, relationship changes and concerns for their children, and meaning-making in cancer experience. CONCLUSIONS Changes in mothers' psychological well-being, role, and identity occurred across cancer diagnoses, treatment, and recovery trajectories. The evidence suggests that mothers may benefit from continued and tailored psychosocial support to cope with these challenges, even after treatment is completed. Further studies with improved methodological quality are needed to explore these issues in depth.
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Affiliation(s)
- Carissa Nadia Kuswanto
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Lesley Stafford
- Centre for Women's Mental Health, The Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Jessica Sharp
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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17
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Hammarberg K, Kirkman M, Stern C, McLachlan RI, Clarke G, Agresta F, Gook D, Rombauts L, Vollenhoven B, Fisher JRW. Survey of Reproductive Experiences and Outcomes of Cancer Survivors Who Stored Reproductive Material Before Treatment. Hum Reprod 2018; 32:2423-2430. [PMID: 29045667 DOI: 10.1093/humrep/dex314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION What are the reproductive experiences and outcomes of people who store reproductive material before cancer treatment? SUMMARY ANSWER Of respondents who had tried to achieve pregnancy since completing cancer treatment almost all had succeeded, in most cases through natural conception. WHAT IS KNOWN ALREADY People of reproductive age who are diagnosed with cancer can cryopreserve reproductive material to guard against the adverse effects on fertility of gonadotoxic treatment. Little is known about the reproductive outcomes of people who undergo fertility preservation before cancer treatment. STUDY DESIGN, SIZE, DURATION Cross-sectional survey. PARTICIPANTS/MATERIALS, SETTING, METHODS Women and men who had stored reproductive material before cancer treatment at two private and one public fertility clinics up to June 2014 and were at least 18 years old at the time were identified from medical records and invited to complete an anonymous questionnaire about their reproductive experiences. MAIN RESULTS AND THE ROLE OF CHANCE Of the 870 potential respondents 302 (171 female and 131 male) returned completed questionnaires yielding a response rate of 34.5% (39.5% and 29.7% for female and male respondents, respectively). Current age was similar for women and men (37.2 years) but men had been diagnosed with cancer significantly earlier in life than women (28.2 versus 30.3 years, P = 0.03). Almost two-thirds of respondents wished to have a child or another child in the future, some of whom knew that they were unable to. One in ten respondents was a parent before the cancer diagnosis and around one-third had had a child since diagnosis or was pregnant (or a partner in pregnancy) at the time of the survey. Of those who had tried to conceive since completing cancer treatment (N = 119) 84% (79% of women and 90% of men) had had a child or were pregnant (or a partner in pregnancy). Most of the pregnancies since the diagnosis of cancer occurred after natural conception (58/100, 58%). Of the 22 women (13% of all women) and 35 men (27% of all men) who had used their stored reproductive material four women (18%) and 28 men (80%) had had a child or were pregnant or a partner in pregnancy at the time of completing the survey. The most commonly stated reason for not using the stored material was not being ready to try for a baby. LIMITATIONS, REASON FOR CAUTION The relatively low response rate, particularly among men, means that participation bias may have influenced the findings. As type of cancer was self-reported and we did not ask questions about respondents' cancer treatments, it is not possible to link reproductive outcomes to type of cancer or cancer treatment. Also, there is no way of comparing the sample with the populations they were drawn from as data on reproductive outcomes of people who store reproductive material before cancer treatment are not collected routinely. This might have led to over- or underestimates of the reproductive experiences and outcomes reported in this paper. WIDER IMPLICATIONS OF THE FINDINGS The findings add to the limited evidence about the reproductive outcomes of this growing group of people and can be used to inform the advice given to those contemplating fertility preservation in the context of cancer. STUDY FUNDING/COMPETING INTERESTS The study was funded by the National Health and Medical Research Council (APP1042347). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- K Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Victorian Assisted Reproductive Treatment Authority, Victoria, Australia
| | - M Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - C Stern
- Melbourne IVF, Victoria, Australia.,Reproductive Services, Royal Women's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - R I McLachlan
- Monash IVF, Victoria, Australia.,Andrology Australia, Victoria, Australia.,Hudson Institute, Monash Medical Centre, Victoria, Australia
| | - G Clarke
- Royal Women's Hospital, University of Melbourne, Victoria, Australia
| | | | - D Gook
- Melbourne IVF, Victoria, Australia.,Reproductive Services, Royal Women's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - L Rombauts
- Monash IVF, Victoria, Australia.,Hudson Institute, Monash Medical Centre, Victoria, Australia.,Monash Health, Monash Medical Centre, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - B Vollenhoven
- Monash IVF, Victoria, Australia.,Monash Health, Monash Medical Centre, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - J R W Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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18
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Raanani H, Dirnfeld M, Patrizio P. Medical egg freezing: How cost and lack of insurance cover impact women and their families. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2018; 5:82-92. [PMID: 30014045 PMCID: PMC6024226 DOI: 10.1016/j.rbms.2017.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/28/2017] [Accepted: 12/18/2017] [Indexed: 05/03/2023]
Abstract
Medical egg freezing (MEF) is being recommended increasingly for women at risk of losing their reproductive ability due to cancer chemotherapy or other fertility-threatening medical conditions. This first, binational, ethnographic study of women who had undergone MEF sought to explore women's experiences under two different funding systems: (i) the USA, where the cost of MEF is rarely covered by private or state health insurance; and (ii) Israel, where the cost of MEF is covered by national health insurance. Women were recruited from four American and two Israeli in-vitro fertilization clinics where MEF is offered. In-depth, semi-structured interviews were conducted with 45 women (33 Americans, 12 Israelis) who had completed at least one cycle of MEF. All of the Israeli women had cancer diagnoses, but were not faced with the additional burden of funding an MEF cycle. In marked contrast, the American women - 23 with cancer diagnoses and 10 with other fertility-threatening medical conditions - struggled, along with their families, to 'piece together' MEF funding, which added significant financial pressure to an already stressful situation. Given the high priority that both American and Israeli women in this study placed on survival and future motherhood, it is suggested that insurance funding for MEF should be mandated in the USA, as it is in Israel. This article concludes by describing new state legislative efforts in this regard.
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Affiliation(s)
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, Sunnyvale, CA, USA
| | | | | | - Dror Meirow
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Hila Raanani
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Martha Dirnfeld
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, Haifa, Israel
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19
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Raanani H, Dirnfeld M, Patrizio P. Medical egg freezing: the importance of a patient-centered approach to fertility preservation. J Assist Reprod Genet 2018; 35:49-59. [PMID: 29124460 PMCID: PMC5758476 DOI: 10.1007/s10815-017-1081-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses. METHODS Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions. RESULTS Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age < 30), unmarried, resource-constrained women, who are facing not only fertility loss but also the "double jeopardy" of cancer. Through in-depth, qualitative interviews, these women's MEF stories reveal 10 dimensions of care important to fertility preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF." CONCLUSIONS Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to mostly young, single women facing the daunting prospect of fertility loss and life-threatening medical diagnoses.
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Affiliation(s)
- Marcia C. Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520 USA
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, 1195 W. Fremont Ave., Sunnyvale, CA 94087 USA
| | - Joseph Doyle
- Shady Grove Fertility, 9600 Blackwell Road, Rockville, MD 20850 USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY 10021 USA
| | - Dror Meirow
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Hila Raanani
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Martha Dirnfeld
- Division Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Ruth and Bruce Faculty of Medicine, Technion, 3436212 Haifa, Israel
| | - Pasquale Patrizio
- Yale Fertility Center, Yale University, 150 Sargent Drive, New Haven, CT 06511 USA
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20
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Inhorn MC, Birenbaum-Carmeli D, Patrizio P. Medical egg freezing and cancer patients’ hopes: Fertility preservation at the intersection of life and death. Soc Sci Med 2017; 195:25-33. [DOI: 10.1016/j.socscimed.2017.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 01/02/2023]
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21
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Armuand G, Wettergren L, Nilsson J, Rodriguez-Wallberg K, Lampic C. Threatened fertility: A longitudinal study exploring experiences of fertility and having children after cancer treatment. Eur J Cancer Care (Engl) 2017; 27:e12798. [DOI: 10.1111/ecc.12798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 01/15/2023]
Affiliation(s)
- G. Armuand
- Department of Neurobiology; Care Sciences and Society (NVS); H1, Division of Nursing; Karolinska Institutet; Huddinge Sweden
- Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - L. Wettergren
- Department of Neurobiology; Care Sciences and Society (NVS); H1, Division of Nursing; Karolinska Institutet; Huddinge Sweden
| | - J. Nilsson
- Department of Neurobiology; Care Sciences and Society (NVS); H1, Division of Nursing; Karolinska Institutet; Huddinge Sweden
| | - K. Rodriguez-Wallberg
- Department of Oncology - Pathology; Karolinska Institutet; Karolinska University Hospital Solna; Stockholm Sweden
- Reproductive Medicine Karolinska; Karolinska University Hospital Huddinge; Huddinge Sweden
| | - C. Lampic
- Department of Neurobiology; Care Sciences and Society (NVS); H1, Division of Nursing; Karolinska Institutet; Huddinge Sweden
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22
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Kim K, Yang J. Decision-making process related to treatment and management in Korean women with breast cancer: Finding the right individualized healthcare trajectory. Appl Nurs Res 2017; 35:99-105. [PMID: 28532737 DOI: 10.1016/j.apnr.2017.02.022] [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: 09/10/2016] [Revised: 01/11/2017] [Accepted: 02/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND After being diagnosed with breast cancer, women must make a number of decisions about their treatment and management. When the decision-making process among breast cancer patients is ineffective, it results in harm to their health. Little is known about the decision-making process of breast cancer patients during the entire course of treatment and management. OBJECTIVES We investigated women with breast cancer to explore the decision-making processes related to treatment and management. METHODS Eleven women participated, all of whom were receiving treatment or management in Korea. The average participant age was 43.5years. For data collection and analysis, a grounded theory methodology was used. RESULTS Through constant comparative analyses, a core category emerged that we referred to as "finding the right individualized healthcare trajectory." The decision-making process occurred in four phases: turmoil, exploration, balance, and control. The turmoil phase included weighing the credibility of information and lowering the anxiety level. The exploration phase included assessing the expertise/promptness of medical treatment and evaluating the effectiveness of follow-up management. The balance phase included performing analyses from multiple angles and rediscovering value as a human being. The control phase included constructing an individualized management system and following prescribed and other management options. CONCLUSIONS It is important to provide patients with accurate information related to the treatment and management of breast cancer so that they can make effective decisions. Healthcare providers should engage with patients on issues related to their disease, understand the burden placed on patients because of issues related to their sex, and ensure that the patient has a sufficient support system. The results of this study can be used to develop phase-specific, patient-centered, and tailored interventions for breast cancer patients.
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Affiliation(s)
- Kkotbong Kim
- Department of Nursing, Inje University, Busan, Republic of Korea
| | - Jinhyang Yang
- Department of Nursing, Institute of Health Science, Inje University, Busan, Republic of Korea.
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23
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Jones G, Hughes J, Mahmoodi N, Smith E, Skull J, Ledger W. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update 2017; 23:433-457. [DOI: 10.1093/humupd/dmx009] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/27/2017] [Indexed: 02/07/2023] Open
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24
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Hammarberg K, Kirkman M, Stern C, McLachlan RI, Gook D, Rombauts L, Vollenhoven B, Fisher JRW. Cryopreservation of reproductive material before cancer treatment: a qualitative study of health care professionals' views about ways to enhance clinical care. BMC Health Serv Res 2017; 17:343. [PMID: 28490359 PMCID: PMC5424377 DOI: 10.1186/s12913-017-2292-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer treatment can diminish fertility in women and men. The need for fertility preservation is growing as increasing numbers of people survive cancer. Cryostorage of reproductive material to preserve potential for conception for cancer survivors has moved from being experimental to being a part of clinical management of women and men who are diagnosed with cancer in their reproductive years. There is little existing evidence about how fertility preservation services can be enhanced to meet the complex needs of patients who are diagnosed with cancer in their reproductive years. The aim of this research was to inform clinical practice development by drawing on the collective experience and knowledge of staff at well-established clinics that offer fertility preservation before cancer treatment. METHODS A qualitative research model was adopted using semi-structured interviews with professionals involved in the care of people who freeze reproductive material before cancer treatment. In the state of Victoria, Australia, two large assisted reproductive technology (ART) centres have been providing fertility preservation services for more than two decades. An invitation to participate in a semi-structured interview about clinical care in the context of fertility preservation was emailed to past and current staff members. To capture diverse perspectives, informants were sought from all relevant professions: fertility specialists, andrologists, nurses, embryologists/scientists, counsellors, and administrative staff. Transcripts were analysed thematically. RESULTS Thirteen key informants were interviewed from August 2013 to February 2014. The identified themes relating to enhancing clinical care in a fertility preservation service were communication between oncology and ART specialists; managing urgency; managing patients' expectations; establishing and implementing protocols, systems, and data bases; and maintaining contact with patients. CONCLUSION The collective knowledge of this study's informants, who represent multidisciplinary teams with more than two decades' experience in fertility preservation, yields important insights into strategies that fertility preservation services can employ to promote the integration of oncology and fertility care, the psychosocial care of patients, data recording and monitoring, and reporting of outcomes.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 549 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 549 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Catharyn Stern
- Melbourne IVF, Melbourne, Victoria 3002 Australia
- Reproductive Services, Royal Women’s Hospital, Parkville, Victoria 3052 Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Robert I. McLachlan
- Monash IVF, Clayton, Victoria 3163 Australia
- Andrology Australia, Melbourne, Victoria 3163 Australia
- Hudson Institute of Medical Research, Clayton, Victoria 3163 Australia
| | - Debra Gook
- Melbourne IVF, Melbourne, Victoria 3002 Australia
- Reproductive Services, Royal Women’s Hospital, Parkville, Victoria 3052 Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Luk Rombauts
- Monash IVF, Clayton, Victoria 3163 Australia
- Hudson Institute of Medical Research, Clayton, Victoria 3163 Australia
- Monash Health, Clayton, Victoria 3163 Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3163 Australia
| | - Beverley Vollenhoven
- Monash IVF, Clayton, Victoria 3163 Australia
- Monash Health, Clayton, Victoria 3163 Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3163 Australia
| | - Jane R. W. Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 549 St Kilda Rd, Melbourne, Victoria 3004 Australia
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25
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Hsieh PL, Huang SM, Chien LY, Lee CF, Hsiung Y, Tai CJ. Risk-benefit perception of pregnancy among breast cancer survivors. Eur J Cancer Care (Engl) 2017; 27:e12696. [DOI: 10.1111/ecc.12696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 01/10/2023]
Affiliation(s)
- P.-L. Hsieh
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - S.-M. Huang
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - L.-Y. Chien
- Institute of Community Health care; National Yang-Ming University; Taipei Taiwan
| | - C.-F. Lee
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - Y. Hsiung
- Department of Nursing; Mackay Medical College; New Taipei City Taiwan
| | - C.-J. Tai
- Department of Traditional Chinese Medicine; Taipei Medical University Hospital; Taipei Taiwan
- Department of OB/GYN; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
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26
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Kirkman M, Apicella C, Graham J, Hickey M, Hopper JL, Keogh L, Winship I, Fisher J. Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health 2017; 17:26. [PMID: 28381301 PMCID: PMC5382471 DOI: 10.1186/s12905-017-0383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.
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Affiliation(s)
- Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jillian Graham
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
| | - Martha Hickey
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - John L. Hopper
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Winship
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Hammarberg K, Sullivan E, Javid N, Duncombe G, Halliday L, Boyle F, Saunders C, Ives A, Dickinson J, Fisher J. Health care experiences among women diagnosed with gestational breast cancer. Eur J Cancer Care (Engl) 2017; 27:e12682. [DOI: 10.1111/ecc.12682] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- K. Hammarberg
- Jean Hailes Research Unit; School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - E. Sullivan
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - N. Javid
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - G. Duncombe
- Exosome Biology Laboratory; Centre for Clinical Diagnostics; University of Queensland; Brisbane Qld Australia
- Centre for Clinical Research; Royal Brisbane and Women's Hospital; University of Queensland; Brisbane Qld Australia
| | - L. Halliday
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney NSW Australia
| | - F. Boyle
- Patricia Ritchie Centre for Cancer Care and Research; Mater Hospital North Sydney; North Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - C. Saunders
- School of Surgery; The University of Western Australia; Perth WA Australia
| | - A. Ives
- Cancer Palliative Care Research and Evaluation Unit; School of Surgery; The University of Western Australia; Perth WA Australia
| | - J.E. Dickinson
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
| | - J. Fisher
- Jean Hailes Research Unit; School of Public Health and Preventive Medicine; Monash University; Melbourne Vic. Australia
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Rees S. 'Am I really gonna go sixty years without getting cancer again?' Uncertainty and liminality in young women's accounts of living with a history of breast cancer. Health (London) 2016; 21:241-258. [PMID: 28521649 DOI: 10.1177/1363459316677628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although much research has examined the experience of breast cancer, the distinctive perspectives and lives of young women have been relatively neglected. Women diagnosed with breast cancer under the age of 45, and who had completed their initial treatment, were interviewed, and social constructionist grounded theory methods were used to analyse the data. The end of initial treatment was accompanied by a sense of unease and uncertainty in relation to recurrence and survival, and also fertility and menopausal status. The young women's perceptions about the future were altered, and their fears about recurrence were magnified by the possibility of many decades ahead during which breast cancer could recur. The implications for the young women's life course, in terms of whether they would be able to have children, would not become clear for several years after initial treatment. This resulted in a liminal state, in which young women found themselves neither cancer-free nor cancer patients, neither pre- nor post-menopausal, neither definitively fertile nor infertile. This liminal state had a profound impact on young women's identities and sense of agency. This extends previous understanding of life after cancer, exploring the age-related dimensions of liminality.
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Croson E, Keim-Malpass J. Grief and Gracefulness Regarding Cancer Experiences Among Young Women. Oncol Nurs Forum 2016; 43:747-753. [DOI: 10.1188/16.onf.747-753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Martino ML, Freda MF. Meaning-Making Process Related to Temporality During Breast Cancer Traumatic Experience: The Clinical Use of Narrative to Promote a New Continuity of Life. EUROPES JOURNAL OF PSYCHOLOGY 2016; 12:622-634. [PMID: 27872670 PMCID: PMC5114876 DOI: 10.5964/ejop.v12i4.1150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/18/2016] [Indexed: 11/20/2022]
Abstract
Previous research has agreed that meaning-making is a key element in the promotion of patients' well-being during and after a traumatic event such as cancer. In this paper, we focus on an underestimated key element related to the crisis/rupture of this meaning-making process with respect to the time perspective. We consider 40 narratives of breast cancer patients at different times of treatment, undergoing chemotherapy and biological therapy. We collected data through writing technique. We performed an interpretative thematic analysis of the data and highlighted specific ways to signify time during the different treatment phases. Our central aspect "the time of illness, the illness of time" demonstrates that the time consumed by illness has the risk of becoming an illness of time, which transcends the end of the illness and absorbs a patient's past, present, and future, thus saturating all space for thought and meaning. The study suggests that narrative can become a therapeutic and preventive tool for women with breast cancer in a crisis of temporality, and enable the promotion of new semiotic connections and a specific functional resynchronization with the continuity/discontinuity of life. This is useful during the illness and medical treatment and also after the treatment.
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Affiliation(s)
- Maria Luisa Martino
- SInAPSi Centre, University of Naples Federico II, Naples, Italy
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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Rees S, Young A. The Experiences and Perceptions of Women Diagnosed with Breast Cancer during Pregnancy. Asia Pac J Oncol Nurs 2016; 3:252-258. [PMID: 27981168 PMCID: PMC5123527 DOI: 10.4103/2347-5625.189814] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Although much has been documented about the experience of breast cancer, the accounts of young women have been relatively neglected, despite that around 20% of the breast cancer diagnoses occur in women under the age of 50. In particular, the voices of young women diagnosed during pregnancy are missing from research. Breast cancer is the most common cancer associated with pregnancy, and it is diagnosed in about 1 in 3000 pregnancies. METHODS This study presents data from three women drawn from a larger study of women who had been diagnosed under the age of 45 and had completed their treatment for breast cancer. Semi-structured qualitative interviews were undertaken, with a methodology informed by social constructionist grounded theory and feminism. RESULTS The findings here report the ways that having breast cancer during pregnancy disrupted taken-for-granted assumptions about their pregnancies, new motherhood, and their future life course, and how this occurred within the context of gendered ideas about femininity and motherhood. CONCLUSIONS Breast cancer during pregnancy has a far-reaching impact on young women's lives, and women affected may need practical support in caring for young children, and counselling may be appropriate. Further research is needed in this important area.
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Affiliation(s)
- Sophie Rees
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - Annie Young
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
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Weller D, Knott VE. Occupational stress, survivorship issues and key themes in this issue: occupational stress, survivorship interventions, cancer in Chinese populations. Eur J Cancer Care (Engl) 2015; 23:423-5. [PMID: 24934717 DOI: 10.1111/ecc.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Weller
- University of Edinburgh, Edinburgh, UK; Cancer and Primary Care Research International Network (Ca-PRI), Edinburgh, UK
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Banerjee R, Tsiapali E. Occurrence and recall rates of fertility discussions with young breast cancer patients. Support Care Cancer 2015; 24:163-171. [PMID: 25967235 DOI: 10.1007/s00520-015-2758-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Fertility preservation is an important issue for premenopausal cancer patients; however, not all patients receive counseling about chemotherapy-induced infertility and potential mitigation strategies. We aimed to identify characteristics of premenopausal breast cancer patients less likely to receive fertility counseling. We also investigated patient recall of chart-documented fertility discussions and patient attitudes toward fertility preservation. METHODS The study was approved by our institution's Institutional Review Board. All female patients with invasive primary breast cancer of any type, aged 40 or younger at the time of diagnosis, who were diagnosed during or up to 5 years prior to the study period were eligible. The study was conducted between February 2012 and October 2013. Enrolled patients completed an anonymous survey, and their medical charts were subsequently reviewed to identify provider documentation of fertility discussions, referral to fertility specialists, or implementation of fertility preservation. Patient comments regarding their fertility were solicited and examined thematically. RESULTS Forty-nine patients consented to participate. Fertility discussions were documented by providers in 55% of patients. Patients aged over 35 and multiparous patients were significantly less likely than their counterparts (p < 0.01 in both cases) to have had chart-documented fertility discussions. Only 52% of patients with chart-documented discussions recalled having had such a conversation. Patient comments highlighted the difficulty of considering fertility at the time of diagnosis and also the risks and obstacles facing fertility preservation. CONCLUSIONS Despite increasing awareness, fertility is not universally discussed with premenopausal breast cancer patients at the time of diagnosis; older and multiparous patients are at particular risk of not receiving fertility counseling. Even when such discussions are documented, only about half of patients recall the conversation. Patient-reported barriers to fertility preservation include lack of education combined with the stress of diagnosis, financial costs, and perceived treatment toxicities.
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Affiliation(s)
- Rahul Banerjee
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ekaterini Tsiapali
- Medstar Regional Breast Health Program at Medstar Southern Maryland Hospital Center, Department of Surgery, Georgetown University, Washington, DC, USA. .,, 7501 Surratts Road, Suite 303, Clinton, MD, 20735, USA.
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Liamputtong P, Suwankhong D. Living with breast cancer: the experiences and meaning-making among women in Southern Thailand. Eur J Cancer Care (Engl) 2015; 25:371-80. [PMID: 25899775 DOI: 10.1111/ecc.12321] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/30/2022]
Abstract
We conducted in-depth interviews with 20 women living with breast cancer and invited them to take part in a drawing method. In this paper, we discuss the lived experiences and meaning-making of breast cancer among women in southern Thailand. Our data revealed that the diagnosis of breast cancer generated numerous emotional responses. However, after the initial shock, most women started to accept their reality. The acceptance of their breast cancer played an essential role in the meaning-making discourse because it assisted the women to be able to sustain the equilibrium of their emotional well-being. Meaning-making and the Buddhist belief about bad karma was a prominent theme. The belief that adversities in life were the result of bad deeds that one had committed to others in the past not only helped the women to accept their fate but also to deal with their life situations better. Our findings suggest that these women act in their own agencies to counteract any negativity they might encounter from their breast cancer trajectory. It provides a theoretical understanding about the ways Thai women deal with their breast cancer which can be adopted as a means to provide culturally sensitive care for women with breast cancer in Thailand and elsewhere.
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Affiliation(s)
- P Liamputtong
- Department of Public Health, School of Psychology and Public Health, College of Science Health and Engineering, La Trobe University, Bundoora, Vic., Australia
| | - D Suwankhong
- School of Public Health, Thaksin University, Phatthalung, Thailand
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Cho J, Jung SY, Lee JE, Shim EJ, Kim NH, Kim Z, Sohn G, Youn HJ, Kim KS, Kim H, Lee JW, Lee MH. A review of breast cancer survivorship issues from survivors' perspectives. J Breast Cancer 2014; 17:189-99. [PMID: 25320616 PMCID: PMC4197348 DOI: 10.4048/jbc.2014.17.3.189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
Despite the fact that more breast cancer survivors are currently enjoying longer lifespans, there remains limited knowledge about the factors and issues that are of greatest significance for these survivors, particularly from their perspectives. This review was based on the concept that the topics addressed should focus on the perspectives of current survivors and should be extended to future modalities, which physicians will be able to use to gain a better understanding of the hidden needs of these patients. We intended to choose and review dimensions other than the pathology and the disease process that could have been overlooked during treatment. The eight topics upon which we focused included: delay of treatment and survival outcome; sexual well-being; concerns about childbearing; tailored follow-up; presence of a family history of breast cancer; diet and physical activity for survivors and their families; qualitative approach toward understanding of breast cancer survivorship, and; mobile health care for breast cancer survivors. Through this review, we aimed to examine the present clinical basis of the central issues noted from the survivors' perspectives and suggest a direction for future survivorship-related research.
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Affiliation(s)
- Jihyoung Cho
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Sookmyung Women's University, Seoul, Korea
| | - Eun-Jung Shim
- Department of Psychology, Pusan National University School of Medicine, Busan, Korea
| | - Nam Hyoung Kim
- Department of Advertising and Branding, Kaywon University of Art and Design, Uiwang, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Guiyun Sohn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Ku Sang Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hanna Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
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