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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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2
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Glackin A, Marino JL, Peate M, McNeil R, Orme LM, McCarthy MC, Sawyer SM. Experiences of Oncofertility Decision-Making and Care in a National Sample of Adolescent and Young Adult Cancer Patients and Parents. J Adolesc Young Adult Oncol 2024; 13:170-179. [PMID: 37535814 DOI: 10.1089/jayao.2023.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Purpose: Cancer and its treatments are known to compromise fertility in adolescents and young adults (AYAs). The emotional burden of possible infertility is reduced in those who receive supportive oncofertility care. In legal minors, provision of health care must consider the legal context and desire that AYAs have for autonomous decision-making, together with their competence to make health decisions. This has important implications for how oncofertility discussions may, or may not, involve parents. The aim of this study was to explore oncofertility decision-making and care experiences in a national Australian sample of AYA cancer patients and their parents. Methods: AYAs aged 15-25 years and parents were recruited from 17 cancer care sites and CanTeen Australia as part of a national AYA cancer care study. The cross-sectional survey included open-ended questions regarding oncofertility care experiences. We used reflexive thematic analysis to identify themes. Results: Data were available for 99 AYAs and 111 parents. Four themes were identified: emotional care needs; parent-AYA dynamics including AYA autonomy and agency; decision-making considerations including values and practicalities; and reflections on oncofertility care and follow-up. Both AYAs and parents placed importance on AYA autonomy in fertility decision-making, but many AYAs appreciated the role of parents in providing support and guidance throughout the process. Conclusion: Health care professionals are encouraged to autonomously engage AYAs around fertility decision-making, while concurrently offering opportunities that promote parental support. Better psychological support and follow-up oncofertility care are also needed.
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Affiliation(s)
- Aoife Glackin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa M Orme
- ONTrac at Peter Mac, Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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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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Burns K, Phillips C, Brannigan R, Franklin A, Howell J, Schmidt D, Sopfe J, Appiah LC, Anazodo A. Male pediatric, adolescent, and young adult reproductive survivorship. Pediatr Blood Cancer 2023; 70 Suppl 5:e28823. [PMID: 37381156 DOI: 10.1002/pbc.28823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 06/30/2023]
Abstract
As pediatric, adolescent, and young adult cancer survival rates increase, emphasis is placed on reducing late effects, including reproductive complications and potential impact to fertility. Male survivors are at risk of abnormalities in sperm, hormone deficiencies, and sexual dysfunction. This can impact one's progression into puberty and ability to have a biological child and impacts quality of life following treatment. Access to reproductive care is important and requires patient assessment and appropriate referral to reproductive specialists. This review addresses reproductive complications associated with therapy, standard-of-care testing, and therapeutic interventions. The psychologic impact on psychosexual functioning is also addressed.
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Affiliation(s)
- Karen Burns
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine Phillips
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert Brannigan
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Anna Franklin
- Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan Howell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Deb Schmidt
- Division of Oncology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Jenna Sopfe
- Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Leslie Coker Appiah
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, Colorado
- Department of Surgery, Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Denver, Colorado
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- Nelune Comprehensive Cancer Centre, Randwick, New South Wales, Australia
- School of Women's and Children's, University of New South Wales, Sydney, New South Wales, Australia
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5
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El Alaoui-Lasmaili K, Nguyen-Thi PL, Demogeot N, Lighezzolo-Alnot J, Gross MJ, Mansuy L, Chastagner P, Koscinski I. Fertility discussions and concerns in childhood cancer survivors, a systematic review for updated practice. Cancer Med 2023; 12:6023-6039. [PMID: 36224740 PMCID: PMC10028046 DOI: 10.1002/cam4.5339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To provide ways to improve the clinical practice of fertility preservation (FP) for children, adolescents, and young adults (AYA) with cancer. DESIGN A systematic research of online databases was undertaken in March 2020 following the PRISMA criteria, including Medline and Web of Science. RESULTS Fifty-nine articles were included. Surveys, interviews, and focus groups were used to collect data from patients, parents, and health care providers (HCPs). Four themes worth exploring emerged: (a) what do patients and professionals think of and know about FP? (b) what makes the fertility discussion happen or not? (c) what, retrospectively, led to FP being pursued or not? and (d) how do patients and HCPs feel about fertility issues? CONCLUSION A minority of AYAs preserve their fertility (banking assay for 45% of boys and 23% of girls). Yet fertility concerns have a significant impact on the quality of life of young cancer survivors. Although recommendations and guidelines regarding FP are available internationally, there are no specific guidelines as to how to conduct fertility counseling for children and adolescents. Some barriers are not removable, such as a poor prognosis of an obvious severe disease, time constraints for starting treatment, and cultural and religious beliefs. In response to aspects hindering patients and families to be receptive to any discussion at the time of diagnosis, psychological support could reduce the level of emotional distress and help restore a degree of open-mindedness to open a window for discussion. Moreover, as the lack of knowledge of professionals about fertility is frequently pointed out as a limiting factor for fertility discussion, reinforcing professional training regarding FP could be proposed to promote fertility discussion and eventually referral for FP.
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Affiliation(s)
| | - Phi Linh Nguyen-Thi
- Unité d'évaluation médicale, Unité de Méthodologie, Data management et Statistique - UMDS, CHRU de Nancy
| | - Nadine Demogeot
- Interpsy Laboratory (UR4432), University of Lorraine, Nancy, France
| | | | | | - Ludovic Mansuy
- Department of Pediatric Hematology and Oncology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Isabelle Koscinski
- Laboratory of Biology of Reproduction-CECOS Lorraine, University Hospital of Nancy, Nancy, France
- INSERM U1256, NGERE, Université de Lorraine, Nancy, France
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6
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Exploration of fertility and early menopause related information needs and development of online information for young breast cancer survivors. BMC Womens Health 2022; 22:329. [PMID: 35922784 PMCID: PMC9351061 DOI: 10.1186/s12905-022-01901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Approximately half of premenopausal women diagnosed with breast cancer desire to conceive after they finish treatment. Counseling about the risk of infertility prior to cancer treatment has been proven to improve quality of life after cancer treatment. As a result of this, guidelines focus on informing women on this topic prior to treatment. However, it is equally important to provide fertility related information after primary treatment has been completed, when the wish to conceive might become actual. Therefore, the aim of this study was to identify the fertility and early menopause related information needs of young breast cancer survivors and to design, develop and implement online information material with input of stakeholders.
Methods
A phenomenological qualitative study consisting of four phases was performed: identification of information needs through semi-structured interviews from a professional perspective (1) and a patient perspective (2). Exploration of stakeholders perspective regarding development and implementation of online information material (3) and development and implementation of the information material (4).
Results
Professionals indicated that there are no guidelines regarding the provision of fertility related information during cancer survivorship. Survivors reported unmet information needs. Women identified the following as most important information needs (a) fertility preservation options, (b) the risk of menopause or infertility, and (c) long term consequences of early menopause. A wide range of stakeholders involved in breast cancer care were interviewed. Based on their proposed design the information material was implemented on a nationwide website aiming at informing and supporting breast cancer patients.
Conclusions
Fertility and early menopause related information needs of young breast cancer survivors and their professionals were identified. Information material has been designed, developed and nationally implemented. This way, professionals in breast cancer care are provided with an information tool that helps them meet the information needs and preferences of their patients.
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7
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Factors influencing perceived communication quality for successful fertility preservation counseling for adolescent and young adult cancer patients and their caregivers in Korea. Support Care Cancer 2022; 30:9751-9762. [DOI: 10.1007/s00520-022-07425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
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8
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Assogba ELF, Dumas A, Woronoff AS, Mollévi C, Coutant C, Ladoire S, Desmoulins I, Dabakuyo-Yonli TS. Cross-sectional nationwide mixed-methods population-based study of living conditions, and identification of sexual and fertility profiles among young women after breast cancer in France: the Candy study protocol. BMJ Open 2022; 12:e056834. [PMID: 36171047 PMCID: PMC9528580 DOI: 10.1136/bmjopen-2021-056834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION At the end of the treatment, many young breast cancer (BC) survivors face difficulties related to fertility and sexuality, mainly due to the side effects of treatment. Integrating patient needs into medical decisions is becoming increasingly essential for high quality care. To this end, there is a compelling need to elicit patients' perspectives through qualitative studies, to understand their experiences and needs in the aftermath of cancer. We aim to: (1) identify clinical, social and economic determinants of sexuality and fertility, and describe other living conditions of young BC survivors in France; and (2) explore young women's experience after BC in relation to clinical and information needs about fertility preservation and sexual health. METHODS AND ANALYSIS This is a mixed-methods, cross-sectional, population-based study. In the quantitative component, women diagnosed with non-metastatic BC between 2009 and 2016 and aged 40 years or younger at diagnosis will be identified through the French network of cancer registries (FRANCIM). Participants will complete self-report questionnaires including standardised measures of sexuality, health-related quality of life (HRQoL), anxiety, depression, social deprivation and social support. Fertility and professional reintegration issues will also be assessed. Sexuality profiles will be identified by ascending hierarchical classification and fertility profiles will be identified by latent class models. Determinants of sexuality, fertility and HRQoL will be identified using a mixed regression model. Subsequently, semistructured interviews will be performed with a sample of 30 women who participated in the quantitative study. Interviews will be recorded, transcribed synthetically and content analysis will be performed, with the aid of NVivo software. ETHICS AND DISSEMINATION This study will be performed in accordance with the declaration of Helsinki. The protocol was approved in October 2020 by the Committee for the Protection of Persons North-West III (20.07.16.44445) and by the French national data protection authority (CNIL-MR003 No1989764-v0).The results of this project will be communicated to the scientific community through publications in international scientific peer-reviewed journals and communications to national and international congresses. Popularised results will also be provided to patient associations. The results of Candy project will also be published on the website of the sponsor, www.cgfl.fr.
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Affiliation(s)
- Emerline L F Assogba
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Epidemiology and Quality of Life Research Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Lipids, Nutrition, Cancer Research Center, French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) U1231, Dijon, Bourgogne-Franche-Comté, France
| | - Agnès Dumas
- Clinical Epidemiology and Economic Evaluation Applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE])-INSERM UMR 1123, University of Paris, Paris, Île-de-France, France
| | - Anne-Sophie Woronoff
- Cancer Registry of Doubs, Besançon Regional University Hospital Centre, Besançon, Bourgogne-Franche-Comté, France
- EA3181, Burgundy Franche-Comté University, Besançon, Bourgogne-Franche-Comté, France
| | - Caroline Mollévi
- Biometrics Unit, Montpellier Cancer Research Institute, Montpellier, Languedoc-Roussillon-Midi-Pyrénées, France
- University of Montpellier, Montpellier, Languedoc-Roussillon-Midi-Pyrénées, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Faculty of Medicine and Pharmacy, Burgundy Franche-Comté University, Dijon, Bourgogne-Franche-Comté, France
| | - Sylvain Ladoire
- Medical Oncology Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Chemotherapy and Immune Response Team, Lipides Nutrition Cancer, Dijon, Bourgogne-Franche-Comté, France
| | - Isabelle Desmoulins
- Medical Oncology Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Epidemiology and Quality of Life Research Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Lipids, Nutrition, Cancer Research Center, French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) U1231, Dijon, Bourgogne-Franche-Comté, France
- National Quality of Life and Cancer Clinical Research Platform, Dijon, Bourgogne-Franche-Comté, France
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van den Berg M, Kaal SEJ, Schuurman TN, Braat DDM, Mandigers CMPW, Tol J, Tromp JM, van der Vorst MJDL, Beerendonk CCM, Hermens RPMG. Quality of integrated female oncofertility care is suboptimal: A patient-reported measurement. Cancer Med 2022; 12:2691-2701. [PMID: 36031940 PMCID: PMC9939180 DOI: 10.1002/cam4.5149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend to inform female cancer patients about their infertility risks due to cancer treatment. Unfortunately, it seems that guideline adherence is suboptimal. In order to improve quality of integrated female oncofertility care, a systematic assessment of current practice is necessary. METHODS A multicenter cross-sectional survey study in which a set of systematically developed quality indicators was processed, was conducted among female cancer patients (diagnosed in 2016/2017). These indicators represented all domains in oncofertility care; risk communication, referral, counseling, and decision-making. Indicator scores were calculated, and determinants were assessed by multilevel multivariate analyses. RESULTS One hundred twenty-one out of 344 female cancer patients participated. Eight out of 11 indicators scored below 90% adherence. Of all patients, 72.7% was informed about their infertility, 51.2% was offered a referral, with 18.8% all aspects were discussed in counseling, and 35.5% received written and/or digital information. Patient's age, strength of wish to conceive, time before cancer treatment, and type of healthcare provider significantly influenced the scores of three indicators. CONCLUSIONS Current quality of female oncofertility care is far from optimal. Therefore, improvement is needed. To achieve this, improvement strategies that are tailored to the identified determinants and to guideline-specific barriers should be developed.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Suzanne E. J. Kaal
- Department of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands,Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands
| | - Teska N. Schuurman
- Center for Gynecologic Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch HospitalDen BoschThe Netherlands
| | - Jacqueline M. Tromp
- Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands,Department of Medical OncologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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Gelgoot EN, Kruglova K, Chan P, Lo K, Rosberger Z, Chown P, Kazdan J, O'Connell SBL, Zelkowitz P. Evaluation of a Mobile Health App Offering Fertility Information to Male Patients With Cancer: Usability Study. JMIR Cancer 2022; 8:e33594. [PMID: 35507408 PMCID: PMC9118008 DOI: 10.2196/33594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/23/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cancer and its treatment can adversely affect male fertility. Although sperm banking is an effective fertility preservation method, there is an unmet need for information and support surrounding these issues. Objective This usability study evaluates a mobile health app providing male patients with cancer with credible information about the impact of cancer and its treatment on fertility and fertility preservation. Methods Participants were recruited by a market research firm. Eligibility criteria were men who were 18-45 years of age, identified as male, diagnosed with new or recurring cancer within 1 year, not in fertility treatment, able to read and write in English or French, and had internet access. App usage was tracked for 2 weeks. After app use, participants provided qualitative feedback about their experiences using the app as well as quantitative data regarding their sperm banking decisions, perceived change in fertility knowledge, evaluation of the app’s information on the Information Assessment Method, and the app’s quality on the user version of the Mobile App Rating Scale. Results The sample included 40 men aged 27-45 years. Approximately 68% (27/40) indicated that no one had previously spoken to them about the impact of cancer on fertility, and 85% (34/40) had not received information on fertility preservation. Approximately 83% (33/40) found the app’s information relevant, and 85% (34/40) said that it increased their fertility knowledge. Approximately 23% (9/40) made a decision about sperm banking after using the app. Participants rated the app’s quality highly, with mean scores (out of 5) of 4.14 for information, 4.06 for functionality, 3.84 for aesthetics, and 3.63 for engagement. Conclusions The app proved to be useful for male patients with cancer, suggesting that mobile health resources could be beneficial to incorporate into clinical care to enable shared decision-making about fertility.
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Affiliation(s)
- Eden Noah Gelgoot
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Katya Kruglova
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Peter Chan
- McGill University Health Centre, Montréal, QC, Canada.,Department of Surgery, McGill University, Montréal, QC, Canada
| | - Kirk Lo
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada.,Department of Psychology, McGill University, Montréal, QC, Canada.,Department of Oncology, McGill University, Montréal, QC, Canada
| | - Philippa Chown
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychology, McGill University, Montréal, QC, Canada
| | - Jordana Kazdan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Siobhan Bernadette Laura O'Connell
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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11
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Huang SM, Kao TS, Lien PJ, Hsieh PL, Chen PH, Tseng LM. Oncofertility care: A qualitative study to understand personal perspectives and barriers in the multidisciplinary breast care team in Taiwan. WOMEN'S HEALTH 2022; 18:17455057221078480. [PMID: 35156483 PMCID: PMC8848045 DOI: 10.1177/17455057221078480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Previous studies indicate significant gaps exist in current practices and perceptions of oncofertility care. Objectives: We aim to understand the clinical experience regarding oncofertility care among health providers in a multidisciplinary breast care team. Methods: A qualitative, descriptive study was conducted. Data were collected through in-depth interviews with 16 health care providers who worked in a hospital in Taipei. Verbatim transcriptions were analyzed using constant analysis methods. Results: Health care providers’ experiences regarding fertility care for reproductive-age women with breast cancer were divided into two themes: personal perspectives and barriers. Personal perspectives consisted of six subthemes including empathizing with the patient’s suffering during the diagnosis and treatment, safety as a prerequisite, satisfying the women’s needs, respecting the women’s choice, questioning women’s ability to raise children, and returning to family life. There were also six subthemes under barriers. These subthemes were poor communication among the multidisciplinary team, lack of initial screening, insufficient support in the women’s families, treatment considerations, lack of evidence-based information regarding oncofertility, and non-follow-up protocol. Conclusion: Nurses should evaluate the fertility needs of women with cancer and identify potential gaps during oncofertility care. Education strategies and tactics should be improved in order to overcome difficulties arising from health care providers’ personal perspectives and barriers to the provision of optimal fertility care in women with cancer.
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Affiliation(s)
| | - Teh-Sing Kao
- Department of Nursing, MacKay Medical College, New Taipei City
| | - Pei-Ju Lien
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei City
| | - Pei-Ling Hsieh
- Department of Nursing, University of Kang Ning, Taipei City
| | - Ping-Ho Chen
- Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taipei City
| | - Ling-Ming Tseng
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei City
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City
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12
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Viviani S, Dellino M, Ramadan S, Peracchio C, Marcheselli L, Minoia C, Guarini A. Fertility preservation strategies for patients with lymphoma: a real-world practice survey among Fondazione Italiana Linfomi centers. TUMORI JOURNAL 2021; 108:572-577. [PMID: 34431742 DOI: 10.1177/03008916211040556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improvement in the prognosis of lymphomas in recent decades has allowed focus on reducing long-term toxicity of treatment, including infertility. The aim of this study was to assess the fertility preservation knowledge and practices among hematologic centers affiliated with Fondazione Italiana Linfomi (FIL) in Italy. METHODS A survey questionnaire was provided to 152 FIL centers between December 2019 and December 2020. RESULTS Responses from 58 centers (38%) were received. All respondents reported informing patients about treatment-related gonadotoxicity. A minority of patients (10% female, 20% male) refused fertility preservation due to personal reasons. The most common fertility preservation options offered to female patients were mature oocyte cryopreservation (43.1%), ovarian tissue cryopreservation (6.9%), and mature oocyte or ovarian tissue cryopreservation (39.7%). Six centers (10.3%) did not perform any procedures. All centers offered sperm cryopreservation for male patients. Challenges regarding the time intervals between lymphoma diagnosis and fertility consultation (up to 20 days) as well as between consultation and fertility preservation procedure (up to 40 days) were revealed. CONCLUSIONS This survey provides insight into fertility preservation practices among Italian hematologic centers and points out an urgent need to improve close cooperation between hematologists and fertility preservation specialists in order to avoid unacceptable delays in lymphoma treatment.
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Affiliation(s)
- Simonetta Viviani
- Division of Onco-Hematology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Miriam Dellino
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II," Bari, Italy
| | - Safaa Ramadan
- Division of Onco-Hematology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | - Carla Minoia
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II," Bari, Italy
| | - Attilio Guarini
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II," Bari, Italy
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13
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Wide A, Wettergren L, Ahlgren J, Smedby KE, Hellman K, Henriksson R, Rodriguez-Wallberg K, Ståhl O, Lampic C. Fertility-related information received by young women and men with cancer - a population-based survey. Acta Oncol 2021; 60:976-983. [PMID: 33764839 DOI: 10.1080/0284186x.2021.1900909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Infertility is a well-known sequela of cancer treatment. Despite guidelines recommending early discussions about risk of fertility impairment and fertility preservation options, not all patients of reproductive age receive such information. AIMS This study aimed to investigate young adult cancer patients' receipt of fertility-related information and use of fertility preservation, and to identify sociodemographic and clinical factors associated with receipt of information. MATERIALS AND METHODS A population-based cross-sectional survey study was conducted with 1010 young adults with cancer in Sweden (response rate 67%). The inclusion criteria were: a previous diagnosis of breast cancer, cervical cancer, ovarian cancer, brain tumor, lymphoma or testicular cancer between 2016 and 2017, at an age between 18 and 39 years. Data were analyzed using logistic regression models. RESULTS A majority of men (81%) and women (78%) reported having received information about the potential impact of cancer/treatment on their fertility. A higher percentage of men than women reported being informed about fertility preservation (84% men vs. 40% women, p < .001) and using gamete or gonadal cryopreservation (71% men vs. 15% women, p < .001). Patients with brain tumors and patients without a pretreatment desire for children were less likely to report being informed about potential impact on their fertility and about fertility preservation. In addition, being born outside Sweden was negatively associated with reported receipt of information about impact of cancer treatment on fertility. Among women, older age (>35 years), non-heterosexuality and being a parent were additional factors negatively associated with reported receipt of information about fertility preservation. CONCLUSION There is room for improvement in the equal provision of information about fertility issues to young adult cancer patients.
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Affiliation(s)
- Alexandra Wide
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Regional Cancer Centre Mellansverige, Uppsala, Sweden
| | - Karin E. Smedby
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Roger Henriksson
- Department of Radiation Science and Oncology, University Hospital, Umeå, Sweden
| | - Kenny Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Claudia Lampic
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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14
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Hernandez SJ, Hohsfield LA. Childbearing vs. clinical trial participation: is it one or the other? J Transl Med 2021; 19:260. [PMID: 34130723 PMCID: PMC8207669 DOI: 10.1186/s12967-021-02930-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Recent advances have shed light on the importance of early therapeutic intervention for neurodegenerative diseases. Primary prevention trials present a potential disease-modifying strategy for pre-symptomatic patients of autosomal dominant neurodegenerative diseases (ADND), such as early onset familial Alzheimer's disease (AD) and Huntington's disease (HD). As trials target earlier disease stages, however, prospective participants face new ethical and logistical challenges, namely childbearing and reproductive health decisions. Since pregnancy is an exclusion criteria for such trials, participants of reproductive age must choose between participating in research and having a family. Such decisions carry significant burdens for ADND patients that if left unaddressed could impact patient well-being and the field as whole. We use our perspective as scientists, advocates, and ADND family members to highlight current shortcomings in the field regarding trial participation and family planning issues for ADND patients and call for the establishment of a normative standard to address these concerns.
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Affiliation(s)
- Sarah J Hernandez
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Lindsay A Hohsfield
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA. .,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 3400A Biological Sciences III, Irvine, CA, 92697-4545, USA.
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15
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Hoffman A, Crocker L, Mathur A, Holman D, Weston J, Campbell S, Housten A, Bradford A, Agrawala S, Woodard TL. Patients' and Providers' Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment. JMIR Form Res 2021; 5:e25083. [PMID: 34096871 PMCID: PMC8218210 DOI: 10.2196/25083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. OBJECTIVE This study aims to assess providers' and survivors' fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. METHODS Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. RESULTS A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. CONCLUSIONS Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors' optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women's clinical characteristics and their information-seeking and deliberative styles.
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Affiliation(s)
- Aubri Hoffman
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Laura Crocker
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aakrati Mathur
- Department of Biostatistics, The University of Texas at Arlington, Arlington, TX, United States
| | - Deborah Holman
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - June Weston
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sukhkamal Campbell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Ashley Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Shilpi Agrawala
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Terri L Woodard
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
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16
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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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17
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Roshandel S, Lamyian M, Azin SA, Haghighat S, Mohammadi E. Development and validation of a guideline on sexual and reproductive health of breast cancer survivors in Iran: a mixed methods study protocol. Health Res Policy Syst 2021; 19:87. [PMID: 34059055 PMCID: PMC8166001 DOI: 10.1186/s12961-021-00738-6] [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: 11/29/2020] [Accepted: 05/13/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Sexual and reproductive health problems significantly decrease quality of life in survivors of breast cancer. The best approach is to provide services according to evidence-based guidelines developed based on their practical context. Here, we aim to develop and validate a guideline on the sexual and reproductive health of breast cancer survivors in Iran. METHODS The guideline will be developed and validated using an exploratory sequential mixed methods approach in three phases: (1) describing sexual and reproductive health needs of survivors of breast cancer in Iran and the health services they receive in this regard, (2) performing a systematic review of existing guidelines, resources, and documents on the sexual and reproductive health of breast cancer survivors worldwide, and (3) developing and validating a guideline on the sexual and reproductive health of women who survived breast cancer in Iran based on the results of phases 1 and 2 through multiple steps. DISCUSSION A comprehensive and practical guideline on the sexual and reproductive health of breast cancer survivors in Iran will be developed which will be compatible with their specific needs and culture, considering the limited resources available. This guideline can significantly improve the quality of life in breast cancer survivors in Iran. In addition, the approach we will use here can be utilized to develop guidelines on sexual and reproductive health of female cancer survivors in general.
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Affiliation(s)
- Solmaz Roshandel
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Minoor Lamyian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Seyed Ali Azin
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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18
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Ussher JM, Perz J, Hawkey AJ. A randomized controlled evaluation of an educational resource to address fertility concerns after cancer. Psychooncology 2021; 30:1442-1448. [PMID: 33860553 DOI: 10.1002/pon.5703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study evaluated the acceptability and impact of a written oncofertility educational resource (ER), as a self-help intervention (SH), and as an adjunct to a one-hour health-care professional discussion (HP). METHODS Within a randomized control trial (RCT), 194 adults with cancer (175 womens; 19 mens) were allocated to the SH or HP intervention. 127 completed 6-weeks post-intervention measures, a retention rate of 65.85%. RESULTS Across interventions, the ER was rated as highly acceptable and useful, in terms of ease of understanding, and information. Heath literacy significantly increased post-intervention, including functional literacy, communicative literacy, and critical health literacy. There were no significant changes in ratings of fertility distress or general distress pre-post intervention. Quality of life was significantly reduced post intervention. Those in the HP condition reported higher quality of life and greater likelihood of communication with others about fertility, most notably with intimate partners, post-intervention. Qualitative identification of increased knowledge, confidence with communication and normalization of fertility concerns, reflects increased health literacy, and provides explanation for significant reductions in feeling nervous and fearful about fertility treatments post-intervention. CONCLUSIONS Our findings confirm the importance of information provision about the impact of cancer on fertility. Written ERs are a useful adjunct to a patient-clinician discussion, increasing health literacy, which facilitates knowledge, self-efficacy and management of fertility concerns and changes.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
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19
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Mosconi L, Crescioli G, Vannacci A, Ravaldi C. Communication of Diagnosis of Infertility: A Systematic Review. Front Psychol 2021; 12:615699. [PMID: 33815202 PMCID: PMC8015870 DOI: 10.3389/fpsyg.2021.615699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: (i) the value that patients give to healthcare professionals' communication skills; (ii) the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and (iii) the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status.
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Affiliation(s)
- Laura Mosconi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy
| | - Giada Crescioli
- Perinatal Research Laboratory (PeaRL), University of Florence, Florence, Italy.,Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- CiaoLapo Foundation for Perinatal Health, Prato, Italy.,Perinatal Research Laboratory (PeaRL), University of Florence, Florence, Italy.,Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Claudia Ravaldi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy.,Perinatal Research Laboratory (PeaRL), University of Florence, Florence, Italy.,Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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20
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Tseng LM, Lien PJ, Huang CY, Tsai YF, Chao TC, Huang SM. Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach. J Med Internet Res 2021; 23:e24926. [PMID: 33729164 PMCID: PMC8074988 DOI: 10.2196/24926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background The pregnancy rate after cancer treatment for female survivors is lower than that of the general population. Future infertility is a significant concern for patients with breast cancer and is associated with a poor quality of life. Reproductive-age patients with breast cancer have safe options when choosing a type of fertility preservation method to be applied. Better information and support resources aimed at women to support their decision making are needed. Objective The objective of this study was to develop a web-based shared decision-making tool for helping patients with breast cancer make decisions on fertility preservation. Methods We used the action research cycle of observing, reflecting, planning, and acting to develop a web-based shared decision-making tool. The following four phrases were applied: (1) observe and reflect—collect and analyze the decision-making experiences of patients and health care providers; (2) reflect and plan—apply the initial results to create a paper design and modify the content; (3) plan and act—brainstorm about the web pages and modify the content; (4) act and observe—evaluate the effectiveness and refine the website’s shared decision-making tool. Interviews, group meetings, and constant dialogue were conducted between the various participants at each step. Effectiveness was evaluated using the Preparation for Decision-Making scale. Results Five major parts were developed with the use of the action research approach. The Introduction (part 1) describes the severity of cancer treatment and infertility. Options (part 2) provides the knowledge of fertility preservation. The shared decision-making tool was designed as a step-by-step process (part 3) that involves the comparison of options, patient values, and preferences; their knowledge regarding infertility and options; and reaching a collective decision. Resources (part 4) provides information on the hospitals that provide such services, and References (part 5) lists all the literature cited in the website. The results show the web-based shared decision-making meets both patients’ and health providers’ needs and helps reproductive-age patients with breast cancer make decisions about fertility preservation. Conclusions We have created the first web-based shared decision-making tool for making fertility preservation decisions in Taiwan. We believe female patients of reproductive age will find the tool useful and its use will become widespread, which should increase patient autonomy and improve communication about fertility preservation with clinicians. Trial Registration Clinicaltrials.gov NCT04602910; https://clinicaltrials.gov/ct2/show/NCT04602910
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Affiliation(s)
- Ling-Ming Tseng
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Ju Lien
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Yu Huang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Fang Tsai
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chung Chao
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Miauh Huang
- MacKay Medical College, Department of Nursing, New Taipei City, Taiwan
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21
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How Do Young Women with Cancer Experience Oncofertility Counselling during Cancer Treatment? A Qualitative, Single Centre Study at a Danish Tertiary Hospital. Cancers (Basel) 2021; 13:cancers13061355. [PMID: 33802795 PMCID: PMC8002475 DOI: 10.3390/cancers13061355] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk of therapy-induced infertility. The importance of initial and specialized fertility counselling to this patient group is undisputed. Despite international guidelines, oncofertility counselling is still inadequate. The purpose of this study was to examine how female AYA cancer patients and survivors experienced initial and specialized oncofertility counselling, and to present their specific suggestions on how to improve the oncofertility counselling. METHODS Twelve individual semi-structured interviews were performed with AYAs aged 20-35 with cancer or who were survivors. Participants were recruited via a youth support centre and social organization for AYAs with cancer. Data was analysed using thematic analysis. RESULTS Three main themes were found: Support is needed for navigating the fertility information jungle; The doctor's approach determines the content of the patient consultation; Inadequate and worrying information causes mistrust and frustration. CONCLUSION Results indicate a continuing problem regarding insufficient oncofertility counselling to AYAs with cancer. To ensure adequate and uniform information, especially in the initial oncofertility counselling, national guidelines for oncology specialists are suggested including multidisciplinary effort and collaboration between oncology and fertility specialists in mind. In addition, participants suggest focus on communication skills.
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22
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Tang H, Wang S, Dong S, Du R, Yang X, Cui P, Liu W, Kou J, Chen C. Surgery decision conflict and its related factors among newly diagnosed early breast cancer patients in China: A cross-sectional study. Nurs Open 2021; 8:2578-2586. [PMID: 33630425 PMCID: PMC8363395 DOI: 10.1002/nop2.791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 01/29/2021] [Indexed: 12/09/2022] Open
Abstract
Aim The aim of this study was to explore surgery decision conflict and its related factors among newly diagnosed early breast cancer patients in China. Design A cross‐sectional survey study was conducted. Methods A total of 262 patients confronted with surgery decision‐making were enrolled. The related factors were assessed with a demographic questionnaire, the Chinese version of the Decision Conflict Scale (DCS‐C‐16) and the Patient Participation Competence Scale (PPCS). Results Patients had a high level of decision conflict that was negatively correlated with the PPCS score. Age, marital status, living environment, education level, family income, cancer stage and the PPCS score were independent factors influencing decision conflict. Marital status, education level, cancer stage and participation competence were significant predictors of decision conflict. Patients who had higher participation competence were married, were well educated and had a lower cancer stage were likely to experience lower decision conflict.
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Affiliation(s)
- Han Tang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Shang Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shiqi Dong
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Ruofei Du
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xiao Yang
- The School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Panpan Cui
- The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wei Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Kou
- Nursing department, Henan Provincial People's Hospital, Zhengzhou, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,The School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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23
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Hawkey A, Ussher JM, Perz J, Parton C. Talking but not always understanding: couple communication about infertility concerns after cancer. BMC Public Health 2021; 21:161. [PMID: 33468106 PMCID: PMC7816453 DOI: 10.1186/s12889-021-10188-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer related infertility can have an impact on couple relationships, with evidence that couple communication facilitates coping. However, little is known about the ways in which couples communicate about cancer-related fertility concerns. The aim of this article is to examine couple communication about fertility concerns in the context of cancer, and the perceived quality of such communication from the perspective of cancer survivors and their partners. METHODS Eight-hundred and seventy-eight cancer survivors (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey which examined cancer related fertility concerns. Seventy-eight survivors (61 women and 17 men), and 26 partners (13 women and 13 men), participated in semi-structured interviews, in order to examine the subjective experience of fertility concerns in-depth. Thematic analysis was used to analyse the interviews and open ended survey questions. Valid percentages for single items from the relationships subscale of the Fertility Preservation Inventory (FPI) related to qualitative themes, identified frequency of responses. RESULTS The major theme was 'talking but not always understanding". 89.6% of cancer survivors and partners (95.1%) reported working well together handling fertility questions (FPI), but agreed that communication could be improved (65.9% survivors; 65% partners). Open and honest couple communication was associated with feelings of support, understanding and relationship growth, including perception of partner comfort (79.2% survivors, 81.6% partners). However, 32% survivors and 31.1% partners concealed fertility concerns to avoid upsetting their partner, or reported that their partner doesn't understand their fertility concerns (survivors 25.5%, partners 14.6%), with 14.1% of cancer survivors and 19.4% partners reporting fear of relationship breakdown because of fertility issues. Fear of rejection when forming new relationships, and concerns about how to talk to future partners, was reported by non-partnered individuals. CONCLUSION Health-care professionals should include partners of cancer survivors in fertility discussions. Couple interventions developed in general psycho-oncology should be extended to the domain of fertility, in order to facilitate effective couple communication. Communication in future relationships needs to be addressed for single people and adolescents and young adults (AYAs) who have fertility concerns.
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Affiliation(s)
- Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
| | - Chloe Parton
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, Australia
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24
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Hawkey AJ, Ussher JM, Perz J, Parton C, Patterson P, Bateson D, Hobbs K, Kirsten L. The impact of cancer-related fertility concerns on current and future couple relationships: People with cancer and partner perspectives. Eur J Cancer Care (Engl) 2020; 30:e13348. [PMID: 33084134 DOI: 10.1111/ecc.13348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to examine how cancer-related fertility concerns impact on couple relationships from the perspectives of people with cancer (PWC) and partners of people with cancer. METHODS A qualitative research design was used, drawing data from open-ended responses to a survey and in-depth individual interviews. Eight hundred and seventy-eight PWC (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey, and 78 PWC (61 women and 17 men) and 26 partners (13 women and 13 men), participated in semi-structured interviews. RESULTS Thematic analysis identified that many PWC and partners experience a 'double burden', manifested by cancer-related fertility concerns creating relational stress, changes to couple sexual intimacy and feelings of inadequacy when forming new relationships. However, many participants adopted strategies to facilitate coping with infertility or fertility concerns. This included acceptance of infertility and privileging of survival, focusing on relationship growth, optimism and nurturing in other ways. CONCLUSION Cancer-related fertility concerns can have a significant impact on couple relationships. Psychological support from clinicians may facilitate couple coping, as well as help to address concerns about future relationships for un-partnered people with cancer.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Chloe Parton
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | | | - Kim Hobbs
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Laura Kirsten
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, NSW, Australia
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25
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Okamoto S, Fujii N, Yoshioka N, Harada M, Tanimoto M, Maeda Y, Suzuki N, Osuga Y. Nationwide survey of fertility preservation in patients with hematological malignancies in Japan. Int J Clin Oncol 2020; 26:438-442. [PMID: 33068221 DOI: 10.1007/s10147-020-01801-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Worldwide, there has been a growing interest in oncofertility issues. In 2017, the Japanese Society of Clinical Oncology published clinical practice guidelines for fertility preservation (FP) in cancer patients. We conducted a questionnaire survey to explore the FP practices among hematologists before the publication of this guideline. METHODS We sent 427 designated cancer hospitals in Japan a questionnaire about FP treatment for patients with hematological malignancies between January and December 2014. RESULTS Of these, 137 institutions responded, and 81 (19.0%) were included in the analysis. A total of 324 female and 441 male patients, aged < 40 years, were treated. The percentage of patients informed about FP was higher in patients treated with hematopoietic cell transplant than those without. Female patients were less likely to be informed about FP than male patients. FP was performed in a total of 27 female patients: 20 oocyte cryopreservation, 2 embryo cryopreservation, 3 ovarian tissue cryopreservation, and 2 ovarian shielding during total body irradiation. Sperm cryopreservation was performed in 115 male patients. CONCLUSIONS Our findings indicate the reality of fertility preservation in 2014, before the guideline were issued. Further studies are warranted to investigate the improvement in fertility preservation since the guidelines were issued.
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Affiliation(s)
- Sachiyo Okamoto
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Norihito Yoshioka
- Department of Obstetrics and Gynecoclogy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecoclogy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecoclogy, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecoclogy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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26
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Petrini F, Graziani E, Caputo MA, Meringolo P. Continuum between Relational and Therapeutic Models of Self-help in Mental Health: A Qualitative Approach. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:290-304. [PMID: 31587311 DOI: 10.1002/ajcp.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Self-help groups are generally described as "group[s] composed of individuals who meet on a regular basis to help one another cope with a life problem" (APA, 2019). Yet, it is challenging to find a univocal definition of self-help groups. Scholars usually use different labels to highlight various features of self-help groups, suggesting the need for further inquiry regarding commonalities and differences. The level of professional involvement is one of the most disputed factors influencing whether a group is considered to belong to the "self-help family." The present qualitative study aimed to understand how professional support in Tuscany, Italy can influence the organizational choices of these groups (place for meetings, admission criteria, timing, etc.), as well as the personal beliefs of members. The study included 17 self-help groups. During 13 focus groups meetings, 92 participants were interviewed; then, we individually interviewed 19 facilitators and six additional key informants from mental health settings. We used a grounded theory approach, and we discussed the emerging models with participants at a public event. Results show the emergence of two theoretical models to define self-help groups, not to be interpreted as mutually exclusive. The "relational model" refers to self-help groups whose main feature is to guarantee the acquisition of specific skills (social comparison skills, active listening, and empathy), while the "therapeutic model" seems to represent a kind of assimilation of other types of interventions.
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Affiliation(s)
- Fausto Petrini
- Dipartimento di Psicologia, Università degli Studi di Firenze, Firenze, Italy
| | - Elena Graziani
- Dipartimento di Psicologia, Università degli Studi di Firenze, Firenze, Italy
| | - Maria Angela Caputo
- Dipartimento di Psicologia, Università degli Studi di Firenze, Firenze, Italy
| | - Patrizia Meringolo
- Dipartimento di Psicologia, Università degli Studi di Firenze, Firenze, Italy
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Tholeti P, Uppangala S, Bhat V, Udupa KS, Kumar V, Patted S, Natarajan P, Spears N, Kalthur G, Woodruff TK, Adiga SK. Oncofertility: Knowledge, Attitudes, and Barriers Among Indian Oncologists and Gynecologists. J Adolesc Young Adult Oncol 2020; 10:71-77. [PMID: 32456519 DOI: 10.1089/jayao.2020.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Recommendations from the American Society of Clinical Oncology (ASCO) emphasize the critical need to understand current trends in fertility preservation (FP) among the two sets of primary health care providers involved in oncofertility: the oncologists and the gynecologists. This study is aimed at understanding the health care providers' knowledge, attitudes, and barriers in oncofertility across India. Methods: An 18-item oncofertility survey was designed and directed to 77 oncologists and 214 gynecologists across India. The responses were analyzed by using descriptive statistical methods, and the oncofertility trends between the two groups were studied. Results: The total response rate was 34%, with 49 of 214 oncologists (23%) and 49 of 77 gynecologists (64%) participating in the survey. The awareness of ASCO FP guidelines among oncologists and gynecologists was 53% and 59.5%, respectively. About 48% of oncologists felt knowledgeable about sperm banking, whereas 52% knew about oocyte freezing but not about other options. On the other hand, among gynecologists, 38% reported inadequate knowledge of testicular or ovarian tissue cryopreservation. About 85% of oncologists reported routine referral of cancer diagnosed patients for FP, whereas 75% of gynecologists reported routine FP discussion with patients. Health care providers from both groups perceived the major barriers in oncofertility to be, "financial burden on the patient" (73%-86%) and, "lack of patient awareness" (71%-79.5%). Conclusion: Effective collaboration between oncologists and gynecologists is essential to establish a successful FP program. Economic burden on the patient and lack of patient and physician awareness are limiting factors that need to be overcome.
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Affiliation(s)
- Prathima Tholeti
- Department of Clinical Embryology, Centre for Fertility Preservation, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shubhashree Uppangala
- Department of Clinical Embryology, Centre for Fertility Preservation, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vasudeva Bhat
- Division of Pediatric Hematology and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Karthik S Udupa
- Department of Medical Oncology and Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vijay Kumar
- Department of Pediatric Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shobhana Patted
- Department of Obstetrics & Gynecology, Jawaharlal Nehru Medical College, Belgaum, India
| | - Pandiyan Natarajan
- Department of Andrology and Reproductive Medicine, Chettinad Super Speciality Hospital, Chennai, India
| | - Norah Spears
- Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Guruprasad Kalthur
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Satish Kumar Adiga
- Department of Clinical Embryology, Centre for Fertility Preservation, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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28
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Communication Needs of Cancer Patients and/or Caregivers: A Critical Literature Review. JOURNAL OF ONCOLOGY 2020; 2020:7432849. [PMID: 32454826 PMCID: PMC7229568 DOI: 10.1155/2020/7432849] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/13/2020] [Accepted: 04/21/2020] [Indexed: 12/30/2022]
Abstract
Objective Effective communication for cancer patients and/or caregivers can meet information needs, reduce caregiver burden, improve physical and mental health, and promote intimacy. The aim of this review was to identify the communication needs of cancer patients and/or caregivers and to explore their specific communication needs to guide the development of future communication interventions. Methods Chinese and English databases were systematically searched from January 2010 to October 2019, including MEDLINE, CINAHL, PubMed, and the China Academic Journal Full-text Database. The key search terms used were “cancer” or “carcinoma” or “oncology” AND “patient” or “caregiver” or “carer” AND “communication” or “discussion” or “talk” AND “need” or “needs” or “desire.”. Results A total of 26 articles was identified and included in this review. The findings revealed the needs of cancer patients and/or caregivers in terms of communication target, content, style, timing, and preferences. Communication targets included health professionals, peers, caregivers, and patients. Communication content included illness-related, emotional support, daily life, sexuality, death, and a way to communicate with health professionals. Communication style needed to be expressed through such things as language and communication atmosphere. Communication timing mainly referred to before treatment and approaching death. Communication preferences were related to factors such as demographics and ethnic origin. Conclusions Cancer patients and/or caregivers have different communication needs in terms of target, content, style, and communication timing. A better understanding of the unique communication needs of patients and/or caregivers will offer health professionals detailed information on designing appropriate interventions to support cancer patients and caregivers.
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29
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Cordeiro Mitchell CN, Whiting-Collings LJ, Christianson MS. Understanding Patients' Knowledge and Feelings Regarding Their Cryopreserved Ovarian Tissue: A Qualitative Interviewing Study. J Adolesc Young Adult Oncol 2020; 9:502-507. [PMID: 32255707 DOI: 10.1089/jayao.2020.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: For prepubertal girls, or when gonadotoxic treatment is urgent, ovarian tissue cryopreservation (OTC) represents the only option for fertility preservation. We sought to determine patients' knowledge and feelings about their cryopreserved ovarian tissue. Methods: We conducted qualitative interviews with women aged 18 years or older who underwent OTC at our academic fertility center between 2006 and 2017. Subjects were recruited by phone and participated in a single telephone interview using a standardized guide. Interviews were performed until data saturation was reached. Atlas.ti software was used for content analysis. Results: We interviewed eight women with a mean age of 25.8 ± 6.1 years (range, 19-37 years). The mean age at OTC was 20.4 ± 7.5 years (range, 13-35 years). Indications for fertility preservation included hematologic cancer/disease (4/8) or gynecological cancer/BRCA2 positive (4/8). Most patients (7/8) desired future fertility. Although half of the interviewees understood the OTC procedure, only two knew that the tissue can be used for future fertility and only one was aware of the benefits for vasomotor symptoms. Five subjects expressed positive emotions regarding OTC; one felt angry that the decision was made by her parents and two were concerned that OTC might not have been a good choice. However, most subjects (5/8) expressed a desire to better understand OTC and most (5/8) wished for more education about it. Conclusion: This study identifies a significant knowledge gap among patients with cryopreserved ovarian tissue about its uses and benefits as well as a strong desire among these women for improved education about this fertility preservation modality.
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Affiliation(s)
- Christina N Cordeiro Mitchell
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lillian J Whiting-Collings
- Department of Population, Family, and Reproductive Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Mindy S Christianson
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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30
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Hampe ME, Rhoton-Vlasak AS. Fertility preservation in breast cancer with case-based examples for guidance. J Assist Reprod Genet 2020; 37:717-729. [PMID: 32008180 PMCID: PMC7125269 DOI: 10.1007/s10815-019-01665-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
With more young breast cancer survivors, a trend toward having children later in life, and improvements in assisted reproductive technology (ART), fertility preserving techniques are of growing importance prior to initiation of gonadotoxic treatments. The American Society for Clinical Oncology (ASCO) updated their Fertility Preservation in Patients with Cancer guidelines in April of 2018. ASCO continues to recognize oocyte and embryo cryopreservation as standard practice for women interested in preserving fertility and sperm cryopreservation as standard practice for men. ASCO has clarified their statement on ovarian suppression during chemotherapy as an option when standard methods are unavailable but should not be used as the sole method of fertility preservation (FP) due to conflicting evidence. ASCO also updated their statement on ovarian tissue cryopreservation, which is still labeled experimental but ASCO acknowledges that it can restore global ovarian function and could be of use in specific patients. The NCCN's Version 1.2018 Clinical Practice Guidelines® for treatment of breast cancer include fertility counseling as part of their work-up in all types of breast cancer for premenopausal women.The purpose of this review is to explain the indications and evidence for the different methods of FP for young breast cancer patients in accordance with ASCO and NCCN guidelines. The guidance will then be applied to three theoretical clinical cases in order to highlight actual use in clinical practice.
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Affiliation(s)
- Mary E Hampe
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alice S Rhoton-Vlasak
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA.
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31
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Let us talk about death: gender effects in cancer patients' preferences for end-of-life discussions. Support Care Cancer 2020; 28:4667-4675. [PMID: 31955277 PMCID: PMC7447655 DOI: 10.1007/s00520-019-05275-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/23/2019] [Indexed: 11/06/2022]
Abstract
Purpose Patients with advanced cancer often receive suboptimal end-of-life (EOL) care. Particularly males with advanced cancer are more likely to receive EOL care that is more aggressive, even if death is imminent. Critical factors determining EOL care are EOL conversations or advance care planning. However, information about gender-related factors influencing EOL conversations is lacking. Therefore, the current study investigates gender differences concerning the content, the desired time point, and the mode of initiation of EOL conversations in cancer patients. Methods In a cross-sectional study, 186 female and male cancer patients were asked about their preferences for EOL discussions using a semi-structured interview, focusing on (a) the importance of six different topics (medical and nursing care, organizational, emotional, social, and spiritual/religious aspects), (b) the desired time point, and (c) the mode of discussion initiation. Results The importance of EOL topics differs significantly regarding issue (p = 0.002, η2 = 0.02) and gender (p < 0.001, η2 = 0.11). Males wish to avoid the engagement in discussions about death and dying particularly if they are anxious about their end-of-life period. They wish to be addressed regarding the “hard facts” nursing and medical care only. In contrast, females prefer to speak more about “soft facts” and to be addressed about each EOL topic. Independent of gender, the majority of patients prefer to talk rather late: when the disease is getting worse (58%), at the end of their therapy, or when loosing self-sufficiency (27.5%). Conclusion The tendency of patients to talk late about EOL issues increases the risk of delayed or missed EOL conversations, which may be due to a knowledge gap regarding the possibility of disease-associated incapability. Furthermore, there are significant gender differences influencing the access to EOL conversations. Therefore, for daily clinical routine, we suggest an early two-step, gender-sensitive approach to end-of-life conversations.
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32
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Pastore LM, Cordeiro Mitchell CN, Rubin LR, Nicoloro-SantaBarbara J, Genoff Garzon MC, Lobel M. Patients' preimplantation genetic testing decision-making experience: an opinion on related psychological frameworks. Hum Reprod Open 2019; 2019:hoz019. [PMID: 31598567 PMCID: PMC6777985 DOI: 10.1093/hropen/hoz019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022] Open
Abstract
The process of deciding whether to pursue preimplantation genetic testing (PGT) of an embryo is highly stressful for individuals and couples and has adverse emotional consequences (e.g. distress and uncertainty). PGT influences patients’ lives in both positive and negative ways and is experienced at an individual level, as a dyadic unit, as a family member and as part of the society. Here, we argue that providing a conceptual framework with which to understand the `experience of decision making’ about PGT for monogenic disease (PGT-M) testing specifically, as well as the factors contributing to `decisional distress’ and `uncertainty’ that patients endure as a result—apart from what decision they make—is crucial to optimizing patient counseling, satisfaction and outcomes in the field of ART. Derived from psychological theory, the framework proposed here identifies three categories of contributing factors to decisional distress and uncertainty in considering PGT-M; namely, ‘intraindividual’, ‘interpersonal’ and ‘situational’ factors. We reviewed evidence from the PGT literature to inform our framework. Well-accepted theories of stress and health decision making were also reviewed for their relevance to PGT-M decision making, focusing on potential distress and uncertainty. Our novel conceptual framework can be used to inform clinical practice, to advance research and to aid the development of interventions for individuals and couples who are deciding whether or not to use PGT-M. Alleviating emotional distress and uncertainty can improve patients’ well-being during their reproductive journey.
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Affiliation(s)
- L M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - C N Cordeiro Mitchell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L R Rubin
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | | | - M C Genoff Garzon
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - M Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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33
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Fertility preservation in patients with hematologic malignancies and recipients of hematopoietic cell transplants. Blood 2019; 134:746-760. [PMID: 31292116 DOI: 10.1182/blood.2018846790] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/30/2019] [Indexed: 02/07/2023] Open
Abstract
Patients with hematologic malignancies and those undergoing hematopoietic cell transplantation (HCT) face a complex set of challenges when considering options for fertility preservation (FP). There are no standard options for prepubertal children, and women with hematologic malignancies may not be eligible for standard FP options. Fortunately, initial therapies for most blood cancers are not highly gonadotoxic, affording an important opportunity for postremission counseling and referrals to fertility specialists. These patients face a high risk of relapse, and many will be referred for autologous or allogeneic HCT, which carries an extremely high risk of infertility. The expanding indications for HCT to include benign hematologic disorders as well as autoimmune diseases mandate that all hematologists are familiar with these risks. Oncofertility researchers are continually pushing the boundaries of what may be possible for our patients; in the meantime, communication and shared decision-making between hematologists and patients, as well as program-building, education, and outreach are essential to ensure that these patients, many of whom will be cured, maintain all of their options for a fulfilling life after intensive therapy.
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34
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Supportive oncofertility care, psychological health and reproductive concerns: a qualitative study. Support Care Cancer 2019; 28:809-817. [DOI: 10.1007/s00520-019-04883-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
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35
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Alexandroni H, Shoham G, Levy-Toledano R, Nagler A, Mohty M, Duarte R, Leong M, Shoham Z. Fertility preservation from the point of view of hematopoietic cell transplant specialists—a worldwide-web-based survey analysis. Bone Marrow Transplant 2019; 54:1747-1755. [DOI: 10.1038/s41409-019-0519-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/20/2019] [Accepted: 03/17/2019] [Indexed: 01/09/2023]
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36
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Gorman JR, Drizin JH, Mersereau JE, Su HI. Applying behavioral theory to understand fertility consultation uptake after cancer. Psychooncology 2019; 28:822-829. [PMID: 30761655 DOI: 10.1002/pon.5027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/24/2019] [Accepted: 02/12/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to examine the association between theoretical constructs from the Health Belief Model and fertility consultation status after cancer. METHODS Reproductive-aged female cancer survivors self-reported their use of fertility consultation, perceived severity of and susceptibility to infertility, perceived barriers to and effectiveness of fertility consultation, and cues to action from family/peers and doctors, as well as demographics and cancer characteristics. Logistic regression was used to analyze the association between theoretical constructs and fertility consultation status. RESULTS Fertility consultation uptake was more prevalent among survivors with higher incomes, those without children, those who wanted a (another) child, and those who were diagnosed more recently. In the final multivariate model, higher perceived severity of infertility, fewer perceived barriers to fertility consultation, and more cues to action from family/peers and doctors were significantly associated with fertility consultation uptake, controlling for income. Exploratory bivariate analyses of barriers to fertility consultation revealed that cost and trouble accessing services were significantly associated with not having a fertility consultation. CONCLUSIONS The Health Belief Model is useful for understanding factors associated with fertility consultation uptake. Efforts should be made to reduce financial barriers and improve patient-centered assessment of family-building goals.
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Affiliation(s)
- Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Julia H Drizin
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jennifer E Mersereau
- Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, North Carolina, USA
| | - H Irene Su
- UC San Diego Moores Cancer Center, University of California, San Diego, San Diego, California, USA
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Ussher JM, Perz J. Infertility‐related distress following cancer for women and men: A mixed method study. Psychooncology 2019; 28:607-614. [DOI: 10.1002/pon.4990] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine Western Sydney University Penrith Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine Western Sydney University Penrith Australia
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38
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Parton C, Ussher JM, Perz J. Hope, burden or risk: a discourse analytic study of the construction and experience of fertility preservation in the context of cancer. Psychol Health 2019; 34:456-477. [DOI: 10.1080/08870446.2018.1543764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Chloe Parton
- Western Sydney University, Translational Health Research Institute, Campbelltown Campus, Sydney, Australia
| | - Jane M. Ussher
- Western Sydney University, Translational Health Research Institute, Campbelltown Campus, Sydney, Australia
| | - Janette Perz
- Western Sydney University, Translational Health Research Institute, Campbelltown Campus, Sydney, Australia
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39
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Cancer and fertility: optimizing communication between patients and healthcare providers. Curr Opin Support Palliat Care 2019; 13:53-58. [PMID: 30625120 DOI: 10.1097/spc.0000000000000413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW This article reviews the status of guidelines and recommendations for communication between patients with cancer and healthcare providers (HCPs) concerning fertility issues. RECENT FINDINGS The timing, the type of information provided, and the openness of HCPs can all affect how patients with cancer perceive discussions regarding fertility concerns and preservation. In addition, whether such discussions occur is associated with intrinsic factors, such as age and sex of the patients as well as HCP's knowledge level. It has also been found that the patients have different needs for information regarding fertility preservation and preferences for types of communication strategies regarding the impact of their disease and treatments on options for family planning. SUMMARY Although discussions about fertility concerns in the context of cancer between physicians and patients are occurring more frequently, there are inconsistent findings regarding satisfaction with these discussions. Recent research has found that the timing, type of information given, and level of openness of the HCP can impact how patients perceive communications regarding the risks of cancer treatment on fertility preservation options and future family planning. Age, sex, and HCP's knowledge of fertility risks and fertility preservation services are also notable factors associated with whether and how extensively discussions about fertility take place. More women than men report having a fertility discussion with an HCP. However, men are more likely to report satisfaction with the fertility discussion than women.
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40
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Smith KL, Gracia C, Sokalska A, Moore H. Advances in Fertility Preservation for Young Women With Cancer. Am Soc Clin Oncol Educ Book 2018; 38:27-37. [PMID: 30231357 DOI: 10.1200/edbk_208301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.
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Affiliation(s)
- Karen Lisa Smith
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Clarisa Gracia
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Anna Sokalska
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
| | - Halle Moore
- From The Johns Hopkins University School of Medicine, Baltimore, MD; Hospital of the University of Pennsylvania, Philadelphia, PA; Cleveland Clinic, Cleveland, OH
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41
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Anazodo A, Ataman-Millhouse L, Jayasinghe Y, Woodruff TK. Oncofertility-An emerging discipline rather than a special consideration. Pediatr Blood Cancer 2018; 65:e27297. [PMID: 29972282 PMCID: PMC6150802 DOI: 10.1002/pbc.27297] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
Originally absent from the oncologist's consult, then placed in a 'quality of life' rubric, oncofertility should now be an essential part of a comprehensive cancer treatment plan in patients of reproductive age, including adolescents and young adults (AYAs). Oncofertility encompasses the endocrine health of the patient, as well as fertility management options. Thus, pubertal transitions in males and females, bone health, and menstrual health are all part of this discipline, enabling practitioners to work in interdisciplinary teams to solve problems in reproductive health. This review provides a summary of the essential considerations required for the assessement of reproductive risk and choice of fertility preservation options as well as considerations for developing oncofertility services for AYAs.
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Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women’s and Children’s Hospital, University of New South Wales, Sydney
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology University of Melbourne Royal Women’s Hospital, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Schwartz LF, Braddock CH, Kao RL, Sim MS, Casillas JN. Creation and evaluation of a cancer survivorship curriculum for pediatric resident physicians. J Cancer Surviv 2018; 12:651-658. [PMID: 29938339 DOI: 10.1007/s11764-018-0702-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/15/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE There is a paucity of formal clinician education concerning cancer survivorship care, which produces care barriers and poorer outcomes for survivors of childhood cancer. To address this, we implemented a curriculum in childhood cancer survivorship care for pediatric residents at the University of California, Los Angeles (UCLA). We examined the efficacy of this curriculum following program completion. METHODS A case-based curriculum was created and integrated within existing educational structures using Kern's model. We utilized the retrospective pre-posttest method to evaluate participating residents' knowledge, clinical skills, and attitudes towards cancer survivorship topics before and after receiving the curriculum. Pre-posttest items were compared using paired t tests and one-sided binomial tests. We analyzed free-response question items for major themes using constant comparative methods. RESULTS Thirty-four residents completed the curriculum and its evaluation. Each assessment item significantly increased from pre- to post-curriculum; p < 0.05. Greater than 40% of residents improved in all but one assessment item post-curriculum; p < 0.05. Residents reported the curriculum enhanced their pediatric knowledge base (M = 3.24; SD = 0.65) and would recommend it to other residency programs; M = 3.24; SD = 0.69. Major themes included residents' request for additional oncofertility information, training in counseling survivors, and cancer survivorship training opportunities. CONCLUSIONS A cancer survivorship curriculum can successfully increase trainees' knowledge, clinical skills, and comfort in discussing topics relevant to survivorship care. IMPLICATIONS FOR CANCER SURVIVORS With increasing numbers of childhood cancer survivors living into adulthood, residents will likely treat this population regardless of intended career path. This curriculum represents one method to deliver formal cancer survivorship training.
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Affiliation(s)
- Lindsay F Schwartz
- University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Clarence H Braddock
- University of California, Los Angeles, 885 Tiverton Avenue, Los Angeles, CA, 90024, USA
| | - Roy L Kao
- University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Myung-Shin Sim
- University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA, 90024, USA
| | - Jacqueline N Casillas
- University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
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43
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Ussher JM, Perz J. Threat of biographical disruption: the gendered construction and experience of infertility following cancer for women and men. BMC Cancer 2018; 18:250. [PMID: 29506492 PMCID: PMC5836444 DOI: 10.1186/s12885-018-4172-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 02/26/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infertility is a major concern for people with cancer and their partners. There have been calls for further research on the gendered nature of psychosocial, emotional and identity concomitants of fertility post-cancer across women and men. METHOD The gendered construction and experience of infertility following cancer was examined through a survey of 693 women and 185 men, and in-depth one-to-one interviews with a subsample of survey respondents, 61 women and 17 men, purposively selected across cancer types and age groups. Thematic decomposition was used to examine the open ended survey responses and interviews. The chi square test for independence was used to test for group differences between women and men on closed survey items. RESULTS In the thematic decomposition, infertility was identified as providing a 'Threat of Biographical Disruption' which impacted on life course and identity, for both women and men. Subthemes identified were: 'Parenthood as central to adulthood'; 'Infertility as a threat to gender identity'; ' Unknown fertility status and delayed parenthood'; 'Feelings of loss and grief'; 'Absence of understanding and support'; 'Benefit finding and renegotiation of identity'. In the closed survey items, the majority of women and men agreed that they had always 'wanted to be a parent' and that 'parenthood was a more important life goal than a satisfying career'. 'It is hard to feel like a true adult until you have a child' and impact upon 'my feelings about myself as a man or a woman' was reported by both women and men, with significantly more women reporting 'I feel empty because of fertility issues'. Many participants agreed they 'could visualise a happy life without a child' and there is 'freedom without children'. Significantly more men than women reported that they had not discussed fertility with a health care professional. CONCLUSION The fear of infertility following cancer, or knowledge of compromised fertility, can have negative effects on identity and psychological wellbeing for both women and men, serving to create biographical disruption. Support from family, partners and health care professionals can facilitate renegotiation of identity and coping.
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Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751 Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751 Australia
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