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Perez GK, Salsman JM, Fladeboe K, Kirchhoff AC, Park ER, Rosenberg AR. Taboo Topics in Adolescent and Young Adult Oncology: Strategies for Managing Challenging but Important Conversations Central to Adolescent and Young Adult Cancer Survivorship. Am Soc Clin Oncol Educ Book 2020; 40:1-15. [PMID: 32324424 PMCID: PMC7328818 DOI: 10.1200/edbk_279787] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Research on adolescents and young adults (AYAs) with cancer has flourished over the past decade, underscoring the unique medical and psychosocial needs of this vulnerable group. A cancer diagnosis during adolescence and young adulthood intersects with the developmental trajectory of AYAs, derailing critical physical, social, and emotional development. AYAs face these abrupt life changes needing age-appropriate information and resources to offset these challenges. Greater attention is needed to address AYA-specific concerns on reproductive and sexual health, financial security and independence, emotional well-being, social support, and end-of-life care. If these unique needs are unaddressed, this can adversely affect AYAs' health care engagement and overall quality of life, increasing their risk for cancer-related morbidity and early mortality. In particular, health care decisions made during treatment have important implications for AYA patients' future health. Oncology clinicians are well positioned to address AYA patients' concerns by anticipating and addressing the challenges this age group is likely to face. In this paper, we explore several core topics that affect AYAs' quality of life and that can be challenging to address. Starting from the moment of diagnosis, through cancer treatment and post-treatment survivorship, and into end of life, each section highlights critical developmental-centric life domains that are affected by the cancer experience. Specifically, we discuss resources, tools, and strategies to navigate these challenging conversations. Taking a risk-reduction approach that invites two-way communication and facilitates referral to age-appropriate resources would help destigmatize these experiences and, in turn, would support the provision of compassionate and effective age-concordant care to this vulnerable group.
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Affiliation(s)
- Giselle K. Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - John M. Salsman
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kaitlyn Fladeboe
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
| | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Elyse R. Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - Abby R. Rosenberg
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
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Fridgen O, Sehovic I, Bowman ML, Reed D, Tamargo C, Vadaparampil S, Quinn GP. Contraception: the Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:924-932. [PMID: 26880356 DOI: 10.1007/s13187-016-1003-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Little is known about oncology provider recommendations regarding best practices in contraception use during cancer treatment and through survivorship for adolescent and young adult (AYA) cancer patients. This review examined the literature to identify related studies on contraception recommendations, counseling discussions, and methods of contraception in the AYA oncology population. A literature review was conducted using PubMed, including all peer-reviewed journals with no publication date exclusions. A systematic review of the literature was conducted using combinations of the following phrases or keywords: "oncology OR cancer" AND "contraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agents, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization" AND "young adult OR adolescent" AND "young adult AND adolescent". Reviewers assessed articles using the "Quality Assessment Tool for Quantitative Studies" which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. A total of five articles were included and all studies were quantitative. Results showed no consistent recommendations among providers, references to guidelines, or methods of contraceptive types. Provider guidelines for discussions with AYA patients should be expanded to provide comprehensive, consistent, and quality cancer care in the AYA population.
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Affiliation(s)
- Olivia Fridgen
- Adolescent and Young Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA
| | - Ivana Sehovic
- Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL, 33612, USA
| | - Meghan L Bowman
- Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL, 33612, USA
| | - Damon Reed
- Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA
| | - Christina Tamargo
- Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL, 33612, USA
| | - Susan Vadaparampil
- Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA
- University of South Florida, Morsani College of Medicine University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Gwendolyn P Quinn
- Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL, 33612, USA.
- University of South Florida, Morsani College of Medicine University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
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Patel A, Roston A, Uy A, Radeke E, Roston A, Keith L, Zaren HA. Reproductive health and endocrine disruption in women with breast cancer: a pilot study. Support Care Cancer 2014; 23:411-8. [PMID: 25120011 DOI: 10.1007/s00520-014-2381-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 07/31/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to assess whether incorporation of an original reproductive health assessment and algorithm into breast cancer care helps providers appropriately manage patient reproductive health goals and to follow laboratory markers for fertility and correlate these with menstruation. METHODS This prospective observational pilot study was set in an urban, public hospital. Newly diagnosed premenopausal breast cancer patients between 18 and 49 years old were recruited for this study prior to chemotherapy initiation. As the intervention, these patients received a reproductive health assessment and care per the study algorithm at 3-month intervals for 24 months. Blood samples were also collected at the same time intervals. The main outcome measures were to assess if the reproductive health management was consistent with patient goals and to track any follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) level changes throughout treatment and post-treatment period. RESULTS Two patients were pregnant at study initiation. They received obstetric consultations, opted to continue pregnancies, and postpone treatment; both delivered at term without complications. One woman desired future childbearing and received fertility preservation counseling. All women received family planning consultations and received/continued effective contraceptive methods. Seventy-three percent used long-term contraception, 18 % remained abstinent, and 9 % used condoms. During chemotherapy, FSH rose to menopausal levels in 82 % of patients and TSH rose significantly in 9 %. While 82 % of women experienced amenorrhea, 44 % of these women resumed menstruation after chemotherapy. CONCLUSIONS The assessment and algorithm were useful in managing patients' reproductive health needs. Chemotherapy-induced endocrine disruption impacted reproductive health.
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Affiliation(s)
- Ashlesha Patel
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk St., Room #435, Chicago, IL, 60612, USA,
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Abstract
Women who have survived cancer may need guidance in choosing a method of contraception. This paper reviews the evidence supporting the safety and efficacy of available methods of contraception for cancer survivors and concludes that the Copper T380A intrauterine device (IUD), a highly effective, reversible, long-acting, hormone-free method should be considered a first-line contraceptive option for women with a history of a hormonally mediated cancer. However, the levonorgestrel-containing IUD may be preferable for women being treated with tamoxifen and women who have survived non-hormonally mediated cancers. Women with IUDs can undergo all forms of imaging, including computed tomography and magnetic resonance imaging.
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