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Wolfson JA, Bhatia S, Bhatia R, Smith MW, Dai C, Campbell SB, Gunn DD, Mahoney AB, Croney CM, Hageman L, Francisco L, Kenzik KM. Using Teamwork to Bridge the Adolescent and Young Adult Gap. JCO Oncol Pract 2023; 19:e150-e160. [PMID: 36215685 DOI: 10.1200/op.22.00300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Individuals diagnosed with cancer age between 15 and 39 years (adolescents and young adults [AYAs]) have not seen improvement in survival compared with children or older adults; clinical trial accrual correlates with survival. Unique unmet needs among AYAs related to psychosocial support and fertility preservation (FP) are associated with health-related quality of life. METHODS We enhanced existing structures and leveraged faculty/staff across pediatric/adult oncology to create novel teams focused on AYA (age 15-39 years) care at a single center, with minimal dedicated staff and no change to revenue streams. We aimed to influence domains shown to drive survival and health-related quality of life: clinical trial enrollment, physician/staff collaboration, psychosocial support, and FP. We captured metrics 3 months after patients presented to the institution and compared them before/after Program implementation using descriptive statistics. RESULTS Among 139 AYAs (age 15-39 years) from the pre-Program era (January 2016-February 2019: adult, n = 79; pediatric, n = 60), and 279 from the post-Program era (February 2019-March 2022: adult, n = 215; pediatric, n = 64), there was no change in clinical trial enrollment(P ≥ .3), whereas there was an increase in the proportion of AYAs referred for supportive care and psychology (pediatric: P ≤ .02; adult: P ≤ .001); whose oncologists discussed FP (pediatric: 15% v 52%, P < .0001; adult: 37% v 50%, P = .0004); and undergoing FP consults (pediatric: 8% v39%, P < .0001; adult 23% v 38%, P = .02). CONCLUSION This team-based framework has effected change in most targeted domains. To affect all domains and design optimal interventions, it is crucial to understand patient-level and facility-level barriers/facilitators to FP and clinical trial enrollment.
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Affiliation(s)
- Julie A Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Bhatia
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Mark W Smith
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Sukhkamal B Campbell
- Division of Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, AL
| | - Deidre D Gunn
- Division of Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, AL
| | - Anne Byrd Mahoney
- Division of Pediatric Hematology-Oncology, Vanderbilt University, Birmingham, AL
| | - Christina M Croney
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
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Chiang JL, Shukla P, Pagidas K, Ahmed NS, Karri S, Gunn DD, Hurd WW, Singh KK. Mitochondria in Ovarian Aging and Reproductive Longevity. Ageing Res Rev 2020; 63:101168. [PMID: 32896666 DOI: 10.1016/j.arr.2020.101168] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/04/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023]
Abstract
Mitochondrial dysfunction is one of the hallmarks of aging. Consistently mitochondrial DNA (mtDNA) copy number and function decline with age in various tissues. There is increasing evidence to support that mitochondrial dysfunction drives ovarian aging. A decreased mtDNA copy number is also reported during ovarian aging. However, the mitochondrial mechanisms contributing to ovarian aging and infertility are not fully understood. Additionally, investigations into mitochondrial therapies to rejuvenate oocyte quality, select viable embryos and improve mitochondrial function may help enhance fertility or extend reproductive longevity in the future. These therapies include the use of mitochondrial replacement techniques, quantification of mtDNA copy number, and various pharmacologic and lifestyle measures. This review aims to describe the key evidence and current knowledge of the role of mitochondria in ovarian aging and identify the emerging potential options for therapy to extend reproductive longevity and improve fertility.
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Affiliation(s)
- Jasmine L Chiang
- Division of Reproductive Endocrinology & Infertility, University of Alabama at Birmingham, 1700 6(th)Avenue South, Birmingham, AL, 35233, United States
| | - Pallavi Shukla
- Department of Genetics, University of Alabama at Birmingham, Kaul Genetics Building Room 630, 720 20(th)Street South, Birmingham, AL, 35294, United States; Department of Molecular Endocrinology, National Institute for Research in Reproductive Health (NIRRH), Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Kelly Pagidas
- Department of Reproductive Medicine, TCM University, 9 Jason Drive, Lincoln, RI, 02865, United States
| | - Noha S Ahmed
- Department of Genetics, University of Alabama at Birmingham, Kaul Genetics Building Room 630, 720 20(th)Street South, Birmingham, AL, 35294, United States; Department of Dermatology, Zagazig University, 44519 Shaibet an Nakareyah, Zagazig 2, Ash Sharqia Governorate, Egypt
| | - Srinivasu Karri
- Department of Genetics, University of Alabama at Birmingham, Kaul Genetics Building Room 630, 720 20(th)Street South, Birmingham, AL, 35294, United States
| | - Deidre D Gunn
- Division of Reproductive Endocrinology & Infertility, University of Alabama at Birmingham, 1700 6(th)Avenue South, Birmingham, AL, 35233, United States
| | - William W Hurd
- Division of Reproductive Endocrinology & Infertility, University of Alabama at Birmingham, 1700 6(th)Avenue South, Birmingham, AL, 35233, United States
| | - Keshav K Singh
- Department of Genetics, University of Alabama at Birmingham, Kaul Genetics Building Room 630, 720 20(th)Street South, Birmingham, AL, 35294, United States; UAB Department of Genetics, Center for Women's Reproductive Health, Kaul Genetics Building University of Alabama at Birmingham, Room 620, 720 20(th)Street South, Birmingham, AL, 35294, United States.
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Gunn DD, Bates GW. Evidence-based approach to unexplained infertility: a systematic review. Fertil Steril 2016; 105:1566-1574.e1. [PMID: 26902860 DOI: 10.1016/j.fertnstert.2016.02.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To summarize the available evidence for the efficacy of various treatments for unexplained infertility. DESIGN Systematic review. SETTING Not applicable. PATIENT(S) Patients aged 18-40 years with unexplained infertility. INTERVENTION(S) Clomiphene citrate, letrozole, timed intercourse, IUI, gonadotropins, IVF, and IVF-intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, ongoing pregnancy rate, and live birth rate. RESULT(S) Thirteen studies with a total of 3,081 patients were identified by systematic search and met inclusion criteria. The available literature demonstrates that expectant management may be comparable to treatment with clomiphene and timed intercourse or IUI. Clomiphene may be more effective than letrozole, and treatment with gonadotropins seems more effective, albeit with significantly higher risk of multiple gestations than either oral agent. On the basis of current data, IVF, with or without intracytoplasmic sperm injection, is no more effective than gonadotropins with IUI for unexplained infertility. CONCLUSION(S) Adequately powered, randomized controlled trials that compare all of the available treatments for unexplained infertility are needed. Until such data are available, clinicians should individualize the management of unexplained infertility with appropriate counseling regarding the empiric nature of current treatment options including IVF.
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Affiliation(s)
- Deidre D Gunn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, Alabama.
| | - G Wright Bates
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, Alabama
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