Oncofertility

2021 ◽  
pp. 136-150
Author(s):  
Bruno Ramalho de Carvalho ◽  
Jhenifer Kliemchen Rodrigues ◽  
Teresa K. Woodruff
Keyword(s):  
Ethical Issues ◽  
Survival Rates ◽  
Ethical Considerations ◽  
Death Rates ◽  
Functional Failure ◽  
Personal Level ◽  
After Cancer ◽  
Reproductive Consequences

Advances in cancer treatment, particularly chemotherapeutics, are expected to lead to significant improvements in survival rates. While cancer incidence and death rates are decreasing, quality of life after cancer may be reduced due to early functional failure of the gonads and, consequently, infertility, resulting from either the disease itself or its treatment. This chapter introduces clinicians to the new field of oncofertility and the ethical issues it raises. It will consider the situation of young cancer patients facing reproductive consequences globally, the retrieval of gametes or gonadal tissue from minors, and the use of these tissues long term. The field of oncofertility is new, but ethical considerations regarding reproductive interventions are old. Understanding how we approach these issues on a personal level and from the public’s perspective will be assessed in this chapter.

scholarly journals What lies behind chemotherapy-induced ovarian toxicity?

Reproduction ◽  
2012 ◽  
Vol 144 (2) ◽  
pp. 153-163 ◽  
Author(s):  
Irit Ben-Aharon ◽  
Ruth Shalgi
Keyword(s):  
Adverse Effects ◽  
Supportive Care ◽  
Clinical Evidence ◽  
Survival Rates ◽  
Ovarian Toxicity ◽  
Chemotherapy Protocol ◽  
After Cancer ◽  
The Impact

Seminal advances in anticancer therapy as well as supportive care strategies have led to improved survival rates, posing an emphasis on preserving an optimum quality of life after cancer treatment. This recognition has paved the way to an increasing research of long-term side effects, both clinical and preclinical and to an ongoing design of a supportive care system to evaluate and treat long-term adverse effects of anticancer treatments, including the impact on fertility. As with many adverse effects induced by anticancer treatments, the literature comprised mostly clinical data with regard to chemotherapy-induced gonadotoxicity, while understanding of the biological mechanism is lagging. The impact of anticancer treatments on female fertility depends on the women's age at the time of treatment, the chemotherapy protocol, the duration, and total cumulative dose administered. Several suggested mechanisms that underlie chemotherapy-induced gonadotoxicity have been described. This review illustrates the clinical evidence, as well as its supportive preclinical studies, while proceeding from the ‘bedside to the bench work’ and provides an insight to what lies behind chemotherapy-induced gonadotoxicity.

scholarly journals Advances in the management of craniopharyngioma in children and adults

2019 ◽  
Vol 53 (4) ◽  
pp. 388-396 ◽  
Author(s):  
Mojca Jensterle ◽  
Soncka Jazbinsek ◽  
Roman Bosnjak ◽  
Mara Popovic ◽  
Lorna Zadravec Zaletel ◽  
...  
Keyword(s):  
Survival Rates ◽  
Tumor Location ◽  
Subtotal Resection ◽  
Metabolic Complications ◽  
Optimal Outcomes ◽  
Parasellar Region ◽  
Long Term Follow Up ◽  
Considerable Controversy

Abstract Background Childhood and adult-onset craniopharyngioma is a rare embryogenic tumor of the sellar, suprasellar, and parasellar region. Survival rates are high; however, tumor location and treatment sequalae including endocrine deficits, visual impairment, metabolic complications, cognitive and psychosocial deficits can significantly impair patient’s quality of life. There is considerable controversy regarding the optimal management of craniopharyngiomas. Subtotal resection of the tumor followed by targeted irradiation to avoid further hypothalamic damage is currently indicated. Novel insights in the tumor’s molecular pathology present the possibility for targeted therapy possibly decreasing the rate and severity of treatment-associated morbidity. Conclusions Craniopharyngioma should be seen as a chronic disease. To achieve optimal outcomes a multidisciplinary team of specialized neurosurgeons, neuro-radiologists, neuro-oncologists, pathologists and endocrinologists should be involved in the diagnosis, planning of the surgery, irradiation and long-term follow-up.

scholarly journals Late Effects and Survivorship Issues in Patients with Neuroblastoma

Children ◽  
2018 ◽  
Vol 5 (8) ◽  
pp. 107 ◽  
Author(s):  
Danielle Friedman ◽  
Tara Henderson
Keyword(s):  
Late Effects ◽  
Survival Rates ◽  
Premature Mortality ◽  
The Past ◽  
Excess Morbidity ◽  
Related Risk ◽  
Impaired Quality ◽  
Made In

Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a wide variety of potential treatment-related complications, or “late effects”, which may lead to excess morbidity and premature mortality in this cohort. This review summarizes the existing survivorship literature on long-term health outcomes for survivors of neuroblastoma, focusing specifically on potential injury to the endocrine, sensory, cardiovascular, pulmonary, and renal systems, as well as survivors’ treatment-related risk for subsequent neoplasms and impaired quality of life. Additional work is needed to assess the potential late effects of newer multimodality therapies with the aim of optimizing long-term medical and psychosocial outcomes for all survivors of neuroblastoma.

Gamete quality in fish: evaluation parameters and determining factors

Zygote ◽  
2013 ◽  
Vol 23 (2) ◽  
pp. 177-197 ◽  
Author(s):  
Iván I. Valdebenito ◽  
Patricia C. Gallegos ◽  
Brian R. Effer
Keyword(s):  
Water Quality ◽  
Survival Rates ◽  
Physical Factors ◽  
Male And Female ◽  
Feeding Management ◽  
Determining Factors ◽  
Water Conditions ◽  
Evaluation Parameters

SummaryThe quality of fish gametes, both male and female, are determined by several factors (age, management, feeding, chemical and physical factors, water quality, etc.) that have an impact on the survivability of embryos, larvae and/or fry in the short or long term. One of the most important factors is gamete ageing, especially for those species that are unable to spawn naturally in hatcheries. The chemical and physical factors in hatcheries and the nutrition that they provide can significantly alter harvest quality, especially from females; as a rule, males are more tolerant of stress conditions produced by inadequate feeding, management and/or poor water conditions. The stress produced on broodstock by inadequate conditions in hatcheries can produce adverse effects on gamete quality, survival rates, and the embryonic eggs after hatching.

A literature review of the role of brachytherapy in the management of early-stage breast cancer

2019 ◽  
Vol 19 (3) ◽  
pp. 281-290
Author(s):  
Rebecca Thorpe ◽  
Heather Drury-Smith
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Local Recurrence ◽  
Literature Review ◽  
Survival Rates ◽  
External Beam Radiation ◽  
Recurrence Rates ◽  
Overall Survival Rates

AbstractBackground:This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.Methods:The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.Results:Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.Conclusion:In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.

Ethical Considerations in the Conduct of Electronic Surveillance Research

2006 ◽  
Vol 34 (3) ◽  
pp. 611-619 ◽  
Author(s):  
Ashok J. Bharucha ◽  
Alex John London ◽  
David Barnard ◽  
Howard Wactlar ◽  
Mary Amanda Dew ◽  
...  
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
The United States ◽  
Assisted Living Facilities ◽  
Ethical Considerations ◽  
Term Care ◽  
Baby Boomer Generation ◽  
Demographic Shifts

Nearly 2.5 million Americans currently reside in nursing homes and assisted living facilities in the United States, accounting for approximately five percent of persons sixty-five and older. The aging of the “Baby Boomer” generation is expected to lead to an exponential growth in the need for some form of long-term care (LTC) for this segment of the population within the next twenty-five years. In light of these sobering demographic shifts, there is an urgency to address the profound concerns that exist about the quality-of-care (QoC) and quality-of-life (QoL) of this frailest segment of our population.

Pediatric Cancer Survivorship: Research and Clinical Care

2006 ◽  
Vol 24 (32) ◽  
pp. 5160-5165 ◽  
Author(s):  
Anna T. Meadows
Keyword(s):  
Pediatric Cancer ◽  
Late Effects ◽  
Clinical Care ◽  
Survival Rates ◽  
The United States ◽  
Term Survival ◽  
Pediatric Cancer Survivors ◽  
Effects Of Aging

Regardless of how one defines survivorship, more than 10 million individuals in the United States have been treated for a malignant disease; about 250,000 were younger than 21 years of age at diagnosis. Thirty years ago, pediatric oncologists recognized that children with cancer might be cured by adding chemotherapy to surgery and radiation. Studies were then begun of complications that could reduce survival or the quality of survival, and that might be associated with previous therapy. The complications were termed late effects, and studies focused on patients who were likely to be cured, or less likely to succumb to the original cancer than they were to experience disabilities. Clinical trials tested whether changes in therapy to reduce complications could maintain the same excellent survival rates. During the last 20 years, articles detailing late effects and the relationship between therapy and outcome have been published. This article reviews the progress made in understanding the outcomes reported and the efforts made to improve the quality of long-term survival for children and adolescents. Several questions remain regarding the long-term complications of therapy. Clinicians need more data regarding the effects of aging to guide them in managing former patients. Caregivers and pediatric cancer survivors who are now adults seek the optimal venue in which to receive care as independent adults. In addition, medical oncologists need to determine whether the models for research and clinical care of survivors created in pediatric oncology can be applied to survivors of adult-onset cancer.

Facial transplantation: historical developments and future directions

2015 ◽  
Vol 129 (3) ◽  
pp. 206-211 ◽  
Author(s):  
G L Garrett ◽  
I Beegun ◽  
A D'souza
Keyword(s):  
Functional Outcomes ◽  
Ethical Issues ◽  
Infectious Complications ◽  
Future Directions ◽  
Facial Transplantation ◽  
The Social ◽  
Bibliographic Search ◽  
Historical Developments

AbstractObjective:To present the clinical outcomes obtained by the first facial transplant teams worldwide, reviewing current practice and addressing controversies.Methods:A bibliographic search of Medline and Embase databases was performed, and a comparative analysis of all articles published from 1980 to the present was conducted. Two independent investigators screened the manuscripts in accordance with pre-defined criteria.Results:A total of 12 partial and 5 full facial transplants were recorded in the literature. Procedures included partial and near-total facial myocutaneous flaps, and complex osteomyocutaneous grafts. Fifteen patients had fully vascularised grafts, and two patients died of transplant-related and infectious complications.Conclusion:Facial transplantation can restore quality of life and enable the social re-integration of recipients. Results published by the first facial transplant teams are promising. However, long-term reports of aesthetic and functional outcomes are needed to more precisely define outcomes. In addition, significant technical, medical and ethical issues remain to be solved.

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