Assessment of contraception and fertility knowledge among female oncology patients of child bearing age and their providers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18270-e18270
Author(s):  
Samantha Betman ◽  
Jessica M Madrigal ◽  
Kelly Stempinski-Metoyer ◽  
Ruta D. Rao ◽  
Ashlesha Patel
Keyword(s):  
Fertility Preservation ◽  
Cancer Care ◽  
Safety Net ◽  
Cook County ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Oncology Patients ◽  
Female Patients ◽  
Future Fertility ◽  
Oncology Providers

e18270 Background: Understanding the implications for future fertility is a growing concern among young women diagnosed with cancer. Women are less likely than men to receive information regarding fertility preservation and possible infertility following cancer treatment. Our goal was to examine knowledge of contraception and cancer-related changes in fertility among women of childbearing age treated at John H. Stroger, Jr. Hospital of Cook County and to assess whether or not medical providers prioritized having these conversations with female patients. Methods: We interviewed 20 female oncology patients, and 14 completed an additional 12 question true/false question fertility knowledge survey. We administered a survey to providers in the Medical Oncology department to assess how they prioritize talking about contraception and fertility preservation with their female patients of childbearing age. Providers rated ten items using a five-item Likert scale ranging from strongly disagree to strongly agree. Data was summarized as frequencies and percentages. Results: Among the 20 patients interviewed, six (30%) were under age 35 and 14 (70%) had an income of under $30,000. Of these, only 50% had tried a tier 1 long acting reversible contraceptive method and 43% had tried a tier 2 method. Fertility knowledge scores ranged from 0 to 8, out of 12 (Table). The median score was 2 (IQR 3). Among the 17 oncology providers surveyed, only 24% (n = 4) agreed that they were confident educating their patients about fertility preservation, and only 35% (n = 6) prioritized talking to their female patients of reproductive age about different methods of contraception. Conclusions: Health disparities in cancer care are well-known. Low-income women who seek cancer care at a safety-net institution may have limited knowledge on contraception and fertility. A better understanding of how oncology providers can prioritize these topics when talking to patients about their cancer diagnosis is needed. [Table: see text]

Advances in Fertility Preservation for Young Women With Cancer

2018 ◽  
pp. 27-37 ◽  
Author(s):  
Karen Lisa Smith ◽  
Clarisa Gracia ◽  
Anna Sokalska ◽  
Halle Moore
Keyword(s):  
Fertility Preservation ◽  
Young Female ◽  
Current Data ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Ovarian Suppression ◽  
Female Patients ◽  
Ovarian Protection ◽  
Future Fertility ◽  
Reproductive Techniques

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.

Reproductive health importance in oncology care

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20744-e20744
Author(s):  
H. A. Zaren ◽  
A. Patel ◽  
E. K. Radeke ◽  
A. B. Uy
Keyword(s):  
Reproductive Health ◽  
Fertility Preservation ◽  
Health Care Providers ◽  
Cancer Care ◽  
Case Series ◽  
Improve Patient Care ◽  
Information Provision ◽  
Reproductive Age ◽  
Care Providers ◽  
Health Goals

e20744 Background: Based on a case series of patients, we recognized a disparity between patients’ reproductive health goals and conveyed health information by providers on reproductive health issues. The objective of this study was to assess the reproductive health interest amongst cancer care providers. Methods: This observational study was performed using a 13 item questionnaire that was administered to 15 healthcare professionals in oncology and allied health fields. The items in the questionnaire related to information regarding the importance of cancer care, sexuality, fertility preservation and contraception. Results: Of the providers surveyed, 11 were medical doctors, 3 were nurses, and 1 was indicated as other. On a scale of 0 to 10, 86.6% (n=13) rated cancer care as extremely important (10), 33% (n=5) felt the same for fertility preservation, and 46.6% (n=7) for sexuality. In a rank of importance, cancer care was first, followed by sexuality, fertility, and contraception. Only 33% (n=5) of providers always asked patients about interest in fertility preservation and with regards to contraception, only 33% (n=5) offer contraception to reproductive age patients. Conclusions: Although most providers felt that sexuality and fertility are important to women diagnosed with cancer, their practice and information provision does not reflect these findings. This highlights the significance of bringing closer together the goals of the health care providers with their actual practice to improve patient care. No significant financial relationships to disclose.

scholarly journals The Knowledge, Attitude, and Self-Reported Behaviors of Oncology Physicians Regarding Fertility Preservation in Adult Cancer Patients

2019 ◽  
Vol 35 (6) ◽  
pp. 1119-1127 ◽  
Author(s):  
Hanfeng Zhang ◽  
Guorong Wang ◽  
Bin Jiang ◽  
Maoqiu Cao ◽  
Qinghua Jiang ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Training Program ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Age Groups ◽  
Knowledge Score ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract There is a growing concern about the fertility preservation for adult cancer patients of reproductive age. Very little literature exists about fertility preservation of cancer survivors in Chinese text. This study is first to describe the knowledge level, attitude, and practice behaviors among physicians concerning fertility preservation in adult cancer patients in China. A cross-sectional survey with 30-item was conducted to assess Chinese oncology physicians’ knowledge, attitude, and behaviors regarding fertility issues. Of 360 oncology physicians, 206 (57.2%) submitted valid questionnaires. With possible overall scores for knowledge and attitude of 9 and 15, respectively, physicians’ responses to the questionnaires were 3.91 ± 1.67 and 12.29 ± 1.23. Only 49.5% of physicians routinely informed their cancer patients of childbearing age about the risk of infertility with cancer treatment. The knowledge score of the men physicians was 2-fold that of the women. Physicians aged 20–29 years were significantly more likely than other age groups to prioritize cancer treatment over fertility concerns. Men physicians were significantly more comfortable than the women discussing fertility preservation issues and cooperating with fertility specialists. The oncology physicians in China had limited knowledge of fertility preservation and rarely discussed these issues with their patients, although their attitude was positive. Results suggest that oncology physicians would welcome an in-house fertility-related training program. Key Messages This is the first study to address the topic of fertility preservation as it relates to the care that oncologists provide to cancer patients in China. These results revealed the importance of providing fertility-related training program to oncology physicians. Moreover, this study should provide useful information for other Asian countries, and highlight both the similarities and differences between China and Western countries concerning the reproductive rights of patients. This study should encourage international cooperation with institutions of scientific research and education.

scholarly journals Female Fertility Preservation through Stem Cell-based Ovarian Tissue Reconstitution In Vitro and Ovarian Regeneration In Vivo

2019 ◽  
Vol 13 ◽  
pp. 117955811984800 ◽  
Author(s):  
Taichi Akahori ◽  
Dori C Woods ◽  
Jonathan L Tilly
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Mammalian Species ◽  
Reproductive Age ◽  
Embryo Cryopreservation ◽  
Novel Approach ◽  
Future Fertility ◽  
Female Fertility Preservation

Historically, approaches designed to offer women diagnosed with cancer the prospects of having a genetically matched child after completion of their cytotoxic treatments focused on the existing oocyte population as the sole resource available for clinical management of infertility. In this regard, elective oocyte and embryo cryopreservation, as well as autologous ovarian cortical tissue grafting posttreatment, have gained widespread support as options for young girls and reproductive-age women who are faced with cancer to consider. In addition, the use of ovarian protective therapies, including gonadotropin-releasing hormone agonists and sphingosine-1-phosphate analogs, has been put forth as an alternative way to preserve fertility by shielding existing oocytes in the ovaries in vivo from the side-effect damage caused by radiotherapy and many chemotherapeutic regimens. This viewpoint changed with the publication of now numerous reports that adult ovaries of many mammalian species, including humans, contain a rare population of oocyte-producing germ cells—referred to as female germline or oogonial stem cells (OSCs). This new line of study has fueled research into the prospects of generating new oocytes, rather than working with existing oocytes, as a novel approach to sustain or restore fertility in female cancer survivors. Here, we overview the history of work from laboratories around the world focused on improving our understanding of the biology of OSCs and how these cells may be used to reconstitute “artificial” ovarian tissue in vitro or to regenerate damaged ovarian tissue in vivo as future fertility-preservation options.

scholarly journals Fertility preservation in reproductive-age women facing gonadotoxic treatments

2015 ◽  
Vol 22 (4) ◽  
pp. 294 ◽  
Author(s):  
J. Roberts ◽  
R. Ronn ◽  
N. Tallon ◽  
H. Holzer
Keyword(s):  
Fertility Preservation ◽  
Multidisciplinary Approach ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Future Fertility ◽  
Fertility Sparing ◽  
Cure Rates ◽  
Reproductive Consequences

BackgroundAdvancements in the treatments for cancer and autoimmune and other hematologic conditionscontinue to improve survival and cure rates. Despite those changes, various gonadotoxic agents and other treatments can still compromise the future fertility of many women. Progress in medical and surgical reproductive technologies has helped to offset the reproductive consequences of the use of gonadotoxic therapies, and allows for future fertility and normal pregnancy.Methods A review of the literature was performed to outline the pathophysiology of gonadotoxicity from various treatments. The success of fertility preservation, fertility sparing, and cryopreservation options are reviewed. Barriers and facilitators to referral and oncofertility treatment in Canada are also outlined.ResultsAccording to the quality of the evidence, recommendations are made for fertility assessment, patient referral, cryopreservation, and other assisted reproductive technologies.ConclusionsTo ensure ongoing fertility in women undergoing gonadotoxic treatments, assisted reproductive technologies can be combined with a multidisciplinary approach to patient assessment and referral. 

scholarly journals The Perspectives of Fertility Preservation in Women with Endometrial Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 602
Author(s):  
Jure Knez ◽  
Leyla Al Mahdawi ◽  
Iztok Takač ◽  
Monika Sobočan
Keyword(s):  
Endometrial Cancer ◽  
Fertility Preservation ◽  
Gynecological Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Developed Countries ◽  
Reproductive Age ◽  
Younger Women ◽  
Future Fertility ◽  
Fertility Sparing

Endometrial cancer is the most common gynecological cancer in developed countries. The disease is diagnosed with increasing frequency in younger women, commonly also in their reproductive age. The standard treatment of endometrial cancer is surgical in the form of hysterectomy and bilateral salpingo-oophorectomy, and this precludes future fertility in younger women. The current challenge is to identify the group of women with endometrial cancer and low-risk features that would benefit from more conservative treatment options. More focus in management needs to be aimed towards the preservation of quality of life, without jeopardizing oncological outcomes. In this review, we analyze the current approaches to identification of women for conservative management and evaluate the success of different medical options for treatment and surgical techniques that are fertility sparing. We also elaborate on the future perspectives, focusing on the incorporation of molecular characterization of endometrial cancer to fertility preservation algorithms. Future studies should focus specifically on identifying reliable clinical and molecular predictive markers in this group of young women. With improved knowledge and better risk assessment, the precision medicine is the path towards improved understanding of the disease and possibly widening the group of women that could benefit from treatment methods preserving their fertility.

scholarly journals Physiological uterine uptake of 68Ga-FAPI-04 may limit its application in uterine pathology

2021 ◽  
Author(s):  
Xiao Zhang ◽  
Wenyu Song ◽  
Chunxia Qin ◽  
Yangmeihui Song ◽  
Fang Liu ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Whole Body ◽  
Imaging Features ◽  
Childbearing Age ◽  
Female Patients ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Uterine Volume

Abstract Purpose68Ga-labeled fibroblast activation protein inhibitor (68Ga-FAPI) has been useful in the imaging of desmoplastic reaction in different tumors, as well as fibrosis in inflammatory diseases. As we have found that most female patients showed avid uterine uptake of 68Ga-FAPI, we sought to further investigate the physiological uptake of 68Ga-FAPI by the uterus and analyze its characteristics in women of childbearing age, in perimenopause, and postmenopause.MethodsWe retrospectively reviewed the image data of female patients who had undergone whole-body 68Ga-FAPI-04 PET/MRI at our institute between May 22 and December 16, 2020. The clinical information of the patients, including age, stage of menstrual cycle if present, and gynecologic history, was collected. Uterine volume was calculated from MR images. The characteristics of 68Ga-FAPI-04 uterine uptake were recorded. If the patients also had undergone 18F-FDG PET/CT imaging, those image features were also recorded. The relationship of age, uterine size, surgical history, presence of leiomyomas, and 18F-FDG uptake to 68Ga-FAPI-04 uptake were further analyzed.ResultsForty-three female patients were included in this study. The number of cases with uterine malignancy and non-malignancy were two and 41, respectively. Twenty-seven patients in the benign disease group underwent simultaneous 18F-FDG PET/CT scans. Of 41 patients with benign uterine pathology, 13 patients were of reproductive age, six were perimenopausal, and 22 were postmenopausal. A total of 25 patients had undergone invasive operations, and six patients had uterine fibroids under examination. Lower 68Ga-FAPI-04 uptake (6.58 ± 3.39, n = 22) was noted in postmenopausal women than in reproductive and perimenopausal females (13.32 ± 3.2 and 12.98 ± 3.01, respectively, P < 0.05). The invasive operation or accompany with uterine fibroids may increase 68Ga-FAPI-04 uptake. 68Ga-FAPI-04 uptake was also associated with uterine volume (P < 0.01). There was no correlation between 18F-FDG and 68Ga-FAPI-04 accumulation in the uterus. Two patients with malignant lesions involving the uterus showed completely different imaging features on 68Ga-FAPI-04.ConclusionPhysiological uterine uptake of 68Ga-FAPI-04 limits its diagnostic value in gynecologic diseases. Age, uterine fibroids and uterine volume may influence the uptake of 68Ga-FAPI-04 in uterus. More patients with various uterine diseases could be involved to provide more differential diagnostic information.Clinical Trial RegistrationNCT04605939 and NCT04554719.

scholarly journals An Educational Need Regarding Treatment-Related Infertility and Fertility Preservation: a National Survey Among Members of the Dutch Society for Medical Oncologists

2021 ◽  
Author(s):  
E. M. Krouwel ◽  
E. M. L. Birkhoff ◽  
M. P. J. Nicolai ◽  
S. Osanto ◽  
H. Putter ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Fertility Preservation ◽  
Nationwide Survey ◽  
Information Provision ◽  
Reproductive Age ◽  
Care Providers ◽  
Dutch Society ◽  
Childbearing Age ◽  
Education Practice ◽  
Medical Oncologists

Abstract Cancer diagnosis and treatment may influence reproductive planning and impact fertility in patients of reproductive age. Although guidelines have been established in the past decade, education, practice, and attitudes of medical oncologists regarding fertility preservation remain undecided. A nationwide survey was performed among members of the Dutch Society for Medical Oncology. Demographics, practice, knowledge, and barriers were measured regarding information provision of fertility preservation towards cancer patients of childbearing age. From 392 members, 120 oncologists completed the questionnaire (30.6%). Majority of oncologists was convinced it is their responsibility to discuss impact of cancer treatment to fertility (93.2%), yet 68.3% discussed the subject often or always (n = 82). Oncologists employed in district general hospitals were less likely to discuss fertility (p = 0.033). On average, 44.6% of reproductive men and 28.9% of reproductive women is referred to fertility specialists. Half of the respondents declared to possess sufficient knowledge regarding fertility preservation (n = 57, 47.5%). Poor prognosis (53%), unlikely survival (43.1%), and high chances on fertility recovery (28.7%) were identified as barriers to discussing fertility preservation. Among oncologists, impact of cancer treatment on fertility is a well-accepted responsibility to counsel. Despite, self-reported knowledge regarding fertility preservation is strongly varying. In practice, fertility is discussed to some extent, influenced by several barriers and depending on prognosis and type of hospital. Patients benefit from knowledge improvement among oncology care providers concerning fertility effects of cancer treatment. Education during medical school, residency, and among practicing oncologists may raise awareness, together with enhancement of referral possibilities.

scholarly journals Decisional Regret in Female Oncofertility Decision Making—An Integrative Narrative Review

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4735
Author(s):  
Vânia Gonçalves
Keyword(s):  
Fertility Preservation ◽  
Young Women ◽  
Decisional Conflict ◽  
Narrative Review ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Fertility Decisions ◽  
Pubmed Database ◽  
Fertility Counseling ◽  
Decisional Regret

It is well established that fertility is an important issue for young women with cancer at reproductive age, as many have not initiated or completed their parenthood goals when diagnosed. Because cancer treatments may impair fertility, women face fertility decisions that are often complex and surrounded by uncertainty. This may put patients at risk for psychological distress and the experience of regret regarding decisions made at diagnosis, which may be associated with a negative impact on women’s QoL. This narrative review addresses current knowledge about decisional regret regarding fertility preservation decisions in adult female cancer patients at reproductive age. Electronic searches were conducted on Pubmed database for articles published in English from 1 January 2000 to 1 July 2021 that assessed decisional regret following fertility decisions in young women diagnosed at childbearing age. Of the 96 articles identified, nine provided information on decisional regret regarding fertility decisions. Studies reported that, overall, decisional regret regarding oncofertility decisions was low. Factors associated with the experience of decisional regret were patients’ perceived quality and satisfaction with fertility counseling received, the decision to undergo fertility preservation, desire for children and decisional conflict. Health providers should be aware of the factors that are potentially modifiable and prone to improvement in order to reduce decisional regret. All efforts should be made to improve availability of and access to tailored high quality fertility counseling and fertility preservation. Given the growing evidence that decision aids (DAs) are effective in increasing knowledge and reducing decisional conflict and regret, their use in a routine and timely manner to complement fertility counseling is recommended.

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