scholarly journals Young Men With Cancer Experience Low Referral Rates for Fertility Counseling and Sperm Banking

2016 ◽  
Vol 12 (5) ◽  
pp. 465-471 ◽  
Author(s):  
Natalie S. Grover ◽  
Allison M. Deal ◽  
William A. Wood ◽  
Jennifer E. Mersereau

Purpose: With improved cancer survival rates and the current trend of delaying parenthood, fertility is a growing issue among cancer patients. The purpose of this study was to evaluate the incidence of fertility counseling and sperm banking in reproductive-age male cancer patients and to assess factors that influence counseling and banking. Materials and Methods: Male patients ages 13 to 50 years who received a new cancer diagnosis from January 1, 2013, to May 1, 2015, and planned to initiate curative chemotherapy at our center were identified. Documentation of fertility counseling and sperm cryopreservation was abstracted from the medical record. Univariable and multivariable logistic regression modeling was used to examine variables associated with fertility counseling and sperm banking. Results: Of 201 patients who fit the study criteria, 59 (29%) received fertility counseling and 23 (11%) attempted sperm banking. All patients who banked sperm had documentation of fertility counseling. Younger patients were significantly more likely to be counseled, with mean ages of 27.4 and 40.4 years for counseled and noncounseled patients, respectively (P < .001). Among counseled patients, those with a lower median income (P = .038) or who had Medicaid or no insurance (P = .042) were less likely to bank sperm. In a multivariable logistic regression model, older age (5-year odds ratio, 0.61; P < .001) and presence of comorbidities (odds ratio, 0.15; P = .03) remained significantly associated with a lower counseling rate. Conclusion: There is a low rate of fertility counseling and referral for sperm banking in young men with cancer receiving chemotherapy. Further work is needed to develop interventions to improve fertility counseling rates and opportunities for sperm banking.

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4488-4488
Author(s):  
Natalie S. Grover ◽  
Allison M. Deal ◽  
Jennifer E. Mersereau ◽  
William A. Wood

Abstract Background: Due to improved cancer survival rates as well as the current trend of delaying childbirth, fertility has become a growing issue among cancer patients. The American Society of Clinical Oncology recommends that oncologists discuss fertility preservation with all patients of reproductive age who are about to initiate treatment that may cause infertility. The purpose of this study was to evaluate the incidence of fertility counseling and sperm banking referral in male cancer patients of reproductive age at our center and to assess whether counseling is influenced by demographics or disease specific factors. Methods: We used the University of North Carolina (UNC) Cancer Registry to identify male patients between the ages of 13-50 who received a new diagnosis of cancer between 1/1/2013 and 1/1/2015 and planned to initiate chemotherapy with curative intent. We excluded patients who initiated chemotherapy outside of UNC. We queried the electronic medical record (EMR) for demographic information such as age, race, insurance status, number of children, marital status, sexual orientation and disease-related variables such as type of cancer, type of treatments, and comorbidities. We reviewed the EMR for documentation of fertility counseling and identified patients who banked sperm at UNC since 1/1/2013. Fisher's Exact and Wilcoxon Rank Sum tests were used to compare characteristics between groups. Additionally, multivariable logistic regression modeling was used to evaluate associations after controlling for age. Results: There were initially 594 male patients identified with new cancer diagnoses, of whom 160 received chemotherapy with curative intent. Of this final cohort of 160 patients, 76 had hematologic malignancies (33 with lymphoma, 30 with acute leukemia, and 13 with other hematologic malignancies). The median age was 42 (40 for hematologic malignancies). 41% of patients had children and 46% were married. Based on chart documentation, 28% of patients were counseled regarding fertility and 13% of patients attempted to bank sperm (46% of those receiving fertility counseling). Rates of counseling and sperm banking were similar for hematologic malignancy patients. Younger patients were significantly more likely to be counseled (p <0.001). Among patients with hematologic malignancies, 51% of patients under 30 years were counseled while 18% of patients ≥ 30 years were counseled (p=0.001). Across all cancer types, insurance type was not associated with fertility counseling (p=0.38) but was associated with attempted sperm banking (p=0.03). Having children, being married, and having a comorbidity were associated with a lower rate of counseling in univariate analysis, but not in multivariate analysis after controlling for age. Conclusions: We found a significant unmet opportunity for fertility counseling and referral for sperm banking in young male cancer patients receiving chemotherapy with curative intent at our center. Low rates of counseling and sperm banking were particularly notable in patients over the age of 30. In addition to barriers in clinical practice, the association between insurance status and sperm banking also suggests a financial barrier to sperm cryopreservation. Further work is needed to develop interventions to improve rates of fertility counseling and opportunities for sperm banking in young male cancer patients. Disclosures Wood: Inform Genomics: Consultancy; Best Doctors: Consultancy.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Senri Yamamoto ◽  
Hirotoshi Iihara ◽  
Ryuji Uozumi ◽  
Hitoshi Kawazoe ◽  
Kazuki Tanaka ◽  
...  

Abstract Background The efficacy of olanzapine as an antiemetic agent in cancer chemotherapy has been demonstrated. However, few high-quality reports are available on the evaluation of olanzapine’s efficacy and safety at a low dose of 5 mg among patients treated with carboplatin regimens. Therefore, in this study, we investigated the efficacy and safety of 5 mg olanzapine for managing nausea and vomiting in cancer patients receiving carboplatin regimens and identified patient-related risk factors for carboplatin regimen-induced nausea and vomiting treated with 5 mg olanzapine. Methods Data were pooled for 140 patients from three multicenter, prospective, single-arm, open-label phase II studies evaluating the efficacy and safety of olanzapine for managing nausea and vomiting induced by carboplatin-based chemotherapy. Multivariable logistic regression analyses were performed to determine the patient-related risk factors. Results Regarding the endpoints of carboplatin regimen-induced nausea and vomiting control, the complete response, complete control, and total control rates during the overall study period were 87.9, 86.4, and 72.9%, respectively. No treatment-related adverse events of grade 3 or higher were observed. The multivariable logistic regression models revealed that only younger age was significantly associated with an increased risk of non-total control. Surprisingly, there was no significant difference in CINV control between the patients treated with or without neurokinin-1 receptor antagonist. Conclusions The findings suggest that antiemetic regimens containing low-dose (5 mg) olanzapine could be effective and safe for patients receiving carboplatin-based chemotherapy.


2020 ◽  
Author(s):  
François Niragire ◽  
Celestin Ndikumana ◽  
Marie Gaudence Nyirahabimana ◽  
Dieudonne Uwizeye

Abstract Background: The knowledge of the key determinants of fertility desire among people living with HIV/AIDS is crucial for the design of efficient maternal and child health care programs. However, such determinants are not well understood in the context of a successful scale-up of antiretroviral therapy in Rwanda. The present study aim was to assess fertility desire among HIV- positive women and its determinants in Rwanda.Methods: Data were extracted from the 2015 Rwanda demographic health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable based variable selection as well as multivariable logistic regression analysis were conducted. Results: The prevalence of desire to have another child in HIV-positive women was as high as 40.7%. Multivariable logistic regression analyses showed that the woman’s age, number of her living children, woman’s employment status, and having a co-wife are significant determinants of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, who were unemployed or who had at least a co-wife were associated with greater odds of desire to have another child in the future than other HIV- positive women.. Conclusion: There is a need to devise integrated programs and services that are tailored to support HIV-positive women in planning their fertility, and controlling HIV transmission to their prospective children. Efficient policy and fertility interventions among WLHA in Rwanda should target young women, especially those living with partners and have fewer children than they prefer.


2020 ◽  
Vol 21 (2) ◽  
pp. 1-9
Author(s):  
Bakari L Leguma ◽  
Rajabu Rocky Akarro ◽  
Amina Suleiman Msengwa ◽  
Francis Joseph Sichona

Background: In Tanzania, like in many other poor African countries, cervical cancer is a major problem facing women especially for those aged 30 years and above. This study aimed at constructing a statistical model to enable the prediction of the outcome of treatment for cervical cancer patients in Tanzania. Methods: Data were collected retrospectively from patient’s files with histological proven cervical cancer who were treated at Ocean Road Cancer Institute (ORCI) from year 2009 and followed up to year 2011. The factors considered are screening status, HIV status, disease stage, age, treatment type and the intent of the treatment. The study employed the Chi-square (χ2) test and the logistic regression model for its analysis. Results:  The Chi-square (χ2) test result showed that there was a significant relationship between outcome of treatment and the patient screening status, HIV status, disease stage and intent of treatment at 5% level of significance. On the other hand, the logistic regression results found patient disease stage and intent of the treatment to be statistically significant at 95 percent. Logistic regression results also showed that patients who attended ORCI when their disease at a late stage had an odds ratio of 0.128 less likely to have favorable outcomes compared to those patients who attended ORCI when their disease stage was at early stages. The odds ratio for cervical cancer patients who received both treatment, radiotherapy, and chemotherapy was 2.643 more likely to have favorable outcomes Conclusion:  More emphasis and campaigns should be made in order to encourage women all over the country to attend cancer centers for screening and treatment at early stages or even before any symptoms for cervical cancer and other types of cancers.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jun Muratsu ◽  
Masahiko Hara ◽  
Atsuyuki Morishima ◽  
Katsuhiko Sakaguchi ◽  
Takashi Fujimoto

Abstract Background and Aims Unhealthy life-behaviors such as dietary habits, lack of exercise, drinking large amount of alcohol and smoking cause obesity, hypertension, diabetes, dyslipidemia, cardiovascular disease (CVD). These are also closely associated with chronic kidney disease (CKD). CKD is characterized by proteinuria and low glomerular filtration rate (GFR). Independent of GFR, proteinuria is an important predictor of ESKD. Few studies have assessed which is the most clinical impact among the unhealthy life-behaviors: skipping breakfast, snacking, late-night dinner, smoking, heavy alcohol intake and lack of exercise habits for proteinuria in normal renal function patients. Method This cross-sectional study included 29,780 normal renal function patients: eGFR≥60 mL/min/1.73 m2 and no history of kidney diseases who underwent health checkup at the Physical Checkup Center of Sumitomo Hospital. The endpoint of this investigation is defined as dipstick proteinuria of≥ 1+. To assess the association of life-behaviors and the presence of proteinuria, their odds ratios were calculated in adjusted univariable and multivariable logistic regression model. Multivariable logistic regression model was performed by not selected items, the same with univariable model. We would like to investigate the most impact unhealthy life-behavior for the proteinuria. Results Among 29,780 total study subjects (male: 60.3%; mean age: 49±11 years), 1,118 (3.75%) subjects were shown as urinary protein above 1+. The presence of unhealthy dietary life-behaviors: skipping breakfast, snacking and late-night dinner was 5,293 (17.3%), 3,899 (13.1%) and 11,231 (37.7%), respectively. About sleeping duration, the population of &lt;6 hours, 6-8 hours and &gt;8 hours were 12,027 (40.4%), 17,236 (57.9%) and 517 (1.7%). The population of exercise habits: over 3 days/weeks, 1-2 days/weeks and none were 5,138 (17.3%), 9,375 (31.5%) and 15,237 (51.3%), suggesting half of them did not have exercise habits. About smoking habits, the population of current smoking, past smoking and never smoking were shown 6,445 (21.6%), 8,459 (28.4%) and 14,876 (50.0%). In addition, about alcohol amount per day, the population of over 60g, 40-60g, 20-40g and 0-20g were 1,840 (6.18%), 4,504 (15.1%), 6,727 (22.6%) and 16,709 (56.1%). To investigate the impact of life-behavior for proteinuria, we obtained odds ratio of adjusted multivariable logistic regression model. In multivariable regression, among the life-behavior: skipping breakfast, current smoking, alcohol amount (ethanol over 60 g/day), none of exercise habits and snacking were strongly associated with the prevalence of proteinuria (skipping breakfast, adjusted odds ratio 1.45 [1.26, 1.68]; current smoking, 1.35 [1.14, 1.59]; alcohol amount (ethanol over 60 g/day), 1.35 [1.08, 1.69]; none of exercise habits, 1.29 [1.07, 1.57]; snacking, 1.23 [1.04, 1.46]). In addition, among the history of medical history, diabetes mellitus, hypertension and dyslipidemia were significantly associated with the prevalence of proteinuria (diabetes mellitus, adjusted odds ratio 2.39 [1.93, 2.96]; hypertension, 1.83 [1.53, 2.17]; 1.22 [1.03, 1.45]). Conclusion Among the unhealthy life-behaviors, skipping breakfast is the most impact factor for the presence of proteinuria.


Neurosurgery ◽  
2007 ◽  
Vol 61 (4) ◽  
pp. 716-723 ◽  
Author(s):  
Brian L. Hoh ◽  
Christopher L. Sistrom ◽  
Christopher S. Firment ◽  
Gregory L. Fautheree ◽  
Gregory J. Velat ◽  
...  

Abstract OBJECTIVE Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult because of the need to control for confounding variables. We studied factors associated with rupture in a study model of patients with multiple cerebral aneurysms, one aneurysm that had ruptured and one or more that had not, in which each patient served as their own internal control. METHODS We collected aneurysm location, one-dimensional measurements, and two-dimensional indices from the computed tomographic angiograms of patients in the proposed study model and compared ruptured versus unruptured aneurysms. Bivariate statistics were supplemented with multivariable logistic regression analysis to model ruptured status. A total of 40 candidate models were evaluated for predictive power and fit with Wald scoring, Cox and Snell R2, Hosmer and Lemeshow tests, case classification counting, and residual analysis to determine which of the computed tomographic angiographic measurements or indices were jointly associated with and predictive of aneurysm rupture. RESULTS Thirty patients with 67 aneurysms (30 ruptured, 37 unruptured) were studied. Maximum diameter, height, maximum width, bulge height, parent artery diameter, aspect ratio, bottleneck factor, and aneurysm/parent artery ratio were significantly (P &lt; 0.05) associated with ruptured aneurysms on bivariate analysis. When best subsets and stepwise multivariable logistic regression was performed, bottleneck factor (odds ratio = 1.25, confidence interval = 1.11–1.41 for every 0.1 increase) and height-width ratio (odds ratio = 1.23, confidence interval = 1.03–1.47 for every 0.1 increase) were the only measures that were significantly predictive of rupture. CONCLUSION In a case-control study of patients with multiple cerebral aneurysms, increased bottleneck factor and height-width ratio were consistently associated with rupture.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18101-e18101
Author(s):  
Achuta Kumar Guddati ◽  
Gagan Kumar ◽  
Iuliana Shapira ◽  
Parijat Saurav Joy

e18101 Background: Chemotherapy induced cardiomyopathy is an important complication of some chemotherapeutic agents. The stress of a cancer diagnosis and ongoing chemotherapy may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCP) in cancer patients is unknown. The incidence of TCP and related outcomes in cancer patients was investigated in this study. Methods: The 2007-2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCP with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis. Results: From 2007 through 2013, an estimated 122,750 adults were admitted with a diagnosis of TCP. In 2013, the incidence of admissions in US of patients with coexisting TCP and malignancy was 1.13%. Admissions in 34,957 patients were for a primary diagnosis of TCP with 91.7% females; overall, 665 (2.1%) had solid organ cancer, 237 (0.74%) had hematological malignancy and 354 (1.11%) had metastatic cancer. Patients admitted for TCP with coexisting malignancy had a significantly higher mortality (13.8% vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29291 vs. $ 36231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCP and without any underlying malignancy, males had a higher mortality (4.02% vs. 1.03%, p < 0.0001) whereas there was no gender difference in mortality in those with coexisting malignancy (6.25% vs 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001), venous thromboembolic disease (OR 4.52, p = 0.004), malnutrition (OR 2.41, p = 0.006) and heart failure (OR 1.918, p = 0.004). Conclusions: Outcomes are significantly worse in patients with TCP and solid malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCP is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.


2020 ◽  
Vol 23 (15) ◽  
pp. 2759-2769
Author(s):  
Djibril M Ba ◽  
Paddy Ssentongo ◽  
Duanping Liao ◽  
Ping Du ◽  
Kristen H Kjerulff

AbstractObjective:To identify countries in sub-Saharan Africa (SSA) that have not yet achieved at least 90 % universal salt iodization and factors associated with the consumption of non-iodized salt among women of reproductive age.Design:A cross-sectional study using data from Demographic and Health Surveys (DHS). The presence of iodine in household salt (iodized or non-iodized), which was tested during the survey process, was the study outcome. Multivariable logistic regression models were used to determine independent factors associated with the consumption of non-iodized salt among women of reproductive age.Setting:There were eleven countries in SSA that participated in the DHS since 2015 and measured the presence of iodine in household salt.Participants:Women (n 108 318) aged 15–49 years.Results:Countries with the highest rate of non-iodized salt were Senegal (29·5 %) followed by Tanzania (21·3 %), Ethiopia (14·0 %), Malawi (11·6 %) and Angola (10·8 %). The rate of non-iodized salt was less than 1 % in Rwanda (0·3 %), Uganda (0·5 %) and Burundi (0·8 %). Stepwise multivariable logistic regression showed that women were more likely to be using non-iodized salt (adjusted OR; 95 % CI) if they were poor (1·62; 1·48, 1·78), pregnant (1·16; 1·04, 1·29), aged 15–24 years (v. older: 1·14; 1·04, 1·24) and were not literate (1·14; 1·06, 1·23).Conclusions:The use of non-iodized salt varies among SSA countries. The higher level of use of non-iodized salt among poor, young women and pregnant women is particularly concerning.


2015 ◽  
Vol 193 (4S) ◽  
Author(s):  
Katherine Rotker ◽  
Hari Vigneswaran ◽  
Danly Omil-Lima ◽  
Grayson Baird ◽  
Mark Sigman ◽  
...  

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6109
Author(s):  
Dongyu Zhang ◽  
Neil J. Shah ◽  
Michael Cook ◽  
Matthew Blackburn ◽  
Michael T. Serzan ◽  
...  

Evidence regarding the association between body mass index (BMI) and immune-related adverse events (irAEs) among cancer patients receiving immune checkpoint inhibitors (ICIs) is limited. Here, we use cross-sectional hospital-based data to explore their relationship. Pre-treatment BMI was treated as an ordinal variable (<25, 25 to ≤30, ≥30 kg/m2). The outcome of interest was irAEs after ICI initiation. A multivariable logistic regression model estimated the adjusted odds ratio (aOR) and 95% confidence interval (CI) of BMI. A total of 684 patients with stage III or IV cancer were included in the study (lung: 269, melanoma: 204, other: 211). The mean age at the first dose of ICI was 64.1 years (SD = 13.5), 394 patients (57.6%) were male, and over one-third (N = 260, 38.0%) were non-White. Overall, 52.9% of patients had BMI ≥ 25 kg/m2 (25 to ≤30: 217, ≥30: 145) and 288 (42.1%) had irAEs after ICI treatment. Patients with higher BMI tended to have a higher rate of irAEs (<25: 35.7%, 25 to ≤30: 47.0%, ≥30: 49.0%). The multivariable logistic regression yielded consistent results (BMI ≥ 30 vs. BMI < 25: aOR = 1.47, 95% CI = 0.96–2.23; 25 ≤ BMI < 30 vs. BMI < 25: aOR = 1.46, 95% CI = 1.02–2.11, p-trend = 0.04). In conclusion, among patients with advanced cancer receiving ICIs, the rate of irAEs appears to be higher among those with higher BMI.


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