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.

Family building preferences among young women with invasive breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24057-e24057
Author(s):  
Angelena Crown ◽  
Nadia Abdo ◽  
Ariela Noy ◽  
Cassandra Chang ◽  
Mary Gemignani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Fertility Preservation ◽  
Young Women ◽  
Invasive Breast Cancer ◽  
Reproductive History ◽  
High Rate ◽  
Childbearing Age ◽  
Family Building

e24057 Background: The American Society of Clinical Oncology guidelines recommend discussing the possibility of infertility in cancer patients of childbearing age being treated with gonadotoxic therapies. This prospective study examines the reproductive history and future family building preferences of young women with breast cancer. Methods: This is an Institutional Review Board approved prospective study of women < 45 years of age with non-metastatic invasive breast cancer who completed a questionnaire on reproductive history and family building preferences between April 2013 and December 2019. Questionnaires were administered at initial diagnosis and then annually. Results: Baseline questionnaires were completed by 164 women with a median age of 39 years old (range 20-45); 110 (59%) completed the 1 year follow up survey. Clinicopathologic features and treatment are shown in the table. The majority of women (n = 90, 55%) were parous and many had previous infertility (n = 60, 37%) at time of diagnosis. Most women (n = 87, 53%) wanted additional children or were unsure. Interest in embryo and/or oocyte cryopreservation was common (n = 51, 31%) as was interest in adoption (n = 52, 32%). Of the 110 women who completed the one year follow-up, 39 (35%) saw a reproductive endocrinologist, including 22 (20%) who elected embryo (n = 14) or oocyte (n = 8) cryopreservation. Overall, 88 (80%) women declined fertility preservation. The most common reasons included worrying about delay in cancer treatment (n = 10, 9%), fear of hormonal exposure (n = 7, 6%), and feeling rushed into making a decision (n = 6, 6%). Of 92 women with available data regarding satisfaction with their decision to pursue fertility preservation or not, 84% (n = 77) reported satisfaction whereas 14% (n = 15) reported mixed feelings or regret. Conclusions: Young women with breast cancer expressed a significant interest in family building options. However, pursuit of fertility preservation was uncommon despite a high rate of prior infertility in this cohort of mostly parous women. Decisional satisfaction was common. Further study of factors contributing to patient decision-making regarding fertility preservation and alternative family building options is warranted. Clinical trial information: NCT01788839 . [Table: see text]

scholarly journals Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer

Cancer ◽  
2011 ◽  
Vol 118 (6) ◽  
pp. 1710-1717 ◽  
Author(s):  
Joseph M. Letourneau ◽  
Erin E. Ebbel ◽  
Patricia P. Katz ◽  
Audra Katz ◽  
Wei Z. Ai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Fertility Preservation ◽  
Reproductive Age ◽  
Improve Quality ◽  
Reproductive Age Women ◽  
Fertility Counseling

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 Serous Borderline Ovarian Tumor Diagnosis, Management and Fertility Preservation in Young Women

2021 ◽  
Vol 10 (18) ◽  
pp. 4233
Author(s):  
Marie Carbonnel ◽  
Laetitia Layoun ◽  
Marine Poulain ◽  
Morgan Tourne ◽  
Rouba Murtada ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Young Women ◽  
Reproductive Age ◽  
Borderline Ovarian Tumor ◽  
Minimal Risk ◽  
Optimal Management ◽  
Single Institution ◽  
Women Of Reproductive Age ◽  
Nulliparous Women ◽  
Invasive Carcinomas

Borderline ovarian tumors (BOT) represent about 10 to 20 percent of all epithelial tumors of the ovary. They constitute intermediate lesions between benign ovarian cysts and invasive carcinomas. They often occur in young women of reproductive age, and, albeit with a favorable prognosis, it may recur on the ipsilateral or contralateral ovary. Controversies surround the diagnostic criteria used for their assessment, and the optimal management to minimize their risk of recurrence and/or transformation into malignant carcinoma. Fertility preservation (FP) is considered a priority in the management of these patients, and studies aim at finding the safest and most effective way to help women with BOT history conceive with minimal risk. We present the experience of a single institution in managing three cases of serous BOT in young nulliparous women, followed by a thorough review of the existing literature, highlighting controversies and exploring the possible FP techniques for these women.

Differing Physician Perceptions of Oxcarbazepine and Levetiracetam for Women of Child- Bearing Age: A Physician Survey Based Study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Avani Shukla ◽  
Keyword(s):  
Antiepileptic Drugs ◽  
Young Women ◽  
Significant Proportion ◽  
Reproductive Age ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Women Of Reproductive Age ◽  
Physician Perceptions ◽  
Child Bearing ◽  
Patient Profiles

Background: Young women of reproductive age constitute a significant proportion of India's epilepsy patient population. Doctors take several considerations into account while prescribing antiepileptic drugs (AEDs) to young women to balance the risk of seizures with other concerns. Objective: To understand how doctors perceive various AEDs regarding their safety, efficacy, and other attributes for women of childbearing age. Materials and Methods: This study consisted of a survey designed to understand the usage and perception of 12 antiepileptic drugs in the Indian market. The survey respondents of this study were neurologists, neurosurgeons, and psychiatrists from all over India, from private or government setups, and with different experience and patient load levels. Results: In the study, 93% of all survey respondents indicated that they avoid one or more AEDs in women of childbearing age, making it a significant consideration. This consideration is a specialty split for the second- generation AEDs, Oxcarbazepine, and Levetiracetam. Approximately three times more Neurosurgeons avoid Oxcarbazepine as compared to neurologists and psychiatrists who use this drug. In the case of Levetiracetam, mainly only psychiatrists avoid it for women of reproductive age. Apart from the personal experience of doctors, factors other than teratogenic risks, such as changes in reproductive hormone levels, may have contributed to the observed difference in perception. Conclusion: The study highlights doctors ‘differing perceptions for highly used drugs among all specialties emphasizing the need to determine if such differences in perception exist between other AEDs for various types of patient profiles.

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.

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]

scholarly journals Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

2020 ◽  
Vol 14 ◽  
pp. 117822342095417 ◽  
Author(s):  
Luca Arecco ◽  
Marta Perachino ◽  
Alessandra Damassi ◽  
Maria Maddalena Latocca ◽  
Davide Soldato ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Young Women ◽  
Reproductive Age ◽  
Prior History ◽  
Breast Cancer Patients ◽  
History Of ◽  
Anticancer Treatment ◽  
Young Breast Cancer

The improved prognosis of breast cancer patients makes survivorship issues an area of crucial importance. In this regard, an increased attention is needed toward the development of potential anticancer treatment-related long-term side-effects, including gonadal failure and infertility in young women. Therefore, fertility preservation and family planning are crucial issues to be addressed in all young women of reproductive age with newly diagnosed cancer. Despite a growing availability of data on the efficacy and safety of fertility preservation options and the fact that conceiving after prior history of breast cancer has become more accepted over time, there are still several gray zones in this field so that many physicians remain uncomfortable to deal with these topics. The purpose of this review is to answer some of the most controversial questions frequently asked by patients during their oncofertility counseling, in order to provide a detailed and up-to-date overview on the evidence available in this field to physicians involved in the care of young women with breast cancer.

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