State of the Art in Fertility Preservation for Female Patients Prior to Oncologic Therapies

Quality of life improvement stands as one of the main goals of the medical sciences. Increasing cancer survival rates associated with better early detection and extended therapeutic options led to the specific modeling of patients’ choices, comprising aspects of reproductive life that correlated with the evolution of modern society, and requires better assessment. Of these, fertility preservation and ovarian function conservation for pre-menopause female oncologic patients pose a contemporary challenge due to procreation age advance in evolved societies and to the growing expectations regarding cancer treatment. Progress made in cell and tissue-freezing technologies brought hope and shed new light on the onco-fertility field. Additionally, crossing roads with general fertility and senescence studies proved highly beneficial due to the enlarged scope and better synergies and funding. We here strive to bring attention to this domain of care and to sensitize all medical specialties towards a more cohesive approach and to better communication among caregivers and patients.

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Fertility Preservation Programme in a Tertiary-Assisted Reproduction Unit in Hong Kong

Fertility & Reproduction ◽

10.1142/s2661318221500122 ◽

2021 ◽

Vol 03 (03) ◽

pp. 94-100

Author(s):

Jennifer K. Y. Ko ◽

Kevin K.W. Lam ◽

Heidi H.Y. Cheng ◽

Man Wa Lui ◽

Sofie S.F. Yung ◽

...

Keyword(s):

Hong Kong ◽

Cancer Treatment ◽

Fertility Preservation ◽

Assisted Reproduction ◽

Cancer Survival ◽

Survival Rates ◽

Embryo Cryopreservation ◽

Natural Conception ◽

Female Fertility Preservation ◽

Evaluation And Monitoring

Background: Fertility preservation is increasingly important with improving cancer survival rates and the delay in childbearing in modern societies. The objective of our study was to review the experience of the fertility preservation programme in a tertiary-assisted reproduction unit in Hong Kong. Methods: This is a retrospective study involving men and women who were seen at a tertiary-assisted reproduction unit for fertility preservation counselling before gonadotoxic treatment from January 2005 to December 2020. Their medical records in paper and electronic forms were reviewed. Results: There were 75 consultations for female fertility preservation from 2010 to 2020 involving 72 women. Twenty women underwent 22 cycles of ovarian stimulation for oocyte or embryo cryopreservation, two of whom subsequently transported their oocytes abroad for further management and another two achieved natural conception. Additional four women who did not have oocyte or embryo cryopreservation achieved natural conception after cancer treatment. Eleven (15.2%) women were followed up at a reproductive endocrinology clinic after their cancer treatment. From 2005 to 2020, 265 men had sperm cryopreserved. Twenty-six (9.8%) came back to use the cryopreserved sperms, the wives of 13 (50.0%) of whom achieved an on-going pregnancy. Six of them transferred out and 40 discarded the cryopreserved sperms. Conclusions: There was generally an increasing number of patient consultations for fertility preservation in our Centre over the past decade but a consistently low rate of utilisation of cryopreserved gametes for both women and men. Post-cancer treatment fertility evaluation and monitoring was a major area of deficiency in Hong Kong. More structured post-cancer treatment fertility follow-up is needed.

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Physician Referral for Fertility Preservation in Oncology Patients: A National Study of Practice Behaviors

Journal of Clinical Oncology ◽

10.1200/jco.2009.23.0250 ◽

2009 ◽

Vol 27 (35) ◽

pp. 5952-5957 ◽

Cited By ~ 275

Author(s):

Gwendolyn P. Quinn ◽

Susan T. Vadaparampil ◽

Ji-Hyun Lee ◽

Paul B. Jacobsen ◽

Gerold Bepler ◽

...

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Cancer Survival ◽

Survival Rates ◽

The United States ◽

National Study ◽

Childbearing Age ◽

Practice Behaviors ◽

Patient Recall ◽

American Society

Purpose Cancer survival rates are improving, and the focus is moving toward quality survival. Fertility is a key aspect of quality of life for cancer patients of childbearing age. Although cancer treatment may impair fertility, some patients may benefit from referral to a specialist before treatment. However, the majority of studies examining patient recall of discussion and referral for fertility preservation (FP) show that less than half receive this information. This study examined the referral practices of oncologists in the United States. Methods This study examined oncologists' referral practice patterns for FP among US physicians using the American Medical Association Physician Masterfile database. A 53-item survey was administered via mail and Internet to a stratified random sample of US physicians. Results Forty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist. Referrals were more likely among female physicians (P = .004), those with favorable attitudes (P = .043), and those whose patients routinely ask about FP (odds ratio = 2.09; 95% CI, 1.31 to 3.33). Conclusion Less than half of US physicians are following the guidelines from the American Society of Clinical Oncology, which suggest that all patients of childbearing age should be informed about FP.

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Current and Future Perspectives for Improving Ovarian Tissue Cryopreservation and Transplantation Outcomes for Cancer Patients

Reproductive Sciences ◽

10.1007/s43032-021-00517-2 ◽

2021 ◽

Author(s):

Sanghoon Lee ◽

Sinan Ozkavukcu ◽

Seung-Yup Ku

Keyword(s):

Cancer Treatment ◽

Cancer Patients ◽

Fertility Preservation ◽

Cancer Survival ◽

Ovarian Tissue ◽

Survival Rates ◽

Reproductive Age ◽

Ovarian Tissue Cryopreservation ◽

Tissue Cryopreservation ◽

Transplantation Outcomes

AbstractAlthough advances in cancer treatment and early diagnosis have significantly improved cancer survival rates, cancer therapies can cause serious side effects, including ovarian failure and infertility, in women of reproductive age. Infertility following cancer treatment can have significant adverse effects on the quality of life. However, established methods for fertility preservation, including embryo or oocyte cryopreservation, are not always suitable for female cancer patients because of complicated individual conditions and treatment methods. Ovarian tissue cryopreservation and transplantation is a promising option for fertility preservation in pre-pubertal girls and adult patients with cancer who require immediate treatment, or who are not eligible to undergo ovarian stimulation. This review introduces various methods and strategies to improve ovarian tissue cryopreservation and transplantation outcomes, to help patients and clinicians choose the best option when considering the potential complexity of a patient’s situation. Effective multidisciplinary oncofertility strategies, involving the inclusion of a highly skilled and experienced oncofertility team that considers cryopreservation methods, thawing processes and devices, surgical procedures for transplantation, and advances in technologies, are necessary to provide high-quality care to a cancer patient.

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Cardiac involvement in oncologic patients

The EACVI Textbook of Cardiovascular Magnetic Resonance ◽

10.1093/med/9780198779735.003.0030 ◽

2018 ◽

pp. 329-342

Author(s):

Jennifer H Jordan ◽

Matthias Schmitt ◽

Christopher A Miller ◽

Annalisa Angelini ◽

W Gregory Hundley

Keyword(s):

Cancer Survival ◽

Survival Rates ◽

Chemotherapeutic Agents ◽

Cardiac Morbidity ◽

Clinical Scenarios ◽

Oncologic Patients ◽

And Function ◽

Receptor Targets ◽

Childhood Survivors

As cancer survival rates improve, the development of chemotherapy-induced cardiotoxicity is becoming increasingly relevant and more widely recognized. Childhood survivors of cancer are seven times more likely to die from cardiac causes and 15 times more likely to develop heart failure than their contemporaries. It is not only well-established chemotherapeutic agents that promote cardiac morbidity, but also many newer ‘targeted’ agents share cancer and cardiac receptor targets that also promote cardiovascular injury. This chapter addresses how the imaging specialist may interact with patients receiving potentially cardiotoxic cancer treatment in three clinical scenarios: baseline assessment of cardiac anatomy and function, assessment of acute and subacute treatment-related complications, and long-term surveillance of cardiotoxicity.

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Counseling young women with early breast cancer on fertility preservation

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-019-01615-6 ◽

2019 ◽

Vol 36 (12) ◽

pp. 2593-2604 ◽

Cited By ~ 8

Author(s):

M. E. (Elena) ter Welle-Butalid ◽

I. J. H. (Ingeborg) Vriens ◽

J. G. (Josien) Derhaag ◽

E. M. (Edward) Leter ◽

C. E. (Christine) de Die-Smulders ◽

...

Keyword(s):

Breast Cancer ◽

Fertility Preservation ◽

Young Women ◽

Cancer Survival ◽

Ovarian Function ◽

Early Stage ◽

Genetic Diagnosis ◽

Oncological Treatment ◽

Future Child ◽

Child Wish

Abstract Purpose Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment. Methods A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome. Results Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis. Conclusions Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.

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Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

BMJ Open ◽

10.1136/bmjopen-2019-035678 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035678

Author(s):

Michael Harris ◽

Mette Brekke ◽

Geert-Jan Dinant ◽

Magdalena Esteva ◽

Robert Hoffman ◽

...

Keyword(s):

Primary Care ◽

Diagnostic Test ◽

Cancer Survival ◽

Survival Rates ◽

European Countries ◽

Survey Question ◽

Referral Decisions ◽

Physician Characteristics ◽

Care Survey ◽

Primary Care Practitioners

ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.DesignA primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.SettingCentres in 20 European countries with widely varying cancer survival rates.ParticipantsA total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country.ResultsPCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.ConclusionWhen given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.

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Challenges and Perspectives on Breast Cancer Survivorship: The Journey Continues

Innovation in Aging ◽

10.1093/geroni/igaa057.317 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 96-96

Author(s):

Victoria Raveis ◽

Simona Kwon

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivor ◽

Breast Cancer Survivors ◽

Cancer Survival ◽

Survival Rates ◽

Extended Period ◽

Health Issues ◽

Age Related

Abstract Women have a 1-in-8 lifetime risk of breast cancer. Earlier diagnosis and treatment advances have improved 15- and 20-year survival rates. Increased survival can mean coping with the effects of cancer and its treatment over an extended period of time, while experiencing age-related changes in functioning and the emergence of other health issues. To explore breast cancer survivors’ perspectives on their issues and concerns across the life-course, focus groups were conducted with a culturally diverse sample (N=18) of survivors (72% white, 28% Black, 11% Hispanic). Participants were 44-82 years old. Most, 83% were 50 and older, 56% were 60 and older. The majority (83%) were diagnosed in their 40’s and 50’s. Two were diagnosed in their early 30’s and one at age 68. Participants reaffirmed the necessity, as a breast cancer survivor, of being a life-long health advocate on their own behalf, and the importance of being self-informed. As one woman commented: “Knowledge is power”. Survivors shared that their emergent health issues were complicated by their cancer history, and, that, as a cancer survivor, “I never stop worrying”. A widespread concern was not knowing if the health issues and co-morbidities they experienced (such as joint pain, neuropathy, tendinitis, heart disease), were age-related, a consequence of their cancer, or a late treatment effect. An overriding sentiment expressed was that clinicians have not recognized the importance of quality of life in cancer survival. As a survivor succinctly stated: “We are living longer, but we need to live long with quality of life.”

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Chromosomal copy number heterogeneity predicts survival rates across cancers

Nature Communications ◽

10.1038/s41467-021-23384-6 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Erik van Dijk ◽

Tom van den Bosch ◽

Kristiaan J. Lenos ◽

Khalid El Makrini ◽

Lisanne E. Nijman ◽

...

Keyword(s):

Copy Number ◽

Cancer Survival ◽

Survival Rates ◽

Cancer Prognosis ◽

Disease Outcomes ◽

Distinct Disease ◽

Cancer Types ◽

Chromosomal Copy Number ◽

Chromosomal Copy ◽

Pan Cancer

AbstractSurvival rates of cancer patients vary widely within and between malignancies. While genetic aberrations are at the root of all cancers, individual genomic features cannot explain these distinct disease outcomes. In contrast, intra-tumour heterogeneity (ITH) has the potential to elucidate pan-cancer survival rates and the biology that drives cancer prognosis. Unfortunately, a comprehensive and effective framework to measure ITH across cancers is missing. Here, we introduce a scalable measure of chromosomal copy number heterogeneity (CNH) that predicts patient survival across cancers. We show that the level of ITH can be derived from a single-sample copy number profile. Using gene-expression data and live cell imaging we demonstrate that ongoing chromosomal instability underlies the observed heterogeneity. Analysing 11,534 primary cancer samples from 37 different malignancies, we find that copy number heterogeneity can be accurately deduced and predicts cancer survival across tissues of origin and stages of disease. Our results provide a unifying molecular explanation for the different survival rates observed between cancer types.

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No evidence to support the impact of migration background on treatment response rates and cancer survival: a retrospective matched-pair analysis in Germany

BMC Cancer ◽

10.1186/s12885-021-08141-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Roman Rüdiger ◽

Franziska Geiser ◽

Manuel Ritter ◽

Peter Brossart ◽

Mignon-Denise Keyver-Paik ◽

...

Keyword(s):

Treatment Response ◽

Cancer Survival ◽

Survival Rates ◽

Migration Background ◽

Comprehensive Cancer Center ◽

Matched Pair ◽

Cancer Center ◽

German Population ◽

Matched Pair Analysis ◽

Immigrant Background

Abstract Background Immigration has taken the central stage in world politics, especially in the developed countries like Germany, where the continuous flow of immigrants has been well documented since 1960s. Strikingly, emerging data suggest that migrant patients have a poorer response to the treatment and lower survival rates in their new host country, raising concerns about health disparities. Herein, we present our investigation on the treatment response rate and cancer survival in German patients with and without an immigrant background that were treated at our comprehensive cancer center in Germany. Methods Initially, we considered 8162 cancer patients treated at the Center for Integrated Oncology (CIO), University Hospital Bonn, Germany (April 2002–December 2015) for matched-pair analysis. Subsequently, the German patients with a migration background and those from the native German population were manually identified and catalogued using a highly specific name-based algorithm. The clinical parameters such as demographic characteristics, tumor characteristics, defined staging criteria, and primary therapy were further adjusted. Using these stringent criteria, a total of 422 patients (n = 211, Germans with migration background; n = 211, native German population) were screened to compare for the treatment response and survival rates (i.e., 5-year overall survival, progression-free survival, and time to progression). Results Compared to the cohort with migration background, the cohort without migration background was slightly older (54.9 vs. 57.9 years) while having the same sex distribution (54.5% vs. 55.0% female) and longer follow-up time (36.9 vs. 42.6 months). We did not find significant differences in cancer survival (5-year overall survival, P = 0.771) and the response rates (Overall Remission Rate; McNemar’s test, P = 0.346) between both collectives. Conclusion Contrary to prior reports, we found no significant differences in cancer survival between German patients with immigrant background and native German patients. Nevertheless, the advanced treatment protocols implemented at our comprehensive cancer center may possibly account for the low variance in outcome. To conduct similar studies with a broader perspective, we propose that certain risk factors (country-of-origin-specific infections, dietary habits, epigenetics for chronic diseases etc.) should be considered, specially in the future studies that will recruit new arrivals from the 2015 German refugee crisis.

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Extended adverse effects of cyclophosphamide on mouse ovarian function

BMC Pharmacology and Toxicology ◽

10.1186/s40360-020-00468-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jihyun Kim ◽

Sooseong You

Keyword(s):

Adverse Effects ◽

Cancer Survivors ◽

Cancer Survival ◽

Ovarian Function ◽

Treatment Options ◽

Bioinformatics Analyses ◽

Hormonal Stimulation ◽

Patients With Cancer ◽

Multiple Exposures

Abstract Purpose Most patients with cancer undergo multiple administrations of anticancer drugs during treatment, resulting in chronic impairment of their reproductive health. As improved treatment options increase cancer survival, it has become increasingly important to address fertility issues in cancer survivors. In this study, we examined the pathophysiological effects of multiple exposures to cyclophosphamide (Cy) on the ovaries of mice and their underlying molecular mechanism. Methods Female C57BL/6 mice were intraperitoneally injected with 100 mg/kg Cy six times over 2 weeks; 4 weeks later, the mice were sacrificed and their ovaries, sera, and oocytes were collected for histological observation, measurement of anti-Müllerian hormone levels, and assessment of oocyte quantity and quality in response to hormonal stimulation. Gene expression changes in Cy-treated ovaries were examined by microarray and bioinformatics analyses. Results After repeated Cy exposure, the anti-Müllerian hormone level was decreased, and follicle loss and impairments in the quality of oocyte were irreversible. The expression levels of genes involved in folliculogenesis, oogenesis, and zona pellucida glycoprotein transcription displayed sustained alterations in Cy-exposed ovaries even after 4 weeks. Conclusion The adverse effects of Cy on ovarian function and oocytes remained even after chemotherapy was complete. Therefore, strategies to prevent ovarian damage or restore ovarian function after treatment are required to safeguard the fertility of young cancer survivors.

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