Feasibility, acceptability and appropriateness of a reproductive patient reported outcome measure for cancer survivors

Background Cancer patients can experience a number of reproductive complications as a result of cancer treatment and may benefit from reproductive preventative health strategies. A Reproductive Survivorship Patient Reported Outcome Measure (RS-PROM) is not currently available but could assist patients address reproductive concerns. Purpose To develop and test the acceptability, feasibility and appropriateness of a RS-PROM tool to be used to assess reproductive needs of cancer survivors aged 18–45 years. Methods We reviewed the outcomes of a recently published audit of reproductive care provided in our cancer survivorship clinic to identify gaps in current service provided and used this along with available validated reproductive measures, to develop this pilot RS-PROM. Survivors aged 18–45 years either attending the SCH survivorship clinic over a 1-year period or participants on the Australasian Oncofertility Registry (AOFR) who had agreed to be contacted for future research studies were asked to complete the RS-PROM and a questionnaire on the acceptability, feasibility and appropriateness of content included. Results One-hundred and fifty patients participated (61.3% females). Median age at cancer diagnosis was 24.5 years (range: 2–45 years). Eighty percent of participants reported the length of the RS-PROM was “just right”, 92% agreed they would not mind completing the RS-PROM and 92.7% were willing to answer all questions, with 97% agreeing that the RS-PROM would be an important tool in addressing difficult sexual/reproductive topics concerning with healthcare professionals. Conclusion The large majority of survivors participating in our pilot study found the RS-PROM to be an acceptable, feasible and useful tool to assist discussions of their sexual and reproductive health concerns and experiences with their clinical team.

P–041 Reproductive concerns and sexual health in men with newly diagnosed testicular cancer prior to orchiectomy: preliminary results from an on-going study

Study question What is the prevalence of reproductive concerns among patients with newly diagnosed testicular cancer (TC), and how do they rate their sexual health (SH). Summary answer Of 20 patients, 75% (n = 15) were moderate to highly concerned about decreased reproductive functioning. Twenty-four percent exhibited overall low SH. What is known already Currently, only little is known about reproductive concerns among TC patients. Furthermore, these concerns have not been investigated in a TC population prior to orchiectomy. One study among post-surgery TC patients two years after diagnosis, reported that 28% had high degree of reproductive concern. The literature indicates that TC patients’ sexual health is negatively affected due to altered body image and sexual dysfunction. However, studies regarding sexual health have primarily been performed on long term survivors of TC. Thus, little is known about SH in this population prior to treatment. Study design, size, duration The present cross-sectional study included patients from the fertility clinic in Horsens, Denmark. Patients were approached at their pre-scheduled appointment for cryopreservation of semen prior to orchiectomy. Enrolment started March, 2019 and is still on-going. Preliminary data is included from 21 enrolled patients. Participants/materials, setting, methods Patients newly diagnosed with TC, who were referred to the fertility clinic for semen cryopreservation prior to orchiectomy and other treatment modalities were invited. The patients responded to a questionnaire package of which reproductive concerns were assessed with seven questions with Likert scale response options ranging from 0 (not concerned) to 5 (highly concerned). SH was assessed with the validated 22-item questionnaire European Organization for Research and Treatment of Cancer Sexual health questionnaire (EORTC-SHQ). Main results and the role of chance A total of 37 patients met the inclusion criteria and of these 21 were enrolled in the study. Due to technical issues, only 20 out of 21 patients completed the full questionnaire package. Patients were asked about concerns regarding the ability to father children. Nine patients (45%) were moderately concerned, and six patients (30%) were highly concerned. When asked about their concerns of not being able to father children without fertility treatment, the answers were mostly unaffected with eight patients (40%) being moderately concerned, and seven patients (35%) highly concerned. Four patients (20%) were highly concerned that decreased semen quality would affect future or present relationships. Patients were also asked if they felt sufficiently informed regarding the chance of fathering children without help from a fertility clinic following cancer treatment. Three patients (15%) reported that they were insufficiently informed, while four patients (20%) responded only to a little extend. Five patients (23,8%) scored ≤ 50 on the EORTC SHQ indicating that they had low SH. Eleven patients (52,3%) felt less masculine due to their disease. Furthermore, one patient (4,8%) scored ≤ 50 on the symptomatic scale, indicating that he had symptomatic sexual problems as fatigue and sexual pain. Limitations, reasons for caution The relatively low participant number is a limitation, making the results less generalizable. Furthermore, there is a risk of selection bias due to the moderate inclusion rate. Also, the questionnaire examining fertility related concerns were non validated, and focused mainly on the fertility-related aspects of reproductive concerns. Wider implications of the findings: A considerable number of patients with newly diagnosed TC show substantial reproductive concerns as well as lowered sexual health. These worries could possibly be alleviated by more sufficient information from the health professionals already in the beginning of the treatment phase, reducing further emotional distress during the remaining treatment period. Trial registration number ClinicalTrials.gov ID:NCT03880994

Overcoming Reproductive and Psychological Concerns of Breast Cancer Survivors: A Randomized Controlled Trial

Background: After developing breast cancer, women experience changes in their sexuality, femininity, and fertility. These changes lead to poor mental health and increased psychological stress. Therefore, this study aimed to investigate the effects of Good Enough Sex (GES)-based, couple-centered group counseling on reproductive and sexual concerns of breast cancer survivors.Methods: This was a quantitative randomized controlled clinical trial (RCT). After completing the informed consent forms, 100 women were assigned to the intervention and control groups (50 individuals per group) using randomized block design. The intervention included four 90-120-minute sexual counseling sessions with 2 and 3-month follow-ups. The data were collected using the socio-demographic and clinical characteristics, Persian version of Depression, Anxiety and Stress Scale (DASS-21), Reproductive Concerns After Cancer (RCAC) scale, and Female Sexual Function Index adaptation for Breast Cancer patients (FSFI-BC). The obtained data were analyzed in SPSS 20 using descriptive and repeated measures analysis of variance (ANOVA) test.Results: Significant differences were observed between the intervention and control groups in terms of the mean stress, anxiety, depression, reproductive concerns, and sexual function scores of the participants (P < 0.001). Therefore, the GES-based, couple-centered group counseling is associated with significant reductions in reproductive and sexual concerns of female breast cancer survivors.Conclusions: The designed psychosocial training and counseling intervention effectively reduced reproductive and sexual concerns of female breast cancer survivors. Therefore, these training and counseling programs can be organized by relevant service centers to promote the reproductive health of women with breast cancer.

'Does HPV affect my fertility?' Reproductive concerns of HPV-positive women: a qualitative study

Background Reproductive health changes can occur following infection with Human papillomavirus. HPV is the most prevalent sexually transmitted infection causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to explore the reproductive concerns of women infected with HPV. Methods In this qualitative study, we used the conventional content analysis approach, with the aid of MAXQDA.10 software, to analyze data extracted from the face-to-face semi-structured interviews with 20 Iranian HPV-positive women (sampled by maximum variation purposive sampling). The accuracy of this research was ensured according to the four criteria proposed by Guba and Lincoln. Results Exploring participants' reproductive concerns, three main categories were identified from the interviews including concerns about fertility potential, pregnancy and non-pregnancy reproductive issues. HPV-positive women concerned about reduced female/ male fertility due to HPV, the impact of the HPV on the fetal health, adverse pregnancy outcomes such as miscarriage and preterm delivery, and mother-to-child transmission of HPV during breastfeeding. HPV-positive women with abnormal cytology results were anxious that becoming pregnant or taking hormonal contraception might worsen their abnormalities. Most married women were reluctant to use a condom. Participants requested further information about the potential reproductive risks of the HPV vaccine. They also wanted to know about the safety of HPV vaccine during pregnancy and breastfeeding. Conclusions HPV-positive women had some reproductive concerns that should be considered in the designing of educational-consulting interventions. Women need to be better understood and informed about the impact of HPV on their reproductive health. Health care providers may lack knowledge about these specific areas, and they could benefit from additional up-to-date information to address women's reproductive concerns.

“It’s like getting a diagnosis of terminal cancer.” An Exploratory Study of the Emotional Landscape of Climate Change Concern in Norway.

Increasingly more people consider climate change a global emergency and emotionally charged terms such as climate anxiety or climate depression have entered public discourse. At the same time, emotions lie at the core of many psychological processes and are thus a critical component of pro-environmental engagement, as well as human health and well-being. Systematic empirical evidence about the emotional experience of climate change and its effects for an individual’s functioning is lacking, however. In the present study, we address this gap in knowledge and conduct an exploratory qualitative study of the emotional experience behind concern for climate change and its impacts on mental and psychosocial functioning. Drawing from 33 in-depth interviews conducted in Norway with a diverse sample of people who self-identified as worried about climate change, we map and contextualise the complex palette of mostly strong negative emotions experienced in relation to the concern for climate change. These emotions affected the participants psychologically in a number of ways, including in terms of lowered mood, reproductive concerns, difficulties in social functioning, but also through feeling an urge and responsibility to engage in pro-environmental behaviour. Our findings empirically validate the view that people can be psychologically affected by the mere awareness of the scale and implications of climate change, and that the emotional labour behind feeling an individual responsibility for climate change can affect people’s psychological well-being.

A correlational study of reproductive concerns with self-disclosure and mental resilience in breast cancer patients of childbearing age in China

ObjectiveThe current study aimed to investigate the prevalence of reproductive concerns in breast cancer patients of Chinese women of childbearing age, to explore the effects of self-disclosure and mental resilience on reproductive concerns, and to explore the relationships among the three variables. MethodsCorrelation research design was used.274 women suffering from breast cancer with age (M=38.10, SD=6.44) were taken from two tertiary hospitals in Guangzhou. The participants were asked to fill out a set of self-reported questionnaires including the Sociodemographic data, Reproductive Concerns after Cancer scale (RCACs), the Distress Disclosure Index (DDI), and the 14-Item Resilience scale (RS-14). The mediation analysis was tested using SPSS (Process-plugin) and the bootstrap method. ResultsA total of 252 valid questionnaires were collected in this study. 36.1% of the patients scored highly in at least one dimension of reproductive concerns, with Child's health and Personal health being the top two concerns. Correlation analysis revealed that there was a significant positive relationship between self-disclosure and mental resilience. Self-disclosure and mental resilience had a negative relationship with reproductive concerns, respectively. The results of the mediation analysis showed that there was a mediational role of mental resilience between self-disclosure and reproductive concerns. ConclusionIt was concluded that breast cancer patients with high levels of self-disclosure, are more resilient and have fewer reproductive concerns.