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.

This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site we present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.

Physicians should consider providing patients with timely, understandable information related to their FP options, prior to the administration of treatment. Such discussions may lead to improved quality of life for individuals as they transition from patients to survivors.

Context-Fatigue is among the most common and distressing symptoms experienced by cancer patients.Objective-This systematic review and meta-analysis evaluates the efficacy of psychological and activity-based interventions against cancer-related fatigue in cancer patients. Data Sources-MEDLINE, PsycINFO, and CINAHL.Study Selection-Randomized controlled trials of psychological and activity-based interventions involving adult cancer patients in which fatigue was an outcome were reviewed.Extraction-Forty-one trials were reviewed and 30 were included in a meta-analysis.Data Synthesis-Fifty percent of psychological trials and 44% of activity-based trials rated fair or better in quality yielded significant findings favoring the intervention condition. Meta-analysis yielded an overall effect size of 0.09 (95% CI = .02 -.16) favoring nonpharmacological conditions. Further analysis indicated that effect sizes were significant for psychological interventions (d w = . 10, 95% CI = .02-.18) but not activity-based interventions (d w = .05, 95% CI = −.08 -.19).Conclusions-Findings provide limited support for use of nonpharmacological interventions to manage cancer-related fatigue. The lack of research with heightened fatigue as an eligibility criterion is a notable weakness of the existing evidence base. Keywordsfatigue; cancer; psychological interventions; activity-based interventions; randomized controlled trials Cancer-related fatigue has been defined as "a persistent subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning" (Mock et al., 2000). Studies suggest it is among the most common symptoms experienced by cancer patients with advanced disease and those being treated with radiotherapy and chemotherapy (Ahlberg, Ekman, GastonJohansson, & Mock, 2003). Furthermore, fatigue does not appear to be limited to the active treatment period. Many individuals with no clinical evidence of disease continue to experience fatigue for months or even years following treatment completion (Servaes, Verhagen, & Bleijenberg, 2002). The clinical significance of fatigue has been examined primarily in terms of its impact on quality of life. Among patients treated with chemotherapy or radiotherapy, more than one third perceived that fatigue interfered with their ability to work, relationships with others, and physical and emotional well-being (Vogelzang et al., 1997). NIH Public AccessMechanisms involved in the development and persistence of cancer-related fatigue are only partially understood. Available evidence suggests that fatigue can occur as a consequence of metabolic changes associated with the underlying disease as well those induced by cancer treatments (Stasi, Abriani, Beccaglia, Terzoli, & Amadori, 2003). In addition, fatigue can occur as a concomitant of other common symptoms experienced by cancer patients (e.g., nausea, and pain; Stasi et al., 2003). A growing body of research also suggests that cognitive and behavioral factors may contribute to exacerbation and persistence...

Objective The purpose of this study was to determine the prevalence of physician recommendation of human papillomavirus (HPV) vaccination in early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) female patients by physician specialty, and to identify factors associated with recommendation in early adolescents. Methods A 38-item survey was conducted April 2009 through August 2009 among a nationally representative random sample of 1,538 Family Physicians, Pediatricians, and Obstetricians and Gynecologists obtained from the American Medical Association Physician Masterfile. A multivariable model was used to assess factors associated with frequency of physician recommendation of HPV vaccination (“always”=76-100% of the time vs. other=0-75%) within the past 12 months. Results Completed surveys were received from 1,013 physicians, including 500 Family Physicians, 287 Pediatricians, and 226 Obstetricians and Gynecologists (response rate = 67.8%). Across the specialties, 34.6% of physicians reported they “always” recommend the HPV vaccine to early adolescents, 52.7% to middle adolescents, and 50.2% to late adolescents/young adults. The likelihood of “always” recommending the HPV vaccine was highest among Pediatricians for all age groups (P < .001). Physician specialty, age, ethnicity, reported barriers, and Vaccines for Children provider status were significantly associated with “always” recommending HPV vaccination for early adolescents. Conclusions Findings suggest missed clinical opportunities for HPV vaccination, and perceived barriers to vaccination may drive decisions about recommendation. Results suggest the need for age and specialty targeted practice and policy level interventions to increase HPV vaccination among US females.

Background Breast cancer (BC) disparities may widen with genomic advances. We compared non-Hispanic white (NHW), Black, and Hispanic BC survivors for: 1) cancer risk management practices (CRM) among BRCA carriers; and 2) provider discussion and receipt of genetic testing. Methods A population-based sample of NHW, Black, and Hispanic women diagnosed with invasive BC ≤ age 50 in 2009–2012 were recruited through the state cancer registry. Using multiple logistic regression we compared CRM in BRCA carriers and association of demographic and clinical variables with provider discussion and receipt of testing. Results Of the 1622 participants, 36.1% (159/440) Blacks, 64.5% (579/897) NHW, 49.6% (58/117) Spanish-speaking Hispanics, and 69.0% (116/168) English-speaking Hispanics had BRCA testing, of whom 90 had a pathogenic BRCA mutation. Among BRCA carriers, RRM and RRSO rates were significantly lower among Blacks compared to Hispanics and NHW after controlling clinical and demographic variables (p=0.025 and 0.008, respectively). Compared to NHW, discussion of genetic testing with a provider was 16 times less likely among Blacks (p<0.0001) and nearly two times less likely among Spanish-speaking Hispanics (p=0.04) after controlling clinical and sociodemographic factors. Conclusions Our results suggest lower rates of RRSO among Black compared to Hispanic and NHW BRCA carriers, which is concerning as benefits from genetic testing arise from CRM options. Furthermore, lower BRCA testing rates among Blacks may partially be due to lower likelihood of provider discussion. Future studies are needed to improve cancer risk identification and management practices across all populations to prevent the widening of disparities.

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