Efficacy of a web-based women’s health survivorship care plan for young breast cancer survivors: a randomized controlled trial

Su, H. Irene; Stark, Shaylyn S.; Kwan, Brian; Boles, Sarah G; Chingos, Diana T.; Ehren, Jennifer; Gorman, Jessica R.; Krychman, Michael; Romero, Sally A. D.; Mao, Jun J.; Pierce, John P.; Natarajan, Loki

doi:10.1007/s10549-019-05260-6

Cited by 24 publications

(40 citation statements)

References 43 publications

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“…To the best of our knowledge, dimensions of the RCAC scale have been used as intervention outcome measures in only one previously published study. A study by Su et al [ 14 ] assessed 2 dimensions of the RCAC scale—fertility potential and becoming pregnant—as part of a comprehensive survivorship care plan for women with breast cancer, in which the proportion of participants having improved (moving from >3 to ≤3 on the subscale mean) was statistically significantly larger in the IG than in the CG. In the present study, all dimensions of RCAC were used.…”

Section: Discussionmentioning

confidence: 99%

“…Psychosocial interventions for cancer survivors, which may or may not include web-based components, often have a broad scope [ 13 ] and are referred to as survivorship care plans [ 14 ], self-management interventions [ 15 ], or multidimensional programs [ 16 , 17 ]. There is a shortage of interventions targeting both medical and psychosocial concerns regarding fertility and parenthood following cancer.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial

Obol¹,

Wiklander²,

Wettergren³

et al. 2022

JMIR Cancer

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Background Threatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking. Objective This study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer. Methods This randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer—Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care. Results Although 62% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child’s health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low. Conclusions The Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child’s health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer. Trial Registration ISRCTN Registry 36621459; https://www.isrctn.com/ISRCTN36621459

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial

Obol¹,

Wiklander²,

Wettergren³

et al. 2022

JMIR Cancer

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“…They were recruited from the investigators’ prior research studies on reproductive health in AYA survivors. 24,25 Among participants who agreed to be contacted for future studies, we restricted to individuals who received care at either of the two oncology programs and were younger than 45. Participants received recruitment emails, questions were answered by the study team, and consents were signed and returned prior to video focus groups.…”

Section: Methodsmentioning

confidence: 99%

Theory-guided development of fertility care implementation strategies for adolescents and young adult cancer survivors

Dornisch

Yang²,

Gruspe³

et al. 2020

Preprint

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Background: Oncofertility care remains under-implemented across oncology and fertility care settings, with limited tools to scale up effective implementation strategies. Guided by the Consolidated Framework for Implementation Research (CFIR), we aimed to systematically assess factors that influence implementation of oncofertility care and map strategies, particularly electronic health record (EHR)-enabled ones, that fit adult and pediatric oncology care contexts. Methods: Using purposeful sampling, we recruited healthcare providers and female adolescent and young adult (AYA) cancer survivors from a comprehensive cancer center and a freestanding children hospital. Participants underwent semi-structured interviews and focus groups. Using thematic analysis combining inductive codes with CFIR-based deductive codes, we characterized barriers and facilitators to oncofertility care and implementation strategies. Two coders independently coded each transcript, with a third coder resolving discrepancies by consensus. Results: We recruited 19 oncology and fertility providers and 9 AYA survivors. We identified barriers and facilitators to fertility care in the CFIR domains of individual, inner setting, outer setting, and process, allowing us to conceptualize oncofertility care in three necessary stages: screening, referral, and fertility preservation counseling. To fit an adult and a children context, five implementation strategies were mapped: needs screen using a best practice advisory, referral order, telehealth fertility counseling, provider audit and feedback, and a provider educational session. All but provider education are facilitated by the EHR system. Conclusions: An implementation science approach enabled systematic assessment of oncofertility care and co-design of implementation strategies with stakeholders, providing a theory-based approach and scalable EHR tools to support wider dissemination.

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“…There is some support for the idea that these younger survivors were more aware of genitourinary symptoms. For example, trouble having children and loss of fertility due to premature menopause may make younger survivors more likely to report genitourinary symptoms (Ben Charif et al, 2015;Su et al, 2020). In addition, although Bubis and colleagues (2018) did not specifically study breast cancer survivors and genitourinary symptoms, they found that, based upon Cancer Care Ontario's Symptom Management Reporting Database, younger age was a predictor for symptom burden for survivors (Bubis et al, 2018).…”

Section: Consistent With Our Situation Specific Model Of Genitourinary Symptoms In Breastmentioning

confidence: 99%

Genitourinary Symptoms in Breast Cancer Survivors: Prevalence, Correlates, and Relationship With Sexual Functioning

Sheng

Carpenter

Cohee

et al. 2021

ONF

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Efficacy of a web-based women’s health survivorship care plan for young breast cancer survivors: a randomized controlled trial

Cited by 24 publications

References 43 publications

Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial

Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial

Theory-guided development of fertility care implementation strategies for adolescents and young adult cancer survivors

Genitourinary Symptoms in Breast Cancer Survivors: Prevalence, Correlates, and Relationship With Sexual Functioning

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