Factors influencing the provision of fertility counseling and impact on quality of life in adolescents and young adults with cancer

Skaczkowski, Gemma; White, Victoria; Thompson, Kate; Bibby, Helen; Coory, Michael; Orme, Lisa; Conyers, Rachel; Phillips, Marianne; Osborn, Michael; Harrup, Rosemary; Anazodo, Antoinette

doi:10.1080/07347332.2018.1443986

Cited by 38 publications

(51 citation statements)

References 39 publications

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“…These needs range from medical risks such as cancer treatment-specific risk of infertility, offspring health, and pregnancy health risks to psychosocial support, such as disclosing their cancer history to partners. 22 With regard to providers, fertility counseling by oncology providers does not appear to be related to general measures of quality of life, but counseling by fertility specialists may result in improvement in satisfaction with life over counseling by oncology providers alone. However, there is evidence that fertility counseling does not consistently address specific oncofertility needs.…”

Section: Introductionmentioning

confidence: 99%

Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors

Young

Shliakhtsitsava

Natarajan

et al. 2018

Cancer

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BACKGROUND: Fertility counseling before cancer treatment has been advocated by clinical guidelines, though little is known about its long-term impact on the unique reproductive concerns of female adolescent and young adult (AYA) cancer survivors. The goal of this study was to measure the association between fertility counseling by fertility specialists before cancer treatment and subsequent reproductive concerns. METHOD: A cross-sectional analysis was performed among 747 AYA survivors aged 18-40 years who had been recruited from cancer registries and physician and advocacy group referrals between 2015 and 2017. Participants self-reported information on past fertility counseling at cancer diagnosis, cancer type and treatment, and current reproductive concerns, as measured using the multidimensional Reproductive Concerns After Cancer scale. Multivariable log-binomial regression models tested associations between fertility counseling and reproductive concerns. RESULTS: The mean age of the cohort was 33.0 years (standard deviation, 5.1 years), and the mean period since diagnosis was 7.7 years (standard deviation, 5.0 years). Seventy-three percent of participants were white, and 24% were Hispanic. Fertility counseling was reported by 19% of survivors; moderate to high overall reproductive concerns were reported by 44% of participants. In adjusted analysis, fertility counseling was significantly associated with moderate to high reproductive concerns (risk ratio, 1.22; 95% confidence interval, 1.02-1.45) and not modified by exposure to fertility-threatening treatments (P interaction = .23). CONCLUSION: A large proportion of AYA cancer survivors across cancer types and treatment exposures reported moderate to high reproductive concerns, suggesting that there is a need to address these cancer-specific reproductive health concerns after treatment. Higher concerns, even with counseling, suggests the need to improve the quality of fertility counseling throughout the cancer continuum. Cancer 2019;125:980-989.

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Section: Introductionmentioning

confidence: 99%

Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors

Young

Shliakhtsitsava

Natarajan

et al. 2018

Cancer

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“…has identified an improvement in resources and referral pathways since this study; however, clear and direct pathways have not been effectively established in all Australian facilities . In a recent study, up to 75% of AYAs in Australia reportedly entered into a discussion regarding fertility preservation during their care; however, only 59% were offered a consultation with a fertility specialist . Documentation of these discussions is not always optimal; while survey studies of patients recall discussions with their clinicians, reportedly only 47% of AYAs had a documented fertility discussion in their clinical notes in a recent population‐based Australian study .…”

Section: Resultsmentioning

confidence: 89%

“…Site‐specific pathways are needed to ensure all patients have access to fertility preservation discussions as part of holistic oncology treatment, especially when considering prepubertal patients . Rates of referral for fertility consultation are considerably higher where a specific youth service or adolescent clinic is pre‐existing and as such, a global recommendation to establish more specialist youth fertility clinics would likely overcome the barrier of sub‐optimal referral pathways …”

Section: Resultsmentioning

confidence: 99%

Fertility preservation in oncology patients: A literature review examining current fertility preservation techniques and access to oncofertility services in Australia

Robson

Phua

Howard

et al. 2019

Aust NZ J Obst Gynaeco

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Background In Australia, between the years 2010 and 2014, over 4500 adolescents and young adults (15–25 years old) were diagnosed with cancer. Treatment regimens are often gonadotoxic and are well known to induce ovarian and testicular failure. Oncofertility is an emerging discipline in obstetrics and gynaecology which seeks to preserve and restore the reproductive future of cancer patients. Aim To perform a systematic literature review to assess the current fertility preservation techniques available to patients and examine access and uptake of fertility preservation in Australia. Materials and Methods Electronic databases, including Medline, Cochrane Review, SCOPUS and CINHAL, were searched for peer‐reviewed publications and national guidelines examining oncofertility practices from 2008 to July 2018. Three hundred and seventy‐five articles were initially screened, with 158 articles for full text review and an additional five clinical guidelines were identified. Results There is a paucity of Australian data on oncofertility with <50% of data included for analysis reflecting the Australian experience. The majority of primary research included retrospective papers with small cohort numbers. Key areas addressed included live birth outcomes, uptake of services and patient and physician perspectives on fertility preservation. Few articles sought to examine the positive and negative side effects of fertility preservation in oncology, social challenges of oncofertility and access to services worldwide. Conclusion Oncofertility is an emerging discipline which seeks to provide safe, efficient and effective fertility preservation options for young adults and adolescents diagnosed with cancer. A multi‐disciplinary approach with collaborative communication with oncologists is key to providing this service within Australia.

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“…The data presented here form part of a larger study of AYAs' experiences of cancer care in Australia . This was a cross‐sectional, retrospective self‐report survey on cancer care experiences.…”

Section: Methodsmentioning

confidence: 99%

Do Australian adolescents' and young adults' experiences of cancer care influence their quality of life?

et al. 2018

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The results suggest that, for most AYAs' quality of life outcomes, positive experiences of age-appropriate communication and emotional support may underpin the effect of positive experiences of care throughout the cancer care pathway. The results support the need for communication and support tailored to an AYA audience, as recognised by recent Australian and international guidelines on the care of AYAs with cancer.

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Factors influencing the provision of fertility counseling and impact on quality of life in adolescents and young adults with cancer

Abstract: Providing a sensitive and proactive discussion about fertility-related risks may benefit AYAs' well-being. Services with an AYA focus are fulfilling their mandate of ensuring optimal fertility-related care for AYA cancer patients.

Cited by 38 publications

References 39 publications

Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors

Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors

Fertility preservation in oncology patients: A literature review examining current fertility preservation techniques and access to oncofertility services in Australia

Do Australian adolescents' and young adults' experiences of cancer care influence their quality of life?

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