Fertility-related knowledge and reproductive goals in childhood cancer survivors: short communication

Lehmann, Vicky; Keim, Madelaine C.; Nahata, Leena; Shultz, Emily L.; Klosky, James L.; Tuinman, Marrit A.; Gerhardt, Cynthia A.

doi:10.1093/humrep/dex297

Cited by 50 publications

(61 citation statements)

References 18 publications

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“…Consistent with prior research, 4,11,20 less than one-third of our participants banked sperm before treatment, and most reported no fertilityrelated discussions with their health care providers in survivorship. It is also notable that almost all the survivors reported a desire for children, yet when prioritizing their life goals, more than two-thirds ranked having children lower than health, school/work, romantic relationships, friends, and money.…”

Section: Discussionsupporting

confidence: 85%

“…Beyond pretreatment counseling, ongoing discussions about fertility have been recommended for adolescents and young adults (AYAs) after treatment to: explore potential reproductive concerns and their impact on psychosocial well‐being, address fertility status through testing and counseling, and examine post‐treatment possibilities for FP . Research supports considering post‐treatment FP for female survivors at risk for primary ovarian insufficiency, and there are indications that after treatment, men with oligospermia are at risk for developing azoospermia .…”

Section: Introductionmentioning

confidence: 99%

“…8 Further, mas-Abbreviation: AYA(s), adolescents and young adult(s); CED, cyclophosphamide equivalent dose; FP, fertility preservation; SD, standard deviation turbating to collect a semen sample may be challenging for those with little sexual experience and/or physical and psychological discomfort due to cancer. 7 Beyond pretreatment counseling, ongoing discussions about fertility have been recommended for adolescents and young adults (AYAs) after treatment [9][10][11] to: explore potential reproductive concerns and their impact on psychosocial well-being, 11,12 address fertility status through testing and counseling, 11,13,14 and examine post-treatment possibilities for FP. 10 Research supports considering post-treatment FP for female survivors at risk for primary ovarian insufficiency, 10 and there are indications that after treatment, men with oligospermia are at risk for developing azoospermia.…”

Section: Introductionmentioning

confidence: 99%

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Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Nahata

Caltabellotta

Yeager

et al. 2018

Pediatric Blood & Cancer

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Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility-related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their "top 3" life goals. Only 40% reported fertility-related discussions with their health care providers in survivorship. Given the importance of biological children among this cohort, future guidelines should encourage a more proactive approach to providing fertility counseling and offering testing, to mitigate distress and prevent unplanned pregnancies.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Nahata

Caltabellotta

Yeager

et al. 2018

Pediatric Blood & Cancer

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“…Cancer survivors experience a range of emotional responses to impacted fertility. Distress (self‐reported or measured via the Brief Symptoms Inventory (BSI)), self‐reported upset, sorrow, and sadness were reported in both male and female survivors. As were being overwhelmed or perceiving infertility to be all‐consuming, shock, fear, anger, anxiety, worry, nervousness, 23 and uncertainty …”

Section: Resultsmentioning

confidence: 99%

“…High rates of unknown fertility status (77%), 54 distress, worry (20%-60%), [54][55][56][57][58] and stress (FPI) 21 related to fertility were experienced by survivors, with distress about fertility commensurate with distress about cancer, 59 and concerns reported on a regular basis (daily or weekly, or 25%-90% of the time). 55,56 When considering prevalence of fertility-related psychological distress relative to controls, research indicates that cancer survivors report greater reproductive concerns (P < 0.001) 13 and greater distress about fertility (OR 5.23; CI 55,64 and a fear of dying and leaving children without a mother.…”

Section: Fertility-related Psychological Distressmentioning

confidence: 99%

Systematic review of fertility‐related psychological distress in cancer patients: Informing on an improved model of care

et al. 2018

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Objective Cancer patients experience reproductive concerns from diagnosis through to survivorship. However, research has yet to investigate the degree of fertility‐related psychological distress at different treatment time points: diagnosis, treatment, and survivorship. Currently, cancer patients are offered fertility counselling at the time of diagnosis, to assist fertility preservation decision making. A systematic review of the short‐term and long‐term psychological impact of infertility in cancer patients would inform on an improved, longitudinal model of psychological care. Methods A systematic review of the literature was conducted in January 2018 utilising electronic databases Medline, EMBASE, PSYCH Info, Web of Science, and SCOPUS. An initial search identified 708 potentially relevant studies. Literature was assessed that reported on fertility‐related psychological distress experienced by male and female cancer patients of reproductive age (<45 years) across oncology treatment time points. Results A total of 47 papers were included within the final review. Fertility‐related psychological distress persists from diagnosis through to survivorship, with cancer patients reporting a range of negative emotional experiences brought about by threatened infertility. In survivorship, reproductive concerns, unfulfilled desire for a child, nulliparous status, and early menopause were linked to higher rates of mental health disorders and psychological distress. Conclusions Fertility‐related psychological distress is prevalent and persistent in cancer patients and survivors. As such, patients and survivors would greatly benefit from fertility‐related psychological support implemented into standard practice from diagnosis through to survivorship. A revised model of care is proposed.

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Interest in fertility status assessment among young adult survivors of childhood cancer

et al. 2022

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Background Cancer survivors who received gonadotoxic treatment are at‐risk for future infertility and may desire a fertility status assessment (FSA), defined as semen analysis for males and consultation with a reproductive specialist for females. The purpose of this study was to describe the proportion of, and factors associated with, interest in FSA among young adult survivors of childhood cancer. Methods This retrospective single‐institution review included patients with prior gonadotoxic treatment, aged 18–25 years and >1 year from cancer treatment completion, who received a fertility‐focused discussion during survivorship. Documentation of interest in and completion of FSA, worry about infertility, sociodemographic, and clinical characteristics were abstracted from medical records. Multivariable logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with interest in FSA. Results Survivors ( N = 259) were on average 19.2 ± 1.2 years at their fertility discussion; 55.6% were male and 57.9% non‐Hispanic white. Interest in FSA was reported by 50.7% of males and 46.1% of females. Factors related to interest in FSA for males and females respectively, included worry about infertility (OR 2.40, 95%CI 1.11–5.27, p = 0.026 and OR 4.37, 95%CI 1.71–12.43, p = 0.003) and ≥2 fertility discussions (OR 3.78, 95%CI 1.70–8.75, p = 0.001 and 2.45, 95%CI 1.08–5.67, p = 0.033). Among males, fertility preservation consult/procedure at diagnosis (OR 3.02, 95%CI 1.09–9.04, p = 0.039) and high‐risk for infertility (OR 2.47, 95%CI 1.07–5.87, p = 0.036) were also associated with interest in FSA. Conclusions Cancer survivors are interested in FSA, particularly those who have had repeated fertility‐focused discussions during survivorship care and who report worry about infertility.

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Fertility-related knowledge and reproductive goals in childhood cancer survivors: short communication

Abstract: This study was funded by the Research Institute at Nationwide Children's Hospital (V.L.) and Dutch Cancer Society (RUG2009-4442, M.A.T.). All authors have no conflict of interest to declare.

Cited by 50 publications

References 18 publications

Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Systematic review of fertility‐related psychological distress in cancer patients: Informing on an improved model of care

Interest in fertility status assessment among young adult survivors of childhood cancer

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