Fertility-Related Perceptions and Impact on Romantic Relationships Among Adult Survivors of Childhood Cancer

Lehmann, Vicky; Nahata, Leena; Ferrante, Amanda C.; Hansen‐Moore, Jennifer; Yeager, Nicholas D.; Klosky, James L.; Gerhardt, Cynthia A.

doi:10.1089/jayao.2017.0121

Cited by 34 publications

(58 citation statements)

References 32 publications

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“…At that time, 28 survivors were lost to follow‐up, and two had died. Thus, a maximum of 119 survivors received a mailed invitation letter, and 92 (77.3%) completed the online survey . Upon completion, participants were invited to also complete a phone interview.…”

Section: Methodssupporting

confidence: 90%

The perceived impact of infertility on romantic relationships and singlehood among adult survivors of childhood cancer

et al. 2019

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Objective To examine whether adult survivors of childhood cancer perceive a direct impact of potential/confirmed infertility on their romantic relationships/singlehood. Methods Open‐ended qualitative phone interviews were conducted with 57 adult survivors of childhood cancer and analyzed through thematic content analysis until saturation was reached (N = 30). Results Interviews revealed three major themes: (1) impact on survivors, (2) impact on partners/romantic relationships, and (3) alternative routes to parenthood. An overarching theme related to (4) timing also emerged. In describing the impact on themselves, survivors shared subthemes of (1.1) becoming aware of infertility as potential late effect of childhood cancer treatment and (1.2) their emotional reactions (ie, worries/concerns, distress, guilt, no emotional reaction). The impact on partners/romantic relationships also included subthemes: (2.1) partner communication, (2.2) partner reactions, and (2.3) the journey of active family planning. Conclusions The perceived impact of potential/confirmed infertility on romantic relationships of adult survivors of childhood cancer varied across individuals and time. Its presence or absence depends on life circumstances (eg, marital status, life goals), and if present, negative effects were typically resolved over time by having a pregnancy. Other survivors found joy and comfort in step‐children, considering adoption, or embracing a life without children. While more research is needed, findings indicate that discussions about infertility and fertility testing should be tailored to individual survivors and their needs, which may change over time. Timely referrals to reproductive specialists or adoption agencies are recommended for those who want children and have difficulties conceiving.

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Section: Methodssupporting

confidence: 90%

The perceived impact of infertility on romantic relationships and singlehood among adult survivors of childhood cancer

et al. 2019

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“…For those of younger age, actual family planning might not have started yet, whereas older participants potentially have had a history of trying and disappointment. Correspondingly, previous research has found that cancer survivors struggle with reproductive concerns irrespective of their age, previous efforts to become pregnant, and even already existing children . Thus, having children as well as remaining childless appear to be crucial issues over the entire life span of cancer survivors of both sexes …”

Section: Discussionmentioning

confidence: 93%

“…However, as the majority of cancer survivors have expressed a wish for having children, failing to address issues of fertility and concerns about parenthood might implicate uncertainties, distress, and missed opportunities . Importantly, cancer survivors of both sexes have stated that infertility strained their romantic relationships . Thus, CCS should be supported in decisions around fertility testing and treatments, alternative approaches such as surrogacy or adoption, and also in processing grief and disappointment.…”

Section: Discussionmentioning

confidence: 99%

“…Correspondingly, previous research has found that cancer survivors struggle with reproductive concerns irrespective of their age, previous efforts to become pregnant, and even already existing children. 11,16,17,33 Thus, having children as well as remaining childless appear to be crucial issues over the entire life span of cancer survivors of both sexes. 16,20,33…”

Section: Discussionmentioning

confidence: 99%

“…6,7,31 Importantly, cancer survivors of both sexes have stated that infertility strained their romantic relationships. 33 Thus, CCS should be supported in decisions around fertility testing and treatments, alternative approaches such as surrogacy or adoption, 38 and also in processing grief and disappointment. More research is needed to investigate emotional aspects of parenthood after cancer in men and women, ideally in conjunction with fertility.…”

Section: Discussionmentioning

confidence: 99%

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The desire for children among adult survivors of childhood cancer: Psychometric evaluation of a cancer‐specific questionnaire and relations with sociodemographic and psychological characteristics

et al. 2019

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Objective Long‐term childhood cancer survivors (CCS) are less likely to become parents than their peers of the same age. Previous research has suggested that besides fertility, this outcome is shaped by psychosocial factors such as emotional motives toward having a child. Drawing from a sample of CCS with survival times >25 years, we present the validation of a questionnaire assessing cancer‐specific reproductive motives and concerns. Methods We evaluated the cancer‐specific version of the Leipzig Questionnaire of Motives to have a Child (LKM‐C) in a register‐based sample of adult CCS (N = 632, 31% had children, 44.5% women). We conducted a confirmatory factor analysis and tested associations with sociodemographic characteristics and psychological symptoms (PHQ‐9, GAD‐2). Results The questionnaire showed good item discrimination parameters and reliability (α = 0.86). The two‐factorial structure was confirmed with the independent scales “return to normalcy” and “illness‐related worries (child's/own health).” On average, CCS reported more motives in favor of a child than worries (P < .001; d = 1.12). Favorable attitudes were associated with the presence of a partnership and children, stronger current desire for a child, and fewer depressive symptoms. Worries were associated with an unfulfilled desire to have a child and elevated levels of depression and anxiety symptoms. Conclusions The LKM‐C offers a brief measure of parenthood motivations in long‐term CCS. Having a child signifies return to normalcy, health, fulfillment of life perspectives, and enrichment of the partnership. Less intense worries included illnesses of the child and concerns regarding one's own health. The questionnaire could inform follow‐up care, psychotherapy, and fertility treatments.

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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 Perceptions and Impact on Romantic Relationships Among Adult Survivors of Childhood Cancer

Cited by 34 publications

References 32 publications

The perceived impact of infertility on romantic relationships and singlehood among adult survivors of childhood cancer

The perceived impact of infertility on romantic relationships and singlehood among adult survivors of childhood cancer

The desire for children among adult survivors of childhood cancer: Psychometric evaluation of a cancer‐specific questionnaire and relations with sociodemographic and psychological characteristics

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

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