Fertility, sexuality and cancer in young adult women

Condorelli, M.; Lambertini, Matteo; Mastro, Lucia Del; Boccardo, Francesco; Demeestere, Isabelle; Bober, Sharon L.

doi:10.1097/cco.0000000000000540

Cited by 22 publications

(13 citation statements)

References 78 publications

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“…During gonadotoxic therapies, early gynecological adverse effects are a significant issue. In the literature, cancer patients, especially those treated with chemotherapy, report low rates of overall sexual satisfaction and less arousal and pleasure, and these problems are not always adequately addressed (Condorelli et al, 2019;Schover, 2018;Dominick et al, 2015). This requires specific expertise, especially in women who had hormone sensitive cancers and, therefore, limited treatment options (American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice and Farrell, 2016).…”

Section: Discussionmentioning

confidence: 99%

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

et al. 2019

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STUDY QUESTION Are there reasons that motivate young cancer survivors to ask for follow-up visits at an oncofertility unit? SUMMARY ANSWER Cancer survivors request oncofertility follow-up visits for the management of treatment-related side effects or ovarian reserve evaluation, even if not (or not yet) wishing for a pregnancy. WHAT IS KNOWN ALREADY Personalised oncofertility counselling before gonadotoxic therapies is considered standard of care for young women with newly diagnosed cancer. However, the long-term follow-up of these patients in an oncofertility unit is not described in the literature other than for the use of cryopreserved material. STUDY DESIGN, SIZE, DURATION We retrospectively examined rates and reasons for the first follow-up visits of 154 consecutive young female cancer patients (age range: 18–40 years) who underwent a pre-treatment consultation between January 2012 and June 2017. Demographic and clinical data were collected, as well as information about the chosen fertility preservation method, if any. PARTICIPANTS/MATERIALS, SETTING, METHODS Rates and reasons for follow-up visits were collected and expressed as percentages. Different reasons were examined in the whole cohort and stratified for type of malignancy. Possible predictive factors for return to the follow-up visit (age, nulliparity, presence of a partner, neoplasm, having cryopreserved material) were investigated through logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Out of 154 patients, 74 returned to the oncofertility unit (48.1%) for a follow-up visit. The first visit was requested mostly at the end of anticancer therapies (51.3% versus 40.5% during therapies and 8.1% after cancer relapse). Among these patients, only 10.8% returned for the first time because they were actively desiring a pregnancy. For the others, the most common reasons for consultations were management of gynecological adverse effects of therapies (29.7%) and evaluation of ovarian reserve not linked to an immediate desire for a pregnancy (39.2%). Other patients asked for contraception (4.1%), menopause counselling (5.4%), or new fertility preservation counselling because of cancer relapse (10.8%). None of the examined factors were significantly predictive of return to the oncofertility unit. LIMITATIONS, REASONS FOR CAUTION These findings represent the experience of a single centre. A longer duration of follow-up would be needed to provide more precise information on this regard. WIDER IMPLICATION OF THE FINDINGS The role of an oncofertility unit should not be limited to proposing fertility preservation procedures. In the management of young adult cancer patients, the reproductive medical specialist should be considered a key figure not only before but also during and after anticancer treatments to explore salient aspects of gynecological and reproductive health. STUDY FUNDING/COMPETING INTEREST(S) This research did not receive any specific funding. M.L. served as a consultant for Teva and received honoraria from Theramex outside the submitted work. The other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N.A.

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Section: Discussionmentioning

confidence: 99%

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

et al. 2019

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“…Among mid-term toxicities with a strong impact on quality of life, fertility impairment is one of the most important factors in younger patients who are candidates for systemic adjuvant therapies. This issue is of particular importance due to the substantial increase in the incidence of breast cancer in European women in their 20s and 30s (19). According to individual disease characteristics, a relevant proportion of these young women will require adjuvant treatments, including chemotherapy, and will receive drugs associated with different magnitudes of gonadotoxicity.…”

Section: Ovarian Failure and Fertility Preservationmentioning

confidence: 99%

Breast Cancer Survivorship, Quality of Life, and Late Toxicities

et al. 2020

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Breast cancer is the most frequent cancer in women: in 2018, almost two million cases have been diagnosed all over the world and it represents the principal cause of death from a neoplastic disease in women. In the past years, breast cancer prognosis has significantly improved over time: currently 5-year survival rates are in the range of 90%, and 10-year survival is about 80%. This improvement has been mostly observed in western countries, due to high coverage and compliance with screening programs, leading to early diagnosis, i.e., when the disease is at a subclinical level, and to an improvement in tumor molecular characterization and innovative systemic treatments. Yet the identification of different biological breast cancer subtypes prompted the development of innovative targeted agents and improved treatment personalization. On the other hand, longer survival rates and increasing proportions of cured patients require dedicated strategies to manage long-term sequelae of breast cancer treatments, with particular attention to quality of life. This review analyzes the most important issues, potentially occurring with cancer treatments, concerning long-term sequelae and quality of life, to define a global approach to breast cancer survivorship.

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“…The consequences of cancer treatment can influence all aspects of sexuality, including desire, satisfaction and functioning. Sexuality is considered an extremely important quality-of-life concern by cancer survivors [7][8][9]. Despite reporting concerns regarding their sexual function, patients are frequently not informed about how treatment may affect their sexual function [1,10,11].…”

Section: Introductionmentioning

confidence: 99%

Discussing Sexual Health in the Medical Oncologist’s Practice: Exploring Current Practice and Challenges

et al. 2019

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Sexuality is a significant quality-of-life concern for many cancer patients. Patients may be disadvantaged if they are not informed and not offered sexual health care. We sought to reveal oncologists' current practice and opinions concerning sexual counselling. The aim of this study was to explore the knowledge, attitude and practice patterns of Dutch medical oncologists regarding treatment-related sexual dysfunction. Questionnaires were sent to 433 members of the Dutch Society of Medical Oncology. The majority (81.5%) of the 120 responding medical oncologists (response rate 30.6%) stated they discussed sexual function with fewer than half of their patients. At the same time, 75.8% of the participating oncologists agreed that addressing sexual function is their responsibility. Sexual function was discussed more often with younger patients and patients with a curative treatment intent. Barriers for avoiding discussing sexual function were lack of time (56.1%), training (49.5%) and advanced age of the patient (50.4%). More than half (64.6%) stated they had little knowledge about the subject and the majority (72.9%) wanted to acquire additional training in sexual function counselling. Medical oncologists accept that sexual function counselling falls within their profession, yet they admit to not counselling patients routinely concerning sexual function. Only in a minority of cases do medical oncologists inform their patients about sexual side effects of treatment. Whether they counsel patients is related to how they view patient's prognosis, patient's age, and self-reported knowledge. Findings indicate there is a role for developing education and practical training.

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Fertility, sexuality and cancer in young adult women

Cited by 22 publications

References 78 publications

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

Breast Cancer Survivorship, Quality of Life, and Late Toxicities

Discussing Sexual Health in the Medical Oncologist’s Practice: Exploring Current Practice and Challenges

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