Reproductive concerns and psychosocial adjustment of young breast and gynecologic cancer patients

Abstract

Confrontation with breast and gynecologic cancer causes difficulties of psychological adaptation. In young women, the reproductive and gynecologic consequences of the disease and treatments emerge as an additional threat. This study aimed to: (i) analyze depressive symptoms, anxiety, quality of life and reproductive concerns in young women with breast or gynecologic cancer, in comparison with healthy women; (ii) explore the mediator effect of depression and anxiety symptoms on the relation reproductive concerns → quality of life in women with cancer. This transversal study was conducted in "Centro Hospitalar Baixo Vouga II", Aveiro, and through various Facebook pages supporting women with cancer. The sample included 95 women, 52 with breast or gynecologic cancer diagnosis and 43 healthy controls. Participants completed the Reproductive Concerns Scale, the Hospital Anxiety and Depression Scale (HADS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Diagnosed women reported more depressive symptoms, anxiety and reproductive concerns than healthy women (p<0.001). An effect mediation of depressive symptoms (p=0.001) was found. Reproductive concerns affected the quality of life in this population, by being associated with more depression and anxiety symptoms. Although there is currently a careful selection of treatments to preserve fertility, our findings show that the diagnosis of breast or gynecologic cancer in phase I to III leads to concerns and beliefs associated with impaired fertility. This fact results in difficulties of psychological adaptation. Thus, we emphasize the importance of directing the psychological interventions towards this aspect.

Toward an Understanding of the Factors Associated With Reproductive Concerns in Younger Female Cancer Patients

“…In turn, an exploratory study suggested a potential mediator effect of distress on the negative relation between reproductive concerns and QoL. 36 Regarding the association between dimensions of reproductive concerns and sexual function, only small effects were found. A higher effect was found for the negative relation between satisfaction with sex-life and concerns about personal health.…”

“…or gynecological cancer presented higher reproductive concerns than did control groups. 33,36 One study 28 found no group differences when comparing the infertile gynecological or leukemia/ lymphoma/sarcoma cancer survivors (but eligible for third-party reproductive options) with noncancer, infertile women. Descriptive analysis of the quantitative studies reinforces the findings obtained in the qualitative studies, reporting mainly concerns about potential fertility problems in young female cancer patients.…”

“…Regarding statistical procedures, 5 studies used regression analysis (Table 2). Psychosocial variables included depression (n = 1), 37 nonspecific distress symptoms, quality of life (QoL) (n = 2), 22,36 and sexual function. 39 Data pointed to reproductive concerns as a significant predictor of the depressive symptoms of female cancer survivors.…”

“…Nonspecific distress symptoms were significantly associated with these specific concerns in samples of early-stage breast or gynecological cancer patients. 36 Quality of life also seems to be affected by reproduction-related concerns among oncological samples. Here, the literature points to direct 22 and indirect 36 effects of these concerns on the impairment of QoL.…”

“…36 Quality of life also seems to be affected by reproduction-related concerns among oncological samples. Here, the literature points to direct 22 and indirect 36 effects of these concerns on the impairment of QoL. Benedict et al 22 observed that, besides the association between increased reproductive concerns and lower QoL, young adult female cancer survivors with lower QoL reported higher levels of concerns about fertility and greater difficulty in accepting these problems, higher concerns about becoming pregnant, and partner disclosure compared with a group experiencing higher QoL levels.…”