“Will It Affect Our Chances of Having Children?” and Feeling “Like a Ticking Bomb” —The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer

Abstract

Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence.Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses.Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important.Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

Reproductive concerns among adolescent and young adult cancer survivors: A scoping review of current research situations

“…Five studies used a self‐designed scale to examine reproductive concerns 8,57–60 . Reproductive concerns were also discussed by survivors in qualitative studies 9,27,43,54,61–68 …”

Psychometric Properties of the Fertility Intention Scale among Patients with Breast Cancer of Childbearing Age in Mainland China

“… 16 A comprehensive evaluation of the fertility intention of patients with breast cancer can facilitate personalized fertility-related care for patients to eliminate reproductive concerns. Furthermore, healthcare providers can assist patients in making informed fertility decisions, 17 thus providing patients with targeted fertility preservation measures. 18 , 19 …”

A experiência da menopausa precoce em mulheres com câncer de mama com idade inferior a 45 anos

“…(colaboradora 1)Apesar de serem aspectos importantes, ligados a feminilidade e identidade, as demandas apresentadas pelas mulheres ainda são pouco consideradas e valorizadas pelos profissionais da saúde, por terem a sobrevivência da paciente como única prerrogativa. Por outro lado, alguns estudos apontam que os profissionais de saúde se sentem pouco capacitados e inseguros para abordar as questões relacionadas à fertilidade durante o tratamento do câncer de mama(BROWN;ARMSTRONG;POTDAR, 2021;SOBOTA;OZAKINCI, 2021).Nenhum [procedimento para preservar a fertilidade]. A médica não deu muita atenção [ao seu desejo de engravidar].…”