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Fertility information needs and concerns post-treatment contribute to lowered quality of life among young adult female cancer survivors

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Abstract

Background

Cancer treatment may lead to premature menopause and infertility. Young adult female cancer survivors (YAFCS) are often concerned about their fertility and future family-building options, but research is limited on how concerns may affect more general quality of life (QOL) domains. This study examined how fertility factors relate to QOL among YAFCS who received gonadotoxic therapy.

Method

A national sample of YAFCS completed an online, anonymous survey. The survey included investigator-designed questions about perceived fertility information needs (five items; Cronbach’s α = .83) and general QOL (four items; α = .89), the Reproductive Concerns after Cancer Scale (RCACS) and Decisional Conflict Scale (DCS). Analyses included Pearson’s correlation, t tests, and stepwise regression.

Results

Participants (N = 314) were an average of 30 years old (SD = 4.1) and 5 years (SD = 5.4) post-treatment; 31% reported being infertile and 19% had undergone fertility preservation (FP). Overall, QOL was relatively high (M = 7.3, SD = 1.9, range 0–10) and did not vary by fertility status (t[272] = .743, p = .46), prior FP (t[273] = .53, p = .55) or sociodemographic/clinical factors (p’s > .05) except socioeconomic indicators (p’s < .05).In separate models, greater unmet fertility information needs (β = − .19, p = .004) and, among fertile women, greater reproductive concerns (β = − .26, p = .001) related to lower QOL. Among fertile women without prior FP, greater decisional distress about future FP related to lower QOL (β = − .19, p = .03).

Conclusions

These preliminary findings suggest that unaddressed fertility information needs, concerns, and decision distress may affect general QOL among post-treatment YAFCS who hope to have children in the future. Future work should identify ways to optimally incorporate fertility counseling and support resources into survivorship care programs, including referrals to reproductive specialists as appropriate.

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References

  1. Ruddy KJ, Gelber SI, Tamimi RM, Ginsburg ES, Schapira L, Come SE (2014) Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol 32(11):1151–1156. https://doi.org/10.1200/JCO.2013.52.8877

    Article  PubMed  PubMed Central  Google Scholar 

  2. Benedict C, Thom B, Kelvin JF (2015) Young adult female cancer survivors’ decision regret about fertility preservation. J Adolesc Young Adult Oncol 4(4):213–218. https://doi.org/10.1089/jayao.2015.0002

    Article  PubMed  PubMed Central  Google Scholar 

  3. van Dorp W, Mulder RL, Kremer LC, Hudson MM, van den Heuvel-Eibrink MM, van den Berg MH et al (2016) Recommendations for premature ovarian insufficiency surveillance for female survivors of childhood, adolescent, and young adult cancer: a report from the international late effects of childhood cancer guideline harmonization group in collaboration with the pancaresurfup consortium. J Clin Oncol 34(28):3440–3450. https://doi.org/10.1200/JCO.2015.64.3288

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zebrack BJ, Block R, Hayes-Lattin B, Embry L, Aguilar C, Meeske KA, Li Y, Butler M, Cole S (2013) Psychosocial service use and unmet need among recently diagnosed adolescent and young adult cancer patients. Cancer 119(1):201–214. https://doi.org/10.1002/cncr.27713

    Article  PubMed  Google Scholar 

  5. Murphy D, Klosky JL, Termuhlen A, Sawczyn KK, Quinn GP (2013) The need for reproductive and sexual health discussions with adolescent and young adult cancer patients. Contraception 88(2):215–220. https://doi.org/10.1016/j.contraception.2012.08.041

    Article  PubMed  Google Scholar 

  6. Murphy D, Orgel E, Termuhlen A, Shannon S, Warren K, Quinn GP (2013) Why healthcare providers should focus on the fertility of AYA cancer survivors: it’s not too late! Front Oncol 3:248. https://doi.org/10.3389/fonc.2013.00248

    Article  PubMed  PubMed Central  Google Scholar 

  7. Canada AL, Schover LR (2012) The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology 21(2):134–143. https://doi.org/10.1002/pon.1875

    Article  PubMed  Google Scholar 

  8. Gorman J, Bailey S, Pierce J, Su H (2012) How do you feel about fertility and parenthood? The voices of young female cancer survivors. J Cancer Surviv 6(2):200–209. https://doi.org/10.1007/s11764-011-0211-9

    Article  PubMed  Google Scholar 

  9. Halliday LE, Boughton MA, Kerridge I (2014) Mothering and self-othering: the impact of uncertain reproductive capability in young women after hematological malignancy. Health Care Women Int 35(3):249–265. https://doi.org/10.1080/07399332.2013.770005

    Article  PubMed  Google Scholar 

  10. Halliday LE, Boughton MA (2011) Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women. Nurs Inq 18(2):135–142. https://doi.org/10.1111/j.1440-1800.2011.00532.x

    Article  PubMed  Google Scholar 

  11. Dryden A, Ussher JM, Perz J (2014) Young women’s construction of their post-cancer fertility. Psychol Health 29(11):1341–1360. https://doi.org/10.1080/08870446.2014.932790

    Article  PubMed  Google Scholar 

  12. Crawshaw M (2013) Psychosocial oncofertility issues faced by adolescents and young adults over their lifetime: a review of the research. Hum Fertil (Camb) 16(1):59–63. https://doi.org/10.3109/14647273.2012.733480

    Article  Google Scholar 

  13. Gorman JR, Su HI, Roberts SC, Dominick SA, Malcarne VL (2015) Experiencing reproductive concerns as a female cancer survivor is associated with depression. Cancer 121(6):935–942. https://doi.org/10.1002/cncr.29133

    Article  PubMed  Google Scholar 

  14. Thewes B, Meiser B, Taylor A, Phillips KA, Pendlebury S, Capp A, Dalley D, Goldstein D, Baber R, Friedlander ML (2005) Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 23(22):5155–5165. https://doi.org/10.1200/JCO.2005.07.773

    Article  PubMed  CAS  Google Scholar 

  15. Zebrack B (2009) Information and service needs for young adult cancer survivors. Support Care Cancer 17(4):349–357. https://doi.org/10.1007/s00520-008-0469-2

    Article  PubMed  Google Scholar 

  16. Kent EE, Arora NK, Rowland JH, Bellizzi KM, Forsythe LP, Hamilton AS, Oakley-Girvan I, Beckjord EB, Aziz NM (2012) Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. Patient Educ Couns 89(2):345–352. https://doi.org/10.1016/j.pec.2012.08.014

    Article  PubMed  PubMed Central  Google Scholar 

  17. Benedict C, Shuk E, Ford JS (2016) Fertility issues in adolescent and young adult cancer survivors. J Adolesc Young Adult Oncol 5(1):48–57. https://doi.org/10.1089/jayao.2015.0024

    Article  PubMed  PubMed Central  Google Scholar 

  18. Levine JM, Kelvin JF, Quinn GP, Gracia CR (2015) Infertility in reproductive-age female cancer survivors. Cancer 121(10):1532–1539. https://doi.org/10.1002/cncr.29181

    Article  PubMed  Google Scholar 

  19. Crawshaw MA, Sloper P (2010) ‘Swimming against the tide’—the influence of fertility matters on the transition to adulthood or survivorship following adolescent cancer. Eur J Cancer Care (Engl) 19(5):610–620. https://doi.org/10.1111/j.1365-2354.2009.01118.x

    Article  CAS  Google Scholar 

  20. Quinn GP, Murphy D, Knapp CA, Christie J, Phares V, Wells KJ (2013) Coping styles of female adolescent cancer patients with potential fertility loss. J Adolesc Young Adult Oncol 2(2):66–71. https://doi.org/10.1089/jayao.2012.0038

    Article  PubMed  PubMed Central  Google Scholar 

  21. Armuand GM, Wettergren L, Rodriguez-Wallberg KA, Lampic C (2015) Women more vulnerable than men when facing risk for treatment-induced infertility: a qualitative study of young adults newly diagnosed with cancer. Acta Oncol 54(2):243–252. https://doi.org/10.3109/0284186X.2014.948573

    Article  PubMed  Google Scholar 

  22. Benedict C, Thom B, N. Friedman D, Diotallevi D, M. Pottenger E, J. Raghunathan N et al (2016) Young adult female cancer survivors’ unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation. Cancer 122(13):2101–2109. https://doi.org/10.1002/cncr.29917

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gorman JR, Su HI, Pierce JP, Roberts SC, Dominick SA, Malcarne VL (2014) A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors. J Cancer Surviv 8(2):218–228. https://doi.org/10.1007/s11764-013-0333-3

    Article  PubMed  Google Scholar 

  24. Reed D, Block RG, Johnson R (2014) Creating an adolescent and young adult cancer program: lessons learned from pediatric and adult oncology practice bases. J Natl Compr Cancer Netw 12(10):1409–1415. https://doi.org/10.6004/jnccn.2014.0138

    Article  Google Scholar 

  25. Ferrell BR, Dow KH, Grant M (1995) Measurement of the quality of life in cancer survivors. Qual Life Res 4(6):523–531. https://doi.org/10.1007/BF00634747

    Article  PubMed  CAS  Google Scholar 

  26. Landwehr MS, Watson SE, Macpherson CF, Novak KA, Johnson RH (2016) The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults. Cancer Med 5(5):863–870. https://doi.org/10.1002/cam4.657

    Article  PubMed  PubMed Central  Google Scholar 

  27. Armuand G, Wettergren L, Rodriguez-Wallberg K, Lampic C (2014) Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis. Support Care Cancer 22(10):2805–2812. https://doi.org/10.1007/s00520-014-2279-z

    Article  PubMed  PubMed Central  Google Scholar 

  28. Deshpande NA, Braun IM, Meyer FL (2015) Impact of fertility preservation counseling and treatment on psychological outcomes among women with cancer: a systematic review. Cancer 121(22):3938–3947. https://doi.org/10.1002/cncr.29637

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Hofstra Northwell School of Medicine, 600 Community Drive, Manhasset, NY, 11030, USA

    Catherine Benedict

  2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Bridgette Thom, Nirupa Raghunathan & Joanne F. Kelvin

  3. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Danielle N. Friedman & Elaine Pottenger

Authors
  1. Catherine Benedict
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  2. Bridgette Thom
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  3. Danielle N. Friedman
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  4. Elaine Pottenger
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  5. Nirupa Raghunathan
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  6. Joanne F. Kelvin
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Correspondence to Catherine Benedict.

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Benedict, C., Thom, B., Friedman, D.N. et al. Fertility information needs and concerns post-treatment contribute to lowered quality of life among young adult female cancer survivors. Support Care Cancer 26, 2209–2215 (2018). https://doi.org/10.1007/s00520-017-4006-z

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  • DOI: https://doi.org/10.1007/s00520-017-4006-z

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