Fertility concerns among child and adolescent cancer survivors and their parents: A qualitative analysis

ABSTRACT

Cancer diagnoses and treatment may have long-term effects on fertility. Semistructured interviews were administered to young cancer survivors (<20 years) and their parents (n = 97). Fertility related concerns were reported by 45 participants (46.4%). Themes included: distress regarding potential infertility; the effect of infertility on future relationships, self-esteem, and miscommunications/confusion about fertility status; access to fertility testing; and preservation options. Parents also reported challenges regarding how and when it was developmentally appropriate to talk to their children about fertility. The development of comprehensive consumer-driven approaches to managing the fertility concerns of young survivors and their families is essential.     

Epidemiologic differences between women with colorectal cancer and women with ovarian cancer

BACKGROUND AND OBJECTIVES: The difference between the epidemiologic features of women with colorectal cancer and those with ovarian cancer has not been thoroughly studied. The aim of this study is to review the epidemiologic features of women with colorectal cancer and compare them with those of women with ovarian cancer. METHODS: The epidemiologic features of 705 women with colorectal cancer were compared with those of 503 women with primary epithelial ovarian cancer. Both groups included all women with the confirmed respective histologic diagnoses admitted to Roswell Park Cancer Institute between 1982 and 1996 who returned a voluntary self-administered epidemiologic questionnaire. RESULTS: Women with ovarian cancer were significantly younger, had higher education and income, had fewer children, and were more likely to have never been married and nulligravid than those with colorectal cancer. There was a significant difference in the contraceptive history between both groups among women > or = 45 years of age. More women with ovarian cancer had a family history of ovarian cancer and more women with colorectal cancer had a family history of colorectal cancer. CONCLUSIONS: The epidemiologic features of women with colorectal cancer are different from those with ovarian cancer. The difference between both groups might indicate difference in the environmental or genetic etiology of both cancers.     

Surgical management of women with ovarian cancer

Ovarian carcinoma remains a leading cause of cancer-related death among women. Proper treatment of ovarian cancer begins with a thorough staging operation and attempt to totally debulk tumor sites. Despite even maximal surgical efforts, most patients with ovarian cancer require systemic or intraperitoneal chemotherapy. Even though aggressive therapies are effective for the treatment of ovarian cancer, recurrence of the disease is common and often necessitates salvage surgical procedures and chemotherapy.     

Psychosocial concerns of Nigerian women with breast and cervical cancer

Cancer has the potential to provoke worries which should be assessed in order to adequately respond to patients' problems. We highlight in this paper the problems that concerned 30 women with cervical cancer (mean age 51.2) and 76 with breast cancer (mean age 44.9), how these concerns affected their emotional lives, and the factors associated with these worries. They were interviewed with the 33-item modified version of a German questionnaire rating psychosocial concerns (FBS) by Sullwold, and Goldberg'rsquo;s General Health Questionnaire (GHQ-12) for psychopathological symptoms. Cervical cancer patients had significantly higher FBS and GHQ-12 scores than breast cancer. Breast cancer cases had FBS scores similar to those of women with sickle cell disease and insulin-dependent diabetes mellitus. The commonest recurrent worries in both groups were depression about their condition (45%), thoughts of death (37%), insomnia (33.3%), bodily odour (30%), impairment of work efficiency (30%) terrifying dreams (27%) and fear of illness being life-long (25%). Over 90% denied experience of worries indicating social stigma. FBS scores were significantly correlated with GHQ scores and both were negatively associated with adequacy of social contacts. These data suggest the need for psychosocial intervention in such cases in Nigeria. © 1998 John Wiley & Sons, Ltd.     

妊娠合并卵巢肿瘤的临床诊断和妊娠结局分析

目的:探讨妊娠合并卵巢肿瘤的临床诊断和妊娠结局,总结预防感染措施。方法:随机选取2011年2月-2013年4月75例妊娠合并卵巢肿瘤患者为研究对象,作为观察组,同时期的75例妊娠合并瘤样病变患者为对照组。从临床表现、辅助检查上比较妊娠合并卵巢肿瘤患者临床特征,并分析其妊娠结局,观察采取预防感染措施后感染发生情况。结果:妊娠合并卵巢肿瘤通常无明显的临床症状,有症状则以恶心呕吐、腹痛等为主。和瘤样病变比较,其肿瘤直径增大明显,肿瘤血流阻力指数下降,孕期肿块均较瘤样病变明显。观察组CA125增高46例,平均值为（31.53±14.73）U/ml,对照组CA125增高41例,平均值为（29.27±12.23）U/ml,两组比较无明显差异性（P>0.05）。两组患者CA199、CEA、AFP检测结果比较差异无统计学意义,均在正常范围内。妊娠合并卵巢肿瘤的妊娠结局以足月产为主,占全部的74.67%,早产和流产占全部的25.33%。在不同时间段有不同的妊娠结局,＜12周以流产为主,12-28周以早产和流产较多,>28周-足月则以足月产为主。感染发生率为4%。结论:妊娠合并卵巢肿瘤通常无临床症状,超声和实验室检查有助于鉴别诊断,早期干预对妊娠结局至关重要。     

Intraperitoneal chemotherapy for women with epithelial ovarian cancer

In 2006, i.p. chemotherapy re-emerged as a controversial topic in debates about the optimal treatment for women with advanced epithelial ovarian cancer. In this paper, we address the rationale behind i.p. chemotherapy, the data supporting its use, the selection of appropriate patients for i.p. chemotherapy, how best to avoid and manage the toxicities observed with i.p. chemotherapy, and directions for future research.     

The perils of a vanishing cohort: a study of social comparisons by women with advanced ovarian cancer

Objective: To examine the role social comparisons play in the experience of ovarian cancer patients and to consider the implications this may have for provision of supportive care services for ovarian cancer patients. Methods: We conducted a longitudinal qualitative study of women with advanced ovarian cancer in Sydney, Australia. Semi‐structured interviews were conducted with women with advanced ovarian cancer over a period of 2.5 years. Social comparisons made by 13 study participants in 33 interviews were extracted and analysed using coding categories based on social comparison theory. Results: Participants favoured downward contrasts and lateral comparisons and avoided downward identifications, upward contrasts and upward identifications. Participants expressed a preference for avoiding contact with ovarian cancer patients, for the company of ‘normal’ others, for normalising information and information that facilitated upward identifications. Conclusions: We suggest that social comparisons made by women with ovarian cancer are influenced by specific clinical factors associated with their diagnosis—in particular, their status as a member of a ‘vanishing cohort’—and argue for further research examining the specific comparison needs and preferences of patients with advanced disease and types of cancer with poor prognoses. Practice implications: These findings raise questions about uniform approaches to the provision of cancer care and suggest that further research may be required to ensure that interventions are appropriately tailored to the supportive care needs of patients with different types and stages of disease. Copyright © 2011 John Wiley & Sons, Ltd.     

Evaluation of the needs and concerns of partners of women at high risk of developing breast/ovarian cancer

This exploratory study investigates the experience of partners of women at high risk of developing breast/ovarian cancer and reports on the partners' views concerning their relationship, communication, future planning, children and childbearing, involvement in decision-making regarding screening and prophylactic measures, and information and support needs. In-depth interviews were conducted with 15 partners. Of these, seven were partners of women who were BRCA1/2 mutation carriers, five were partners of women with unknown mutation status, and three were partners of women who were non-carriers. None of the women had a previous diagnosis of breast or ovarian cancer. Partners of carriers and women with unknown mutation status were found to be more distressed than partners of non-carriers, with partners of mutation carriers reporting the most difficulties. Factors associated with better adjustment and coping for partners included dealing with this situation as a team with their wife, greater involvement in decision-making, satisfaction with their supportive roles and being optimistic. Decision-making difficulties in relation to prophylactic measures, concerns about their children possibly being at increased cancer risk, as well as the need to receive information directly from health professionals and the wish to meet other partners were also discussed.     

Second primary ovarian cancer among women diagnosed previously with cancer.

This study assessed the risk of second primary ovarian cancer among United States women diagnosed previously with invasive cancer. We analyzed data from cancer registries participating in the Surveillance, Epidemiology, and End Results program for women diagnosed with invasive cancer between 1973 and 1996. We calculated the risk [observed (O)/expected numbers (E)] of second primary ovarian cancer by cancer site and age at diagnosis of first primary cancer (<50 years and > or =50 years), race (all, white, and black), and years since first cancer (0-4, 5-9, 10-14, and 15-24 years). Statistical tests and 95% confidence intervals (CI) assumed a Poisson distribution. A significantly increased risk of ovarian cancer was found for women who were aged <50 years at diagnosis with melanoma (O/E = 3.5, 95% CI = 2.1-5.5) or cancer of the breast (O/E = 6.0, 95% CI = 4.9-7.2), cervix (O/E = 4.2, 95% CI = 2.6-6.3), corpus uteri (O/E = 11.9, 95% CI = 7.3-18.4), colon (O/E = 17.9, 95% CI = 11.1-27.3), or ovary (O/E = 4.9, 95% CI = 2.7-8.2). No increased risk was found for women aged > or =50 years. Ovarian cancer risk remained elevated after these first primary cancers 5-9 years after diagnosis; for breast and colon cancer, risk remained elevated 15-24 years after diagnosis. Women > or =50 years at diagnosis with melanoma or cancer of the cervix, corpus uteri, ovary, rectum, or lung and bronchus were at a decreased risk for second primary ovarian cancer. Ovarian cancer risk is higher than expected for women who were diagnosed with certain types of cancer at <50 years of age.     

Fertility preservation in young women with epithelial ovarian cancer

BACKGROUND:

Surgical management of ovarian cancer consists of hysterectomy with bilateral oophorectomy. In young women, this results in the loss of reproductive function and estrogen deprivation. In the current study, the authors examined the safety of fertility‐conserving surgery in premenopausal women with epithelial ovarian cancers.

METHODS:

Women aged ≤50 years with stage IA or IC epithelial ovarian cancer who were registered in the Surveillance, Epidemiology, and End Results database were examined. Patients who underwent bilateral oophorectomy were compared with those who underwent ovarian conservation. A second analysis examined uterine conservation versus hysterectomy. Multivariate Poisson regression models were developed to describe predictors of fertility preservation. Survival was examined using Cox proportional hazards models and the Kaplan‐Meier method.

RESULTS:

In total, 1186 women, including 754 women (64%) who underwent bilateral oophorectomy and 432 women (36%) who underwent ovarian preservation, were identified. Younger age, later year of diagnosis, and residence in the eastern or western United States were associated with ovarian preservation (P < .05 for all). Women with endometrioid and clear cell histologies and stage IC disease were less likely to have ovarian conservation (P < .05). In a Cox model, ovarian preservation had no effect on survival (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.39‐1.20). Young age, later year of diagnosis, residence in the eastern or western United States, single women, mucinous tumors, and patients with stage IA disease were more likely to have uterine preservation (P < .05 for all). In a multivariate model, uterine preservation had no effect on survival (HR, 0.87; 95% CI, 0.62‐1.22).

CONCLUSIONS:

Ovarian and uterine‐conserving surgery were safe in young women who had stage IA and IC epithelial ovarian cancer. Cancer 2009. © 2009 American Cancer Society.     

Predictors of ovarian reserve in young women with breast cancer

Ovarian reserve can be diminished following treatment for breast cancer. This study evaluated biochemical and biophysical parameters of ovarian reserve in these patients. Biochemical and biophysical tests of ovarian reserve were performed simultaneously in young (age 22-42 years), regularly menstruating women with breast cancer (n=22) and age-matched controls (n=24). All tests were performed before (baseline) and after transient ovarian stimulation in the early follicular phase. Patients were recruited both before and after completion of chemotherapy, with some patients being followed up prospectively. Serum samples were analysed for follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol (E(2)), inhibins A and B, and antimullerian hormone (AMH). Biophysical (ultrasound) tests included ovarian volume, antral follicle count (AFC), ovarian stromal blood flow and uterine dimensions. Significant differences were revealed (when compared with the controls) for basal FSH (11.32+/-1.48 vs 6.62+/-0.42 mIU ml(-1), P<0.001), basal AMH (0.95+/-0.34 vs 7.89+/-1.62 ng ml(-1), P<0.001) and basal inhibin B (19.24+/-4.56 vs 83.61+/-13.45 pg ml(-1), P<0.001). Following transient ovarian stimulation, there were significant differences in the increment change (Delta) for inhibin B (3.02+/-2.3 vs 96.82+/-16.38 pg ml(-1), P<0.001) and E(2) (107.8+/-23.95 vs 283.2+/-40.34 pg ml(-1), P<0.01). AFC was the only biophysical parameter that was significantly different between patients and the controls (7.80+/-0.85 vs 16.77+/-1.11, P<0.001). Basal and stimulated biochemical (serum AMH, FSH, inhibin B and E(2)) and biophysical (AFC) tests may be potential markers of ovarian reserve in young women with breast cancer.     

Experience of BRCA1/2 mutation-negative young women from families with hereditary breast and ovarian cancer: a qualitative study

Background

Little is known about the experience of young women who become aware of their parent’s BRCA1 or BRCA2 (BRCA) mutation status as adolescents or young adults. There is also currently a gap in the literature pertaining to those who are found to be negative for their familial mutation. We aimed to investigate the experience of these mutation-negative young women from hereditary breast and ovarian cancer (HBOC) families.

Methods

Using a semi-structured questionnaire we interviewed 8 women. All of the women were non-carriers of their familial mutation and had learned of the mutation in their family as adolescents or young adults at least 6 months prior to undergoing genetic testing. All interviews were audio recorded, transcribed, and independently analyzed by the investigators. This was followed by an in-depth cross-case analysis, enabling the formulation of emergent themes.

Results

The women’s age ranged from 22 to 37 years old and all were of Ashkenazi Jewish descent. Prominent emergent themes from the interviews included the impact of how and when the familial mutation status was disclosed, the factors influencing when a young woman chooses to undergo predictive genetic testing, the predictors of post-test adjustment and risk perception, as well as the impact of familial cancer experience versus the familial mutation.

Conclusions

By eliciting detailed patient narratives we have begun to show that this generation of BRCA mutation-negative young women is likely still affected by the degree of cancer history in their family, even with their understanding of the genetic contribution to disease. Larger studies with tightened participant characteristics, as well as studies involving women from different cultural backgrounds, are needed to further define the experience and needs of true negative young women from HBOC families.