Fertility-related worry among emerging adult cancer survivors

Cherven, Brooke; Kelling, Erin; Lewis, Rebecca Williamson; Pruett, Megan; Meacham, Lillian R.; Klosky, James L.

doi:10.1007/s10815-022-02663-1

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…This study characterized factors associated with fertility perception and estimated the accuracy of perceived infertility risk among female AYA cancer survivors. Studying risk perceptions directly is of interest because they are precursors to health behaviors, including information seeking and medical care compliance 40 ; they are distinct from measures of reproductive concerns, 41 , 42 which only measure a component of risk perception. 43 , 44 Both estimated gonadotoxicity of cancer treatment and absent or irregular menses were associated with higher infertility risk perception.…”

Section: Discussionmentioning

confidence: 99%

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Din,

Singh-Carlson,

Corliss

et al. 2023

JAMA Netw Open

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ImportanceFertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population’s fertility perceptions and their alignment with objective infertility risk are scant.ObjectiveTo assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception.Design, Setting, and ParticipantsThis retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022.ExposuresParticipants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review.Main Outcomes and MeasuresParticipants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk.ResultsThis study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation.Conclusions and RelevanceIn this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.

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Section: Discussionmentioning

confidence: 99%

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Din,

Singh-Carlson,

Corliss

et al. 2023

JAMA Netw Open

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“…The majority of research conducted within the nursing discipline intentionally incorporates opportunities for training and mentoring of young investigators (YIs). Traineeship opportunities across the past decade, made possible through cooperative group infrastructure support grants (U10CA098543 and U10CA180886), have yielded opportunities for mentored and independent YI projects aligned with the discipline's key aims 29–37 . Additionally, valuable training opportunities supported through funding sources beyond the cooperative group have yielded outstanding opportunities for doctorally prepared YI nurses, advanced practice nurses, and direct‐care nurses to engage in scientific discovery 38–48 .…”

Section: Organizational Structure Of the Nursing Disciplinementioning

confidence: 99%

“…Cherven et al 37 Cherven et al 36 Delivery of care for pediatric patients receiving blinatumomab Original research project U10CA180886 Thompson et al 52…”

Section: Weight Change During All Induction and Obesitymentioning

confidence: 99%

“…Traineeship opportunities across the past decade, made possible through cooperative group infrastructure support grants (U10CA098543 and U10CA180886), have yielded opportunities for mentored and independent YI projects aligned with the discipline's key aims. [29][30][31][32][33][34][35][36][37] Additionally, valuable training opportunities supported through funding sources beyond the cooperative group have yielded outstanding opportunities for doctorally prepared YI nurses, advanced practice nurses, and direct-care nurses to engage in scientific discovery. [38][39][40][41][42][43][44][45][46][47][48] Findings from these projects have contributed to new knowledge generated by the work of the discipline (Table 3).…”

Section: Nursing Research Subcommitteementioning

confidence: 99%

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Children's Oncology Group 2023 blueprint: Nursing discipline

Zupanec,

Herriage,

Landier

2023

Pediatric Blood & Cancer

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In contrast to other Children's Oncology Group (COG) committees, the COG nursing discipline is unique in that it provides the infrastructure necessary for nurses to support COG clinical trials and implements a research agenda aimed at scientific discovery. This hybrid focus of the discipline reflects the varied roles and expertise within pediatric oncology clinical trials nursing that encompass clinical care, leadership, and research. Nurses are broadly represented across COG disease, domain, and administrative committees, and are assigned to all clinically focused protocols. Equally important is the provision of clinical trials‐specific education and training for nurses caring for patients on COG trials. Nurses involved in the discipline's evidence‐based practice initiative have published a wide array of systematic reviews on topics of clinical importance to the discipline. Nurses also develop and lead research studies within COG, including stand‐alone studies and aims embedded in disease/ treatment trials. Additionally, the nursing discipline is charged with responsibility for developing patient/family educational resources within COG. Looking to the future, the nursing discipline will continue to support COG clinical trials through a multifaceted approach, with a particular focus on patient‐reported outcomes and health equity/disparities, and development of interventions to better understand and address illness‐related distress in children with cancer.

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“…For example, gonadotoxic therapies (e.g., radiation, alkylating chemotherapy) place survivors at increased risk for infertility [ 5 – 7 ]. Accordingly, most childhood cancer survivors treated with gonadotoxic therapies report reproductive concerns and worry about infertility [ 8 – 10 ]. These concerns often increase as survivors become older and more aware of the potential adverse effects of their prior disease and treatment.…”

Section: Introductionmentioning

confidence: 99%

Contraceptive methods and fertility testing in young adult survivors of childhood cancer

Cherven

Quast

Klosky

et al. 2023

J Assist Reprod Genet

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Purpose Reproductive health is important, but often neglected in cancer survivorship care. This study explored contraceptive use and factors associated with fertility testing among young adult survivors of childhood cancer in Germany. Methods Young adult survivors of childhood cancer were identified through the German Childhood Cancer Registry and completed a mailed survey. Survivors were queried regarding contraceptive use, reproductive goals, uncertainty about fertility, and completion or interest in fertility testing. Multivariable stepwise logistic regression models were used to calculate Odds Ratios (OR) and 95% confidence intervals (CI) as a means of identifying factors associated with completion of and interest in fertility testing. Results Survivors (N = 472; 57.8% female; aged 23.3 ± 1.5 years, and 14.9 ± 5.0 years from diagnosis), reported high rates of contraceptive use, including 61.2% using a single method, 30.6% dual methods, and 8.1% no/less effective methods. Few survivors had completed fertility testing (13.0%), although 58.8% were interested. Having been diagnosed during adolescence (OR = 2.66, 95%CI: 1.39–5.09), greater uncertainty about fertility (OR = 1.16, 95%CI: 1.03–1.31), and use of dual contraceptive methods (OR = 1.94, 95%CI: 1.02–3.69) were associated with having completed fertility testing. Factors associated with interest in fertility testing included goals of wanting to have children (OR = 7.76, 95%CI: 3.01–20.04) and greater uncertainty about fertility (OR = 1.19 95%CI: 1.06–1.33). Conclusion In this sample of young adults who survived childhood cancer, most reported contraceptive use. Few survivors had completed fertility testing, although more than half were interested. Interventions are needed to address potential barriers to fertility testing and help survivors manage fertility-related uncertainty.

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Fertility-related worry among emerging adult cancer survivors

Cited by 8 publications

References 35 publications

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Children's Oncology Group 2023 blueprint: Nursing discipline

Contraceptive methods and fertility testing in young adult survivors of childhood cancer

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