Reproductive Health Experiences of Females Diagnosed with Young-Onset Colorectal Cancer: A Multi-Method Cross-Sectional Survey

Abstract

Objective: Given the increasing risk of young-onset colorectal cancer (yCRC) among adults under 50 years, it is important to understand impacts on reproductive health. Our objective was to assess experiences with reproductive health after yCRC diagnosis among females. Methods: We conducted a cross-sectional study among females, 18 years or older, who have been diagnosed yCRC and are able to communicate in English. Data were gathered using an online survey involving both quantitative (e.g., multiple choice) and qualitative (e.g., open-ended text) questions on pregnancy history, influence of yCRC on reproductive decisions, and experiences with reproductive healthcare. Results: Altogether, 101 females with yCRC participated, including 23 who had never been pregnant and 78 who had been pregnant. yCRC influenced family planning goals for one-third of participants. Furthermore, compared to participants who completed treatment, those currently undergoing treatment had higher odds of indicating their yCRC diagnosis influenced family planning goals (adjusted odds ratio 4.93; 95% confidence interval 1.29 to 18.78). Although 53 (52.5%) participants indicated having discussions regarding reproductive health with healthcare provider(s), 44 (43.6%) did not. Content analysis of open-ended survey questions identified themes on the emotional impacts, experiences with reproductive healthcare, reproductive and family planning considerations, and the related issue of sexual health impacts of yCRC. Conclusions: Gaps in care, related to limited reproductive health discussions, influence of yCRC on family planning, and experiencing lasting reproductive health impacts highlight the need for improving reproductive healthcare, particularly for females diagnosed with yCRC.

“Too young to have this kind of diagnosis”: A qualitative exploration of younger adults' experiences of colorectal cancer diagnosis

“…Our findings are particularly relevant to health care systems similar to Australia's where primary care plays a central role in facilitating access to secondary care services. The life‐stage considerations identified in our study were consistent with existing literature, including reproductive plans, 30 career development, 28 and care of young families 29 . While previous studies have identified these factors as important in treatment decisions, our study suggests they are also important in diagnostic decisions, with care of young children and busy employment schedules as reasons for prolonging time to testing.…”

“…While previous work from North America has identified stage-oflife considerations associated with young-onset CRC treatment, 28,30 to our knowledge this is the first time they have been explored in the Australian context in the diagnostic period. Our findings are particularly relevant to health care systems similar to Australia's where primary care plays a central role in facilitating access to secondary care services.…”

Understanding the treatment experiences of adults diagnosed with early‐onset colorectal cancer: A qualitative study

“…European Society for Medical Oncology guidelines state that, “all cancer patients of reproductive age should receive complete oncofertility counselling as early as possible in the treatment planning process, irrespective of type and stage of disease.” 31 However, our study demonstrates a gap between guidelines and clinical practice in early‐onset CRC. Similarly, a study published in 2022 found that 43.6% of female early‐onset CRC patients had no discussion with HCP about this area of their lives ( n = 101, 24% of these receiving active treatment) 32 . Our findings also highlight conflict between whether to prioritise cancer treatment or fertility preservation in early‐onset CRC patients, as has been observed in other cancers 33 …”

“…Similarly, a study published in 2022 found that 43.6% of female early-onset CRC patients had no discussion with HCP about this area of their lives (n = 101, 24% of these receiving active treatment). 32 Our findings also highlight conflict between whether to prioritise cancer treatment or fertility preservation in early-onset CRC patients, as has been observed in other cancers. 33 Our findings show a lack of discussion regarding sex and intimacy.…”