Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätmedizin Berlin, Berlin, Germany.
J Psychosoc Oncol. 2011;29(3):274-85. doi: 10.1080/07347332.2011.563344.
Fertility can be impaired by radiation and chemotherapy among childhood cancer survivors. Therefore, timely and adequate patient counselling about the risk of infertility and preservation methods is needed. The primary study objective was to assess remembered counselling among childhood cancer survivors. As a second objective, the impact of lacking patient counselling on offspring-related attitudes and behaviour was examined. Counselling regarding the late effects of gonadotoxicity that could be recalled by patients was assessed using a questionnaire sent by the German Childhood Cancer Registry. The questionnaire was answered by 2754 adult childhood cancer survivors (53.1% female, mean = 25.7 years). The proportion of patients who could not remember patient counselling about the late effects of chemo-/radiotherapy on fertility decreased significantly over time. In 1980 to 1984 67%, in 2000 to 2004 50% of the patients reported no memories of counselling (p < .001). Counselled patients feared significantly less that their children may have an increased cancer risk (4.4% vs. 6.7%, p = .03). They were also more likely to undergo fertility testing than patients who could not recall counselling (odds ratio = 2.91, 95% confidence interval [2.12, 3.99]). Patients reported an increased memory of patient counselling over the past 25 years. Still, a 50% rate of recalled counselling shows an ongoing need for adequate and especially sustainable counselling of paediatric cancer patients about infertility and other long-term adverse treatment effects. Those who reported a lack of counselling had offspring-related fears more frequently, which stopped them from having children.
生育能力可能会因儿童癌症幸存者的放疗和化疗而受损。因此，需要及时、充分地向患者提供关于不孕风险和保存方法的咨询。主要研究目的是评估儿童癌症幸存者对咨询的记忆。作为第二个目标，研究缺乏患者咨询对与后代相关的态度和行为的影响。通过德国儿童癌症登记处发送的问卷，评估患者可回忆起的与性腺毒性的迟发性影响相关的咨询。该问卷由 2754 名成年儿童癌症幸存者（53.1%为女性，平均年龄 25.7 岁）回答。无法回忆起化疗/放疗对生育能力的迟发性影响的患者咨询比例随时间显著下降。1980 年至 1984 年，有 67%的患者报告没有咨询记忆，而 2000 年至 2004 年则有 50%的患者报告没有咨询记忆（p<.001）。接受咨询的患者明显更少地担心他们的孩子可能有更高的癌症风险（4.4%比 6.7%，p=.03）。与无法回忆起咨询的患者相比，他们更有可能接受生育能力测试（优势比=2.91，95%置信区间[2.12,3.99]）。患者报告称，在过去 25 年中，对患者咨询的记忆有所增加。尽管如此，仍有 50%的患者回忆起咨询，这表明仍需要对儿科癌症患者进行充分且特别可持续的不孕和其他长期不良治疗效果的咨询。那些报告缺乏咨询的人更频繁地担心与后代相关的问题，这阻止了他们生育孩子。
