Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA 94115, USA.
J Cancer Surviv. 2012 Sep;6(3):324-32. doi: 10.1007/s11764-012-0227-9. Epub 2012 Jul 3.
We sought to determine what women recall about reproductive health risks (RHR) from cancer therapy at the time of cancer diagnosis in order to identify barriers to reproductive health counseling (RHC) and fertility preservation (FP).
Data were obtained by surveying 1,041 female cancer survivors from the California Cancer Registry. Inclusion criteria included women age 18-40 with a diagnosis of leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, breast or GI cancer diagnosed between 1993 and 2007. Women were asked to respond to an open-ended question: "what did your doctor tell you about how cancer treatment could affect your ability to get pregnant?" Framework analysis was used to identify themes surrounding patient perceptions of RHC.
Of the patients, 51.8 % (361 out of 697) recalled receiving reproductive health counseling and 12.2 % (85 out of 697) recalled receiving FP counseling. Of the patients, 45.3 % (277 out of 612) reported that uncertain prognosis, risk of recurrence or vertical transmission, age, parity, or uncertain desire may have prevented them from receiving timely and essential information on RHRs. Communication barriers included omission of information, failure to disclose RHRs, and presentation of incorrect information on FP.
In a sample of women diagnosed with cancer of reproductive age, almost half did not recall counseling on RHRs and few recalled FP counseling. Communication barriers between physicians and patients regarding fertility may lead to uninformed (reproductive health) RH decisions.
Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.
我们旨在确定女性在癌症诊断时对癌症治疗相关生殖健康风险（RHR）的记忆，以确定生殖健康咨询（RHC）和生育力保存（FP）的障碍。
通过对加利福尼亚癌症登记处的 1041 名女性癌症幸存者进行调查获得数据。纳入标准包括年龄在 18-40 岁之间、1993 年至 2007 年间诊断为白血病、霍奇金病、非霍奇金淋巴瘤、乳腺癌或胃肠道癌的女性。女性被要求回答一个开放式问题：“您的医生告诉您癌症治疗如何影响您怀孕的能力？” 框架分析用于确定患者对 RHC 的看法的主题。
在患者中，51.8%（697 名中有 361 名）回忆说接受了生殖健康咨询，12.2%（697 名中有 85 名）回忆说接受了 FP 咨询。在患者中，45.3%（612 名中有 277 名）报告说，不确定的预后、复发或垂直传播的风险、年龄、产次或不确定的愿望可能使他们无法及时获得有关 RHR 的必要信息。沟通障碍包括信息遗漏、未披露 RHR 以及 FP 信息不正确。
在一组诊断为育龄期癌症的女性中，近一半的人没有回忆起有关 RHR 的咨询，很少有人回忆起 FP 咨询。医生与患者之间关于生育力的沟通障碍可能导致对生殖健康（RH）决策不知情。
许多女性在癌症诊断时可能没有获得足够的有关 RHR 或 FP 的信息。生殖技术的进步和新兴的涵盖 FP 财务成本的组织极大地改变了女性保留生育力的选择。常规和周到的 RHR 和 FP 咨询以及协作式癌症护理将有助于确保为诊断出患有癌症的女性提供服务和信息，以使其能够对其生殖未来做出明智的选择。
