Benedict Catherine, Thom Bridgette, Kelvin Joanne F
aDepartment of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset bSurvivorship Center, Memorial Sloan Kettering Cancer Center, New York, USA.
Curr Opin Support Palliat Care. 2016 Mar;10(1):87-94. doi: 10.1097/SPC.0000000000000185.
With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to treatment.
Several barriers prevent fertility from being adequately addressed in the clinical context. Providers' and patients' incomplete or inaccurate understanding of infertility risks exacerbate patients' reproductive concerns. For female patients in particular, making decisions about fertility preservation before treatment often leads to decision conflict, reducing the likelihood of making informed, value-based decisions, and posttreatment regret and distress. Recent empirically based interventions to improve provider training around fertility issues and to support patient decision-making about fertility preservation show promise.
Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in fertility preservation options.
随着生存率的提高，生育能力成为许多年轻癌症患者生活质量的一个重要关注点。迫切需要改善临床护理，以确保患者充分了解不孕风险和生育力保存选择，并在治疗前支持他们做出生殖决策。
在临床环境中，有几个障碍阻碍了生育问题得到充分解决。医护人员和患者对不孕风险的理解不完整或不准确，加剧了患者的生殖担忧。特别是对于女性患者，在治疗前就生育力保存做出决定往往会导致决策冲突，降低做出明智的、基于价值观的决定的可能性，以及治疗后的遗憾和痛苦。最近基于实证的干预措施，旨在改善医护人员围绕生育问题的培训，并支持患者就生育力保存做出决策，显示出了前景。
医护人员应了解与癌症治疗相关的不孕风险，并主动与所有可能希望有孩子的患者讨论生育问题。全面的咨询还应包括相关问题，如避孕措施的使用以及早绝经对健康的影响，无论患者未来是否想要孩子。尽管癌症相关不孕的负面心理社会影响现在已得到广泛认可，但在探索如何在癌症护理背景下改善生育问题的临床管理方面，所做的工作有限。应制定基于证据的干预措施，以消除障碍，并为关注生育能力且对生育力保存选择感兴趣的患者提供心理社会和决策支持。
