Lawson Angela K, McGuire Jamie M, Noncent Edernst, Olivieri John F, Smith Kristin N, Marsh Erica E
1 Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
2 Department of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan.
J Womens Health (Larchmt). 2017 Aug;26(8):886-891. doi: 10.1089/jwh.2016.5997. Epub 2017 May 12.
Female cancer patients who are exposed to gonadotoxic chemotherapy are at risk of future infertility. Research suggests that disparities in fertility preservation counseling (FPC) may exist. Previous research is limited by recall bias; therefore, this study examined objective electronic medical chart data regarding FPC at an academic medical center.
This study included reproductive-aged women (18-45 years old) with a diagnosis of breast, gynecological, or hematological cancer and who were exposed to a gonadotoxic chemotherapeutic agent from 2009 to 2013. Chi-square and logistic regression analyses were utilized to analyze disparities in FPC.
Two hundred fifty-nine women met the study criteria. One hundred eighty-one women were diagnosed with breast cancer, 52 with hematological cancer, and 26 with gynecological cancer. 160/259 (62%) women had documented counseling for fertility preservation (FP), 60 (23%) women were not counseled as counseling was determined to be "not applicable," 16 (6%) women were not counseled and no explanation was given for the lack of counseling, and counseling was not documented in 23 (9%) charts. Age, marital status, and racial/ethnic background were related to counseling status. Patients with gynecological or hematological cancer were more likely to be counseled than other patients. Logistic regression results demonstrated that FPC was largely driven by cancer diagnosis.
Although cancer diagnosis was the greatest predictor of FPC, disparities were evident in the counseling of female cancer patients for FP treatment. Equality in counseling female patients for FP treatment is imperative to reduce the risk of emotional harm and future infertility.
接受性腺毒性化疗的女性癌症患者面临未来不孕的风险。研究表明，生育力保存咨询（FPC）可能存在差异。以往的研究受回忆偏倚的限制；因此，本研究在一家学术医疗中心检查了关于FPC的客观电子病历数据。
本研究纳入了2009年至2013年期间诊断为乳腺癌、妇科癌症或血液系统癌症且接受性腺毒性化疗药物治疗的育龄妇女（18 - 45岁）。采用卡方检验和逻辑回归分析来分析FPC中的差异。
259名女性符合研究标准。181名女性被诊断为乳腺癌，52名被诊断为血液系统癌症，26名被诊断为妇科癌症。160/259（62%）的女性有生育力保存（FP）咨询记录，60名（23%）女性因咨询被判定为“不适用”而未接受咨询，16名（6%）女性未接受咨询且未对未咨询给出解释，23份（9%）病历中未记录咨询情况。年龄、婚姻状况和种族/民族背景与咨询状态有关。妇科或血液系统癌症患者比其他患者更有可能接受咨询。逻辑回归结果表明，FPC在很大程度上由癌症诊断驱动。
尽管癌症诊断是FPC的最大预测因素，但在女性癌症患者的FP治疗咨询中差异明显。在女性患者的FP治疗咨询中实现平等对于降低情感伤害风险和未来不孕风险至关重要。
