Pereira Nigel, Schattman Glenn L
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY.
J Oncol Pract. 2017 Oct;13(10):643-651. doi: 10.1200/JOP.2017.023705. Epub 2017 Aug 15.
Recent developments in cancer diagnostics and treatments have considerably improved long-term survival rates. Despite improvements in chemotherapy regimens, more focused radiotherapy and diverse surgical options, cancer treatments often have gonadotoxic side-effects that can manifest as loss of fertility or sexual dysfunction, particularly in young cancer survivors. In this review, we focus on two pertinent quality-of-life issues in female cancer survivors of reproductive age-fertility preservation and sexual function. Fertility preservation encompasses all clinical and laboratory efforts to preserve a woman's chance to achieve future genetic motherhood. These efforts range from well-established protocols such as ovarian stimulation with cryopreservation of embryos or oocytes, to nascent clinical trials involving cryopreservation and re-implantation of ovarian tissue. Therefore, fertility preservation strategies are individualized to the cancer diagnosis, time interval until initiation of treatments must begin, prognosis, pubertal status, and maturity level of patient. Some patients choose not to pursue fertility preservation, and the conversation then centers around other quality of life issues. Not all cancer treatments cause loss of fertility; however, most treatments can directly impact the physical and psychosocial aspects of sexual function. Cancer treatment is also associated with fear, anxiety, and depression, which can further decrease sexual desire, function, and frequency. Sexual dysfunction after cancer treatment is generally ascertained by compassionate inquiry. Strategies to promote sexual function after cancer treatment include pelvic floor exercises, clitoral therapy devices, pharmacologic agents, as well as couples-based psychotherapeutic and psycho-educational interventions. Quality-of-life issues in young cancer survivors are often best addressed by utilizing a multidisciplinary team consisting of physicians, nurses, social workers, psychiatrists, sex educators, counselors, or therapists.
癌症诊断与治疗方面的最新进展已显著提高了长期生存率。尽管化疗方案有所改进、放射治疗更具针对性且手术选择多样，但癌症治疗往往会产生性腺毒性副作用，可能表现为生育能力丧失或性功能障碍，尤其是在年轻的癌症幸存者中。在本综述中，我们聚焦于育龄期女性癌症幸存者两个相关的生活质量问题——生育力保存和性功能。生育力保存涵盖了所有旨在保留女性未来成为遗传意义上母亲机会的临床和实验室努力。这些努力范围广泛，从成熟的方案，如通过胚胎或卵母细胞冷冻保存进行卵巢刺激，到涉及卵巢组织冷冻保存和再植入的新兴临床试验。因此，生育力保存策略是根据癌症诊断、开始治疗前的时间间隔、预后、青春期状态以及患者的成熟程度进行个体化制定的。一些患者选择不进行生育力保存，那么谈话就围绕其他生活质量问题展开。并非所有癌症治疗都会导致生育力丧失；然而，大多数治疗会直接影响性功能的生理和心理社会方面。癌症治疗还与恐惧、焦虑和抑郁相关，这会进一步降低性欲、性功能和性行为频率。癌症治疗后的性功能障碍通常通过同情询问来确定。促进癌症治疗后性功能的策略包括盆底肌锻炼、阴蒂治疗设备、药物制剂，以及基于夫妻的心理治疗和心理教育干预。年轻癌症幸存者的生活质量问题通常最好通过由医生、护士、社会工作者、精神科医生、性教育工作者、顾问或治疗师组成的多学科团队来解决。
