影响癌症青少年及青年生育相关讨论记录的因素。
Factors influencing the documentation of fertility-related discussions for adolescents and young adults with cancer.
作者信息
Skaczkowski G, White V, Thompson K, Bibby H, Coory M, Pinkerton R, Nicholls W, Orme L M, Conyers R, Phillips M B, Osborn M, Harrup R, Anazodo A
机构信息
Center for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia; School of Psychology and Public Health, La Trobe University, Bundoora Campus, Bundoora, 3086 VIC, Australia; Olivia Newton-John Cancer Wellness & Research Center, Austin Health, Level 4, 145 Studley Road, Heidelberg, 3084 VIC, Australia.
Center for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia; School of Psychology, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125, Australia.
出版信息
Eur J Oncol Nurs. 2018 Jun;34:42-48. doi: 10.1016/j.ejon.2018.02.007. Epub 2018 Mar 8.
PURPOSE
A cancer diagnosis and treatment may have significant implications for a young patient's future fertility. Documentation of fertility-related discussions and actions is crucial to providing the best follow-up care, which may occur for many years post-treatment. This study examined the rate of medical record documentation of fertility-related discussions and fertility preservation (FP) procedures for adolescents and young adults (AYAs) with cancer in Australia.
METHODS
A retrospective review of medical records for 941 patients in all six Australian states. Patients were identified through population-based cancer registries (four states) and hospital admission lists (two states). Trained data collectors extracted information from medical records using a comprehensive data collection survey. Records were reviewed for AYA patients (aged 15-24 years at diagnosis), diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, central nervous system (CNS) tumours, soft tissue sarcomas (STS), primary bone cancer or Ewing's family tumours between 2007 and 2012.
RESULTS
47.2% of patients had a documented fertility discussion and 35.9% had a documented FP procedure. Fertility-related documentation was less likely for female patients, those with a CNS or STS diagnosis and those receiving high-risk treatments. In multivariable models, adult hospitals with an AYA focus were more likely to document fertility discussions (odds ratio[OR] = 1.60; 95%CI = 1.08-2.37) and FP procedures (OR = 1.74; 95%CI = 1.17-2.57) than adult hospitals with no AYA services.
CONCLUSIONS
These data provide the first national, population-based estimates of fertility documentation for AYA cancer patients in Australia. Documentation of fertility-related discussions was poor, with higher rates observed in hospitals with greater experience of treating AYA patients.
目的
癌症诊断与治疗可能对年轻患者未来的生育能力产生重大影响。记录与生育相关的讨论和措施对于提供最佳的后续护理至关重要，这种护理可能在治疗后持续多年。本研究调查了澳大利亚癌症青少年和青年（AYA）患者生育相关讨论及生育力保存（FP）程序的病历记录率。
方法
对澳大利亚所有六个州的941名患者的病历进行回顾性研究。通过基于人群的癌症登记处（四个州）和医院入院名单（两个州）识别患者。经过培训的数据收集人员使用综合数据收集调查问卷从病历中提取信息。对2007年至2012年间诊断为急性髓系白血病、急性淋巴细胞白血病、中枢神经系统（CNS）肿瘤、软组织肉瘤（STS）、原发性骨癌或尤因家族肿瘤的AYA患者（诊断时年龄为15 - 24岁）的病历进行审查。
结果
47.2%的患者有生育相关讨论的记录，35.9%的患者有FP程序的记录。女性患者、诊断为CNS或STS的患者以及接受高风险治疗的患者进行生育相关记录的可能性较小。在多变量模型中，专注于AYA患者的成人医院比没有AYA服务的成人医院更有可能记录生育相关讨论（优势比[OR]=1.60；95%置信区间[CI]=1.08 - 2.37）和FP程序（OR = 1.74；95%CI = 1.17 - 2.57）。
结论
这些数据首次提供了澳大利亚AYA癌症患者生育记录的全国性、基于人群的估计。生育相关讨论的记录情况较差，在治疗AYA患者经验更丰富的医院中记录率更高。
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