Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA.
Stanford Cancer Institute, Palo Alto, CA, USA.
Support Care Cancer. 2021 Apr;29(4):2203-2213. doi: 10.1007/s00520-020-05731-3. Epub 2020 Sep 5.
Fertility is an important issue among adolescent and young adult female (AYA-F) cancer survivors. This study examined AYA-F survivors' unmet needs and recommendations for care to address fertility/family-building in post-treatment survivorship.
Semi-structured interviews (45-60 min) explored themes related to fertility and family-building after cancer. Coding categories were derived based on grounded theory methods. Themes were identified through an iterative process of coding and review.
Participants (N = 25) averaged 29 years old (SD = 6.2; range, 15-39) were primarily White and well educated, and averaged 5.81 years post-treatment (SD = 5.43); 32% had undergone fertility preservation (pre- or post-cancer). Six recommendations for improving care were identified: addressing patient-provider communication, need to provide informational, emotional, and peer support, financial information, and decision-making support. AYA-Fs believed the best way to learn about resources was through online platforms or doctor-initiated discussions. Telehealth options and digital resources were generally considered acceptable. Face-to-face interactions were preferred for in-depth information, when AYA-Fs anticipated having immediate questions or distressing emotions, and with concerns about Internet security. Thus, a combined approach was preferred such that information (via web-based communication) should be provided first, with follow-up in-person visits and referrals when needed.
Informational and support services are needed to better educate patients about gonadotoxic effects and options to have children after cancer treatment is completed. Future work should evaluate how to best support oncology providers in meeting the needs of survivors concerned about fertility and family-building including referral to clinical specialties and supportive resources.
生育能力是青少年和年轻成年女性（AYA-F）癌症幸存者的一个重要问题。本研究考察了 AYA-F 幸存者在癌症治疗后未满足的生育/家庭建设需求和护理建议。
半结构式访谈（45-60 分钟）探讨了与癌症后生育和家庭建设相关的主题。根据扎根理论方法得出编码类别。通过编码和审查的迭代过程确定主题。
参与者（N=25）平均年龄 29 岁（SD=6.2；范围 15-39），主要为白人，受教育程度较高，平均治疗后 5.81 年（SD=5.43）；32%的人接受了生育保护（癌症前或后）。确定了 6 项改善护理的建议：改善医患沟通、提供信息、情感和同伴支持、经济信息和决策支持。AYA-F 认为了解资源的最佳方式是通过在线平台或医生发起的讨论。远程医疗选择和数字资源通常被认为是可以接受的。面对面交流更适合获取深入信息，当 AYA-F 预计会立即出现问题或感到情绪困扰，以及对互联网安全存在担忧时。因此，最好采用结合的方法，即首先通过网络通信提供信息，然后在需要时进行面对面访问和转介。
需要提供信息和支持服务，以便更好地教育患者有关性腺毒性作用以及在癌症治疗完成后生育的选择。未来的工作应该评估如何最好地支持肿瘤学提供者满足关注生育和家庭建设的幸存者的需求，包括向临床专科和支持资源转介。
