Faculty of Medicine, School of Women and Children's Health, UNSW Australia, Sydney, Australia.
Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.
J Adolesc Young Adult Oncol. 2021 Apr;10(2):131-141. doi: 10.1089/jayao.2020.0157. Epub 2020 Nov 11.
Reproductive complications for cancer survivors are identified as one of the top unmet needs in the survivorship period. However, current models of cancer care do not routinely incorporate reproductive follow-up for pediatric or adolescent cancer patients. The Kids Cancer Centre has had a one-stop survivorship clinic that includes the attendance of a gynecologist and fertility specialist for the last 12 years. To inform the future development of our reproductive survivorship care, we reviewed the reproductive care our survivorship clinic has provided over a 12-year period, specifically reviewing the electronic and patient records to collect information on the demographics of the patients who used the service and their gonadotoxic risk and associated fertility treatment, their documented reproductive needs and concerns, and information provided on preventative reproductive advice and screening. Two hundred seventy-eight patients were seen (397 consultations) for advice and management of reproductive issues, including 189 female patients (68.0%). Survivors' median age at follow-up was 25.0 years (range = 6-50), on average 19.2 years from their primary diagnosis (range = 3-46). The reviewed data had five overarching themes (fertility care, hormone dysfunction, sexual dysfunction, fertility-related psychological distress due to reproductive concerns, and preventative health care), although each theme had a number of components. Patients had on average 2.5 reproductive concerns documented per consultation (range 1-5). The three most commonly documented symptoms or concerns at the initial consultation related to fertility status (43.9%), endocrine dysfunction (35.3%), and contraception advice (32.4%). In patients younger than 25 years, documented discussions were predominately about endocrine dysfunction, fertility status, and contraception, while dominant themes for 26-35-year olds were fertility status, reproductive-related health prevention strategies, contraception, and endocrine dysfunction. Survivors 36-45 years of age prioritized fertility status, pregnancy, and contraception. Fertility preservation (FP) ( = 0.05), preventative health strategies ( = 0.001), and contraception advice ( < 0.001) were more commonly discussed by females than males. Young cancer survivors have multiple ongoing reproductive concerns that change over time. Assessing survivors' reproductive potential following cancer treatment is important as it gives patients who have not completed their family planning an opportunity to explore a possible window to FP or Assisted Reproductive Treatment. Our data can assist in informing the model of care for a reproductive survivorship clinic.
癌症幸存者的生殖并发症被认为是生存期中未满足的首要需求之一。然而，当前的癌症护理模式通常不包括儿科或青少年癌症患者的生殖随访。儿童癌症中心在过去 12 年中一直设有一站式生存诊所，其中包括妇科医生和生育专家的就诊。为了为我们的生殖生存护理的未来发展提供信息，我们回顾了我们的生存诊所在 12 年期间提供的生殖护理，特别审查了电子病历和患者记录，以收集使用该服务的患者的人口统计学信息、他们的性腺毒性风险和相关的生育治疗、他们记录的生殖需求和关注点，以及提供的关于预防性生殖咨询和筛查的信息。有 278 名患者（397 次咨询）接受了有关生殖问题的建议和管理，其中 189 名是女性患者（68.0%）。幸存者随访时的中位年龄为 25.0 岁（范围 6-50 岁），平均距初次诊断 19.2 岁（范围 3-46 岁）。审查的数据有五个总体主题（生育护理、激素功能障碍、性功能障碍、因生殖问题而产生的生育相关心理困扰、预防性保健），尽管每个主题都有许多组成部分。每位患者平均记录了 2.5 项生殖问题（范围 1-5）。首次就诊时最常记录的三个症状或问题与生育状况（43.9%）、内分泌功能障碍（35.3%）和避孕建议（32.4%）有关。在 25 岁以下的患者中，记录的讨论主要集中在内分泌功能障碍、生育状况和避孕方面，而 26-35 岁的主要主题是生育状况、生殖健康预防策略、避孕和内分泌功能障碍。36-45 岁的幸存者则优先考虑生育状况、怀孕和避孕。生育力保存（FP）（ = 0.05）、预防性健康策略（ = 0.001）和避孕建议（ < 0.001）在女性中比男性更常讨论。年轻的癌症幸存者有多个不断变化的生殖问题。评估癌症治疗后幸存者的生育能力很重要，因为它为尚未完成计划生育的患者提供了一个探索可能的 FP 或辅助生殖治疗窗口的机会。我们的数据可以帮助为生殖生存诊所的护理模式提供信息。
