Interpsy Laboratory (UR4432), University of Lorraine, Nancy, France.
Unité d'évaluation médicale, Unité de Méthodologie, Data management et Statistique - UMDS, CHRU de Nancy.
Cancer Med. 2023 Mar;12(5):6023-6039. doi: 10.1002/cam4.5339. Epub 2022 Oct 12.
To provide ways to improve the clinical practice of fertility preservation (FP) for children, adolescents, and young adults (AYA) with cancer.
A systematic research of online databases was undertaken in March 2020 following the PRISMA criteria, including Medline and Web of Science.
Fifty-nine articles were included. Surveys, interviews, and focus groups were used to collect data from patients, parents, and health care providers (HCPs). Four themes worth exploring emerged: (a) what do patients and professionals think of and know about FP? (b) what makes the fertility discussion happen or not? (c) what, retrospectively, led to FP being pursued or not? and (d) how do patients and HCPs feel about fertility issues?
A minority of AYAs preserve their fertility (banking assay for 45% of boys and 23% of girls). Yet fertility concerns have a significant impact on the quality of life of young cancer survivors. Although recommendations and guidelines regarding FP are available internationally, there are no specific guidelines as to how to conduct fertility counseling for children and adolescents. Some barriers are not removable, such as a poor prognosis of an obvious severe disease, time constraints for starting treatment, and cultural and religious beliefs. In response to aspects hindering patients and families to be receptive to any discussion at the time of diagnosis, psychological support could reduce the level of emotional distress and help restore a degree of open-mindedness to open a window for discussion. Moreover, as the lack of knowledge of professionals about fertility is frequently pointed out as a limiting factor for fertility discussion, reinforcing professional training regarding FP could be proposed to promote fertility discussion and eventually referral for FP.
为儿童、青少年和青年癌症患者（AYA）的生育力保存（FP）的临床实践提供改进方法。
根据 PRISMA 标准，于 2020 年 3 月对在线数据库进行了系统研究，包括 Medline 和 Web of Science。
共纳入 59 篇文章。通过患者、家长和医护人员（HCP）的调查、访谈和焦点小组收集数据。出现了四个值得探讨的主题：（a）患者和专业人员对 FP 的看法和了解程度如何？（b）是什么促成了生育讨论的发生或不发生？（c）回顾性地，是什么导致了 FP 的追求或不追求？（d）患者和 HCP 对生育问题的感受如何？
少数 AYA 保留了生育能力（男孩中有 45%，女孩中有 23%进行了生育力检测）。然而，生育问题对年轻癌症幸存者的生活质量有重大影响。尽管国际上有关于 FP 的建议和指南，但对于如何为儿童和青少年进行生育咨询尚无具体指南。有些障碍是不可消除的，例如疾病预后明显严重、开始治疗的时间限制以及文化和宗教信仰。为了应对在诊断时阻碍患者和家庭接受任何讨论的方面，可以提供心理支持，以减轻情绪困扰的程度，并帮助恢复一定的开放性，为讨论打开一扇窗。此外，由于专业人员对生育力的了解不足经常被指出是生育讨论的限制因素，因此可以提出加强 FP 专业培训，以促进生育讨论，并最终转介进行 FP。
