Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Obstetrics and Gynecology, Lenox Hill Hospital-Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
Support Care Cancer. 2023 Oct 5;31(10):612. doi: 10.1007/s00520-023-08081-y.
Colorectal cancer (CRC) incidence in adults younger than 50 years is steadily increasing in the USA, and treatment for CRC can impact future fertility. However, fertility decision-making in female patients with CRC can be complex, with fertility preservation (FP) counseling occurring inconsistently.
The goal of this scoping review was to assess the literature regarding the frequency and quality of fertility preservation (FP) discussions taking place among oncology clinicians and their reproductive-age female patients with colorectal cancer (CRC) in order to identify existing gaps in care and inform future research, interventions, or potential changes in practice.
A comprehensive literature search was conducted using the Ovid Medline, PsycInfo, and Scopus databases in order to identify studies pertaining to FP counseling in reproductive-age female patients with CRC. We used Covidence to screen studies for relevance and to extract data. Findings of interest included rate of fertility and/or FP discussions, patient characteristics associated with fertility discussions, initiators of discussions, rate of referrals to fertility specialists, patient utilization of FP services, and unmet fertility needs. We performed both quantitative and qualitative data synthesis.
We identified five studies that met our inclusion criteria, all published between 2007 and 2022. Frequency of fertility counseling discussions was low across studies, with a range of 15 to 52.5% of female patients with CRC receiving counseling. Patient characteristics which may be associated with likelihood of fertility discussion included age, parity, number of children, cancer location and stage, treatment type, and quality of life. The literature suggested that fertility discussions were initiated by clinicians about two-thirds of the time, and medical oncologists were the clinicians most likely to initiate. Studies did capture unmet fertility-related patient needs; participants who did not receive counseling often expressed desire for these discussions and regret that they did not occur.
Despite increasing incidence of CRC in patients at younger ages, this scoping review found a dearth of research conducted on young female CRC patients' experiences with fertility counseling and referrals. Notably, the existing research reveals that relatively few of these patients are receiving appropriate counseling. Additional research is needed to clarify current FP counseling practices, patient and clinician perceptions about FP, and ways to improve the quantity and quality of FP counseling in this patient population.
在美国，50 岁以下成年人的结直肠癌（CRC）发病率稳步上升，CRC 的治疗可能会影响未来的生育能力。然而，CRC 女性患者的生育决策可能很复杂，生育保存（FP）咨询的情况并不一致。
本综述的目的是评估有关肿瘤临床医生与其生殖年龄女性结直肠癌（CRC）患者之间进行 FP 讨论的频率和质量的文献，以确定护理方面存在的差距，并为未来的研究、干预措施或潜在的实践改变提供信息。
使用 Ovid Medline、PsycInfo 和 Scopus 数据库进行全面的文献检索，以确定与生殖年龄女性 CRC 患者的 FP 咨询相关的研究。我们使用 Covidence 筛选研究的相关性并提取数据。感兴趣的发现包括生育力和/或 FP 讨论的频率、与生育讨论相关的患者特征、讨论的发起者、向生育专家转诊的频率、患者对 FP 服务的利用情况以及未满足的生育需求。我们进行了定量和定性数据综合。
我们确定了五项符合纳入标准的研究，这些研究均发表于 2007 年至 2022 年期间。各项研究中 FP 咨询讨论的频率均较低，有 15%至 52.5%的 CRC 女性患者接受了咨询。可能与生育讨论可能性相关的患者特征包括年龄、产次、子女数量、癌症部位和分期、治疗类型和生活质量。文献表明，三分之二的时间是由临床医生发起的生育讨论，而肿瘤内科医生是最有可能发起讨论的医生。研究确实发现了未满足的与生育相关的患者需求；未接受咨询的参与者经常表示希望进行这些讨论，并对未进行讨论感到遗憾。
尽管年轻患者的 CRC 发病率不断上升，但本综述发现，针对年轻女性 CRC 患者的生育咨询和转诊经验的研究相对较少。值得注意的是，现有的研究表明，这些患者中相对较少的人接受了适当的咨询。需要进一步研究以阐明当前的 FP 咨询实践、患者和临床医生对 FP 的看法，以及改善该患者群体 FP 咨询的数量和质量的方法。
