Stroeken Yaël, Hendriks Florine, Beltman Jogchum, Ter Kuile Moniek
Department of Obstetrics and Gynecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Cancers (Basel). 2024 Oct 12;16(20):3456. doi: 10.3390/cancers16203456.
BACKGROUND/OBJECTIVES: With growing survival rates for Adolescent and Young Adults (AYAs) diagnosed with gynecological cancer, the focus shifted to Quality of Life (QoL). Fertility-sparing surgery offers a viable alternative to standard, usually fertility-impairing treatments. Treatment choice remains difficult and renders perspectives of AYAs on decision-making and psychological outcomes afterwards. This review examines the impact of (in)fertility on psychological well-being both during cancer treatment, and in the long term.
A systematic review of the peer-reviewed literature was conducted by searching Pubmed, Web of Science, Cochrane Trial database and PsycINFO on 30 November 2023. The review included studies with a focus on gynecological cancer, fertility and pregnancy related psychological outcomes, QoL, and psychosocial factors influencing decision-making. Case reports and reviews were excluded. Quality was assessed with the Mixed Methods Appraisal Tool (MMAT).
15 studies, published between 2005 and 2023, involving 1328 participants, were included. Key findings highlight the significance of informing all AYAs about cancer treatment effects on fertility and discussing fertility preservation options. Feeling time-pressured and conflicted between choosing the best oncological outcomes and preserving fertility were common. Factors such as younger age at diagnosis, time pressure, and inadequate counseling by healthcare workers increased reproductive concerns which contributed to long term psychological distress. Research on AYAs with gynecological cancer without fertility preservation possibilities is limited and should be prioritized.
This review shows that both Shared Decision-Making (SDM) and follow-up processes can be improved by addressing fertility-related questions and concerns, therefore increasing long-term QoL. This review is registered in PROSPERO (ID 448119).
背景/目的：随着被诊断为妇科癌症的青少年及年轻成人（AYA）生存率的提高，关注点已转向生活质量（QoL）。保留生育功能手术为标准的、通常会损害生育能力的治疗方法提供了一种可行的替代方案。治疗选择仍然困难，并影响AYA术后的决策观点和心理结果。本综述探讨了（不）生育在癌症治疗期间及长期对心理健康的影响。
2023年11月30日，通过检索PubMed、科学网、Cochrane试验数据库和PsycINFO对同行评议文献进行了系统综述。该综述纳入了关注妇科癌症、生育与妊娠相关心理结果、生活质量以及影响决策的社会心理因素的研究。排除了病例报告和综述。采用混合方法评估工具（MMAT）评估质量。
纳入了2005年至2023年发表的15项研究，涉及1328名参与者。主要发现强调了告知所有AYA癌症治疗对生育的影响并讨论生育保留方案的重要性。在选择最佳肿瘤治疗结果和保留生育能力之间感到时间紧迫和矛盾是常见的。诊断时年龄较小、时间压力以及医护人员咨询不足等因素增加了生殖方面的担忧，这导致了长期的心理困扰。关于无法保留生育功能的妇科癌症AYA的研究有限，应优先进行。
本综述表明，通过解决与生育相关的问题和担忧，可以改善共同决策（SDM）和后续流程，从而提高长期生活质量。本综述已在PROSPERO注册（ID 448119）。
