Dataset Information

Determinants of fertility issues experienced by young women diagnosed with breast or gynaecological cancer - a quantitative, cross-cultural study.

ABSTRACT:

Background

Although there is a recognition of the importance of fertility to young women with cancer, we do not know who is at risk of distress related to fertility issues following diagnosis. We investigated the determinants of fertility-related distress adopting a cross-cultural perspective and using the Common Sense Model (CSM). We chose the CSM as a theoretical framework as it allows to explore how individuals conceptualise illness within the socio-cultural context.

Methods

British and Polish women with breast or gynaecological cancer were recruited through outpatient clinics or online outlets and completed a questionnaire. Linear regression, mediation and moderated mediation methods were performed.

Results

One hundred sixty-four women participated (mean age 34.55 (SD = 6.66); 78.7% had gynaecological cancer). The determinants of fertility-related distress were: country of origin, recruitment site, negative affect, desire to have children, treatment regret, and total illness perception score. The impact of the desire to have children on fertility-related distress was mediated by psychological value of children, perceived consequences of cancer on one's life, emotional representation, and treatment-related regret. Country of origin moderated the relationship between the desire to have children and fertility-related distress when mediated by treatment-related regret.

Conclusions

The CSM proved useful in investigating predictors of fertility-related distress, with emotional, rather than cognitive representation of illness determining its levels. Socio-cultural background played a role in determining one's fertility-related distress and contributed to the explanation of the relationship between one's desire to have children, treatment-related regret, and fertility-related distress.

SUBMITTER: Sobota A

PROVIDER: S-EPMC6127915 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundEach year, approximately 11% of women diagnosed with breast cancer in the United States are 45 years of age or younger. These women have concerns specific to or accentuated by their age, including fertility-related concerns, and have higher rates of psychosocial distress than women diagnosed at older ages. Current guidelines recommend that fertility risks be considered early in all treatment plans; however, the extant research indicates that attention to fertility by the healthcare team is limited. Importantly, attention to fertility may be a proxy for whether or not other important issues warranting attention in younger women with breast cancer are addressed, including genetic risks, psychosocial distress, sexual functioning, and body image concerns. The Young & Strong study tests the efficacy of an intervention designed for young women recently diagnosed with breast cancer and their oncologists with the intention to: 1) increase attention to fertility as an important surrogate for other issues facing young women, 2) educate and support young women and their providers, and 3) reduce psychosocial distress among young women with breast cancer.Methods/designThe study employs a cluster randomized design including 14 academic institutions and 40 community sites across the U.S. assigned to either the study intervention arm or contact-time comparison intervention arm. Academic institutions enroll up to 15 patients per site while community sites enroll up to 10 patients. Patient eligibility requirements include: an initial diagnosis of stage I-III invasive breast cancer within three months prior, without a known recurrence or metastatic breast cancer; 18-45 years of age at diagnosis; ability to read and write in English. The primary outcome is oncologists' attention to fertility concerns as determined by medical record review. Secondary outcomes include differences in patient satisfaction with care and psychosocial distress between the two study arms.DiscussionStudy findings will provide valuable insight into how to increase attention to fertility and other issues specific to young women with breast cancer and how to improve doctor-patient communication around these issues, which may promote better quality of care for this population.Trial registrationNCT01647607. Registered July 19, 2012.

Project description:Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence. Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18-45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses. Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important. Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an "add-on" was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

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