Fertility preservation and cancer: challenges for adolescent and young adult patients.
Fertility preservation and cancer: challenges for adolescent and young adult patients.
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DOI：
10.1097/spc.0000000000000185
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发表时间：
2016-03
影响因子：
2.1
通讯作者：
Kelvin JF
中科院分区：
文献类型：
--
作者：
Benedict C;Thom B;Kelvin JF
随着生存率的提高，生育能力成为许多年轻癌症患者重要的生活质量问题。迫切需要改进临床护理，以确保患者充分了解不孕风险和生育力保留（FP）选择，并在治疗前支持他们做出生殖决策。许多障碍阻碍了生育能力在临床上得到充分解决。提供者和患者对不孕风险的不完整或不准确理解加剧了患者的生殖担忧。特别是对于女性患者来说，在治疗前做出有关 FP 的决定往往会导致决策冲突，从而降低做出明智的、基于价值观的决定的可能性，并减少治疗后的遗憾和痛苦。最近基于经验的干预措施改善了有关生育问题的提供者培训并支持患者有关 FP 的决策，这些干预措施显示出了希望。医疗服务提供者应该了解与癌症治疗相关的不孕风险，并积极主动地为所有可能有一天想要孩子的患者解决生育问题。全面的咨询还应包括相关问题，例如避孕药具的使用和提前绝经的健康影响，无论对未来孩子的渴望如何。尽管癌症相关不孕症的负面心理社会影响现已被广泛接受，但在探索如何在癌症护理背景下改善生育问题的临床管理方面所做的工作仍然有限。应制定基于证据的干预措施来解决障碍，并为担心自己的生育能力和对 FP 选择感兴趣的患者提供社会心理和决策支持。
With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation (FP) options and to support them in their reproductive decision-making prior to treatment. A number of barriers prevent fertility from being adequately addressed in the clinical context. Providers’ and patients’ incomplete or inaccurate understanding of infertility risks exacerbate patients’ reproductive concerns. For female patients in particular, making decisions about FP before treatment often leads to decision conflict, reducing the likelihood of making informed, values-based decisions, and post-treatment regret and distress. Recent empirically-based interventions to improve provider training around fertility issues and to support patient decision-making about FP show promise. Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in FP options.