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Chan J.L.,University of California at San Francisco | Chan J.L.,University of Pennsylvania | Letourneau J.,University of California at San Francisco | Salem W.,University of California at San Francisco | And 6 more authors.
Journal of Cancer Survivorship | Year: 2016

Purpose: Data have demonstrated an association between regret and lack of fertility counseling among patients undergoing treatment for non-gynecologic cancers. We sought to determine if fertility-related regret is reduced with pre-treatment counseling or fertility-sparing surgery (FSS) in patients with gynecologic cancers. Methods: A cross-sectional survey was administered to 593 reproductive-age survivors (18–40 years old at diagnosis) of localized cervix, ovarian, or endometrial cancers that were eligible for FSS. A validated decision regret score was used to evaluate regret in patients. Results: Four hundred seventy women completed the survey. Forty-six percent received pre-treatment counseling about treatment’s effects on fertility. Having received counseling (adjusted ß-coefficient of −1.24, 95 % CI = −2.29 to −0.18, p = 0.02), satisfactory counseling (adjusted ß-coefficient of −2.71, 95 % CI = −3.86 to −1.57, p < 0.001), and FSS (adjusted ß-coefficient of −1.26, 95 % CI = −2.39 to −0.14, p = 0.03) were associated with lower regret post-treatment, after adjusting for age. Time since diagnosis, prior parity, socioeconomic status and cancer type were not associated with regret (p > 0.05). While 50 % of women reported desiring more children after diagnosis, desire for children after treatment was associated with increased regret (adjusted ß-coefficient of 3.97, 95 % CI = 2.92–5.02, p < 0.001). Conclusions: Though less than half of study participants received counseling about the effect of cancer treatment on future fertility, both fertility counseling and FSS were associated with decreased regret in reproductive-aged women with gynecologic cancers. The desire for more children after treatment was associated with increased regret. Implications for cancer survivors: Inquiring about fertility desires and providing counseling regarding reproductive outcomes following cancer treatment should be implemented as part of the treatment process. © 2016 Springer Science+Business Media New York


Chan J.L.,University of California at San Francisco | Chan J.L.,University of Pennsylvania | Letourneau J.,University of California at San Francisco | Letourneau J.,University of North Carolina at Chapel Hill | And 6 more authors.
Gynecologic Oncology | Year: 2015

Objective To determine if sexual satisfaction and sexual quality of life (QOL) are different in survivors of localized cervical and ovarian cancers who undergo fertility-sparing surgery (FSS) as compared with standard surgery. Methods 470 survivors of localized cervical and ovarian cancers diagnosed between the ages of 18-40 were recruited from the California Cancer Registry to complete a cross-sectional survey. Validated questionnaires were used to assess sexual satisfaction and sexual QOL. Results 228 women with localized cervical cancer and 125 with localized ovarian cancer completed the survey. In the cervical cancer group, 92 underwent FSS. Compared with the 84 women who did not undergo FSS (had a hysterectomy, but retained at least one ovary), there was no significant difference in sexual satisfaction or sexual QOL mean scores in women who maintained their uterus (cold-knife cone or trachelectomy), after controlling for age and menopausal status. 82 women with ovarian cancer underwent FSS. Compared with the 39 women that had a bilateral salpingo-oophorectomy, we found no significant differences in sexual satisfaction or sexual QOL in women who maintained at least one ovary (USO or cystectomy), after controlling for age and menopausal status. Conclusions While FSS may allow for post-treatment fertility, it may not confer a significant benefit with regard to sexual satisfaction or sexual QOL. Thus, the decision to perform FSS should not be dictated based on preservation of sexual functioning. © 2015 Elsevier Inc. All rights reserved.

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