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J Cancer Surviv. 2017 Feb;11(1):58-63. doi: 10.1007/s11764-016-0563-2. Epub 2016 Aug 1.

Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients.

Author information

1
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA. jessicachanmd@gmail.com.
2
Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA. jessicachanmd@gmail.com.
3
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.
4
Department of Obstetrics and Gynecology, University of Southern California, 1240 North Mission Road, Los Angeles, CA, 90033, USA.
5
Istanbul Memorial Hospital ART and Reproductive Genetics Center, Piyale Pasa Bulvari, 34385, Okmeydani Sisli, Istanbul, Turkey.

Abstract

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.

KEYWORDS:

Counseling; Fertility; Fertility preservation; Gynecologic oncology; Regret; Survivorship

PMID:
27480882
PMCID:
PMC5269477
DOI:
10.1007/s11764-016-0563-2
[Indexed for MEDLINE]
Free PMC Article

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