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      Sex Differences in Fertility-Related Information Received by Young Adult Cancer Survivors

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          Abstract

          Purpose

          The aim was to investigate male and female cancer survivors' perception of fertility-related information and use of fertility preservation (FP) in connection with cancer treatment during reproductive age.

          Methods

          The study sample consisted of cancer survivors diagnosed from 2003 to 2007 identified in population-based registers in Sweden. Inclusion criteria included survivors who were age 18 to 45 years at diagnosis and had lymphoma, acute leukemia, testicular cancer, ovarian cancer, or female breast cancer treated with chemotherapy. Of 810 eligible participants, 484 survivors (60% response rate) completed a postal questionnaire.

          Results

          The majority of male participants reported having received information about treatment impact on fertility (80%) and FP (68%), and more than half of the men banked frozen sperm (54%). Among women, less than half (48%) reported that they received information about treatment impact on fertility, and 14% reported that they received information about FP. Only seven women (2%) underwent FP. Predictors for receiving information about treatment impact on fertility were a pretreatment desire to have children (odds ratio [OR], 3.5), male sex (OR, 3.2), and being ≤ 35 years of age at diagnosis (OR, 2.0). Predictors for receiving information about FP included male sex (OR, 14.4), age ≤ 35 at diagnosis (OR, 5.1), and having no children at diagnosis (OR, 2.5).

          Conclusion

          Our results show marked sex differences regarding the receipt of fertility-related information and use of FP. There is an urgent need to develop fertility-related information adapted to female patients with cancer to improve their opportunities to participate in informed decisions regarding their treatment and future reproductive ability.

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          Most cited references22

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          Why do people postpone parenthood? Reasons and social policy incentives.

          Never before have parents in most Western societies had their first children as late as in recent decades. What are the central reasons for postponement? What is known about the link between the delay of childbearing and social policy incentives to counter these trends? This review engages in a systematic analysis of existing evidence to extract the maximum amount of knowledge about the reasons for birth postponement and the effectiveness of social policy incentives. The review followed the PRISMA procedure, with literature searches conducted in relevant demographic, social science and medical science databases (SocINDEX, Econlit, PopLine, Medline) and located via other sources. The search focused on subjects related to childbearing behaviour, postponement and family policies. National, international and individual-level data sources were also used to present summary statistics. There is clear empirical evidence of the postponement of the first child. Central reasons are the rise of effective contraception, increases in women's education and labour market participation, value changes, gender equity, partnership changes, housing conditions, economic uncertainty and the absence of supportive family policies. Evidence shows that some social policies can be effective in countering postponement. The postponement of first births has implications on the ability of women to conceive and parents to produce additional offspring. Massive postponement is attributed to the clash between the optimal biological period for women to have children with obtaining additional education and building a career. A growing body of literature shows that female employment and childrearing can be combined when the reduction in work-family conflict is facilitated by policy intervention.
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            Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors.

            The goal of this study was to survey male patients aged 14 to 40 years at diagnosis and recently treated in two cancer centers to determine their knowledge, attitudes, and experiences regarding cancer-related infertility and sperm banking. A postal survey about cancer-related infertility and sperm banking was offered to 904 men diagnosed with cancer within the previous 2 years. Eight percent opted out of the study. The others were sent the survey, with a cover letter stating elements of informed consent. Although the return rate was only 27%, yielding a sample of 201 men, responders did not differ significantly from nonresponders by institution, age, ethnicity, or cancer site. Overall, 51% of men wanted children in the future, including 77% of men who were childless at cancer diagnosis. Despite some anxieties about their own survival and risks to their children's health, men felt that the experience of cancer increased the value they placed on family closeness and would make them better parents. Only 60% of men recalled being informed about infertility as a side effect of cancer treatment, and just 51% had been offered sperm banking. Those who discussed infertility with their physicians had higher knowledge about cancer-related infertility and were significantly more likely to bank sperm. Only 24% of men banked sperm, including 37% of childless men. Lack of information was the most common reason for failing to bank sperm (25%). All men who are about to receive cancer treatment that could impair fertility should be counseled about such side effects and given adequate information to make an informed decision about banking sperm.
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              Doctor-patient communication and satisfaction with care in oncology.

              This review summarises current knowledge on the impact on patient satisfaction of initiatives undertaken to enhance the communication between doctors and their patients in oncology. Recent studies have assessed the effectiveness of different approaches aimed at improving doctor-patient communication in oncology. These have been assessed on outcomes related to the patient (e.g., anxiety, quality of life, medical knowledge, satisfaction) or to the doctor (e.g., communication behaviour, attitudes). Patient satisfaction has been recognised as a particularly relevant outcome, and a positive effect of recent initiatives to improve the interaction between cancer patients and their doctors on patient satisfaction has been suggested. To better respond to cancer patients' health care needs, various strategies focusing on doctor-patient communication have been developed. Addressing patients' overall needs and sharing complex information in an emotionally charged context and under time constraints is a daily challenge for the oncology clinician, resulting often in cancer patients' dissatisfaction. Recent interventions elaborated to facilitate doctor-patient communication in oncology focus on patients, such as handing out of videos or written preparatory information; on doctors, such as patients' self-rating feedback to doctors or communication skills trainings; or on both, such as the audiotaping of the consultation or the provision of decision aids. Although these strategies offer promising results, further research should be implemented to assess their appropriateness across sociocultural contexts and their long-term effectiveness in clinical practice.
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                Author and article information

                Journal
                Journal of Clinical Oncology
                JCO
                American Society of Clinical Oncology (ASCO)
                0732-183X
                1527-7755
                June 10 2012
                June 10 2012
                : 30
                : 17
                : 2147-2153
                Affiliations
                [1 ]Gabriela M. Armuand, Kenny A. Rodriguez-Wallberg, Lena Wettergren, and Claudia Lampic, Karolinska Institutet; Kenny A. Rodriguez-Wallberg, Karolinska University Hospital, Stockholm; Johan Ahlgren, Centre of Clinical Research, Gävle; Johan Ahlgren, Gunilla Enblad, and Martin Höglund, Uppsala University, Uppsala, Sweden.
                Article
                10.1200/JCO.2011.40.6470
                22585695
                42d92604-2309-4776-b492-5adef74f4319
                © 2012
                History

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