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

Journal of Cancer Survivorship volume 11, pages 58–63 (2017)Cite this article

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.

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Acknowledgments

This research was supported by the National Institutes of Health (Grant Number T32 HD007440—Dr. Chan).

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Authors and Affiliations

  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

    Jessica L. Chan, Joseph Letourneau, Wael Salem, Aylin Pelin Cil, Sai-Wing Chan, Lee-may Chen & Mitchell P. Rosen

  2. Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA

    Jessica L. Chan

  3. Department of Obstetrics and Gynecology, University of Southern California, 1240 North Mission Road, Los Angeles, CA, 90033, USA

    Wael Salem

  4. Istanbul Memorial Hospital ART and Reproductive Genetics Center, Piyale Pasa Bulvari, 34385, Okmeydani Sisli, Istanbul, Turkey

    Aylin Pelin Cil

Authors
  1. Jessica L. Chan
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  2. Joseph Letourneau
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  3. Wael Salem
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  4. Aylin Pelin Cil
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  5. Sai-Wing Chan
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  6. Lee-may Chen
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  7. Mitchell P. Rosen
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Corresponding author

Correspondence to Jessica L. Chan.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Chan, J.L., Letourneau, J., Salem, W. et al. Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv 11, 58–63 (2017). https://doi.org/10.1007/s11764-016-0563-2

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  • DOI: https://doi.org/10.1007/s11764-016-0563-2

Keywords

  • Regret
  • Fertility
  • Fertility preservation
  • Counseling
  • Survivorship
  • Gynecologic oncology