Psychosocial Distress in Young Cancer Survivors

doi:10.1016/j.soncn.2009.08.004

Seminars in Oncology Nursing

Volume 25, Issue 4, November 2009, Pages 268-277

https://doi.org/10.1016/j.soncn.2009.08.004 Get rights and content

Objectives

To review existing literature about the psychosocial reactions of cancer patients and provide information about the needs of patients wishing to preserve fertility.

Data Sources

Journal articles, research studies.

Conclusion

The desire for biological parenthood is an important issue for cancer survivors. Patients may not receive accurate, timely information about fertility-sparing options; those not receiving this information are at increased risk for psychological distress.

Implications for Nursing Practice

Fertility-preservation decisions are complex and a team approach may identify patients at risk for psychological distress and provide opportunities for discussion of psychosocial issues involved. Nurses must be informed about the emotional reactions and informational needs of their patients.

Section snippets

The Need for Timely Communication

We know that the desire for biological parenthood and genetically related children is an important issue for many cancer survivors.2, 3, 4 Many surveys of cancer survivors have found that survivors are at increased risk of emotional distress if they become infertile as a result of their treatment.2, 3, 5, 6, 7 We also know from investigations of infertility in noncancer patients that infertility in itself can be associated with long-term effects on quality of life because of unresolved grief

Provider Communication Skills

In general, information provides realistic expectations, empowers patients to ask pertinent questions, and may prevent avoidable distress. Conversely, poor communication can profoundly impact patients' quality of life. Kerr et al³⁰ prospectively studied the impact of patient-rated provider communication skill with cancer patients. They found that 45% of a sample of 990 cancer patients reported that some aspect of communication with their physician was unclear, and that 59% wanted to speak to

The Psychosocial Impact of Cancer Diagnosis

Cancer patients have strong emotional needs. Prevalence rates for depression in cancer patients have been reported by some studies to be as high as 47% and 58%.49, 50, 51 However, reported rates of depression, anxiety, and psychological distress have varied widely between studies (0% to 46% for depression; 0.9% to 49% for anxiety; and 5% to 50% for psychological distress).⁵² The different rates of psychological sequelae associated with cancer may be due to selection bias, the sensitivity of

Conclusion

We know that the desire for biological parenthood and genetically related children is an important issue for many cancer survivors. Yet many patients do not receive information about fertility-sparing options in a timely, clear manner. Patients who do not receive this information are at increased risk for psychological distress, particularly younger women who have not yet completed their families. The decisions and actions required of cancer patients wishing to preserve fertility are complex; a

Allison Rosen, PhD: Consultant Psychologist, The Institute for Fertility Preservation. New York Medical College, Valhalla NY.

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The increased survival achieved with surgery and cancer treatments for breast cancer has led to a growing concern about fertility in young women, adversely affecting quality of life outcomes. The potential loss of fertility not only has a psychological but can also affect patients' treatment adherence or decisions, such as selection of treatments associated with a lower risk of infertility despite inferior outcomes. Our objective is to provide an overview of current knowledge about how systemic cancer treatments could impact the future fertility of breast cancer survivors The main hypothesis of how chemotherapy produce damage to the ovaries is a direct damage to the DNA of the oocytes, resulting in the activation of apoptosis and/or autophagy-related pathways. Alkylating agents as cyclophosphamide are the chemotherapeutic agents that are associated with the highest risk of gonadotoxicity; however, breast cancer patients are usually given combinations of chemotherapy drugs. Conversely, endocrine therapy, such as tamoxifen, does not appear to have a permanent effect on fertility but long-term use could lower oocyte quality due to patient aging. There is still not enough evidence about the effect on ovarian reserve for many biological therapies and for new drugs being used in the non-metastatic setting, and further research in this area is needed. Members of multidisciplinary teams in breast cancer should understand the impact on fertility of cancer treatments and the importance of an early referral of premenopausal patients to specialists in reproductive medicine to discuss all possible fertility preservation strategies.
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Citation Excerpt :
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View all citing articles on Scopus

Allison Rosen, PhD: Consultant Psychologist, The Institute for Fertility Preservation. New York Medical College, Valhalla NY.

Kenny A. Rodriguez-Wallberg, MD, PhD: Senior Consultant, Head of Fertility Preservation Program, Karolinska Institute and Karolinska University Hospital Huddinge, Fertility Unit, Department of Obstetrics and Gynecology, Stockholm, Sweden.

Lisa Rosenzweig, BS: Doctoral Candidate, Department of Counseling and Clinical Psychology, Teachers College Columbia University, New York, NY.

: Dr Rodriguez-Wallberg was supported by research grants from The Swedish Society of Medical Research and The Swedish Society of Medicine.

View full text

Psychosocial Distress in Young Cancer Survivors

Objectives

Data Sources

Conclusion

Implications for Nursing Practice

Section snippets

The Need for Timely Communication

Provider Communication Skills

The Psychosocial Impact of Cancer Diagnosis

Conclusion

Gynecol Oncol

Soc Sci Med

Gynecol Obstet Fertil

J Pediatr Surg

Fertil Steril

Ann Oncol

Eur J Cancer

Prog Neuropsychopharmacol Biol Psychiatry

Patient Educ Couns

Soc Sci Med

Soc Sci Med

Patient Educ Couns

Gen Hosp Psychiatry

Psychosomatics

Psychosomatics

Patient Educ Couns

Patients with medically complicating conditions

Having children after cancer: a pilot survey of survivors' attitudes and experiences

Cancer

Web-based survey of fertility issues in young women with breast cancer

J Clin Oncol

Preserving fertility after cancer

CA Cancer J Clin

Long-term effects on sexual function and fertility after treatment of testicular cancer

Br J Cancer

Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors

J Clin Oncol

Defining and measuring reproductive concerns of female cancer survivors

J Natl Cancer Inst Monogr

Life after infertility treatment: a long-term investigation of marital and sexual function

Hum Reprod

In vitro fertilization: a long-term follow-up after treatment failure

Hum Fertil (Camb)

The psychological impact of infertility: a comparison with patients with other medical conditions

J Psychosom Obstet Gynaecol

Third-party reproduction and adoption in cancer patients

J Natl Cancer Inst Monogr

Discussion of fertility preservation with newly diagnosed patients; oncologists views

J Cancer Surviv

Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy

J Clin Oncol

The fertility- and menopause-related information needs of younger women with a diagnosis of breast cancer: a qualitative study

Psychooncology

Web-based survey of fertility issues in young women with breast cancer

J Clin Oncol

Oncologists' attitudes and practices regarding banking sperm before cancer treatment

J Clin Oncol

Do doctors discuss fertility issues before they treat young patients with cancer?

Hum Reprod

Fertility preservation: successful transplantation of cryopreserved ovarian tissue in a young patient previously treated for Hodgkin's disease

Oncologist

National guideline ‘Cryopreservation of ovarian tissue’

Ned Tijdschr Geneeskd

Human oocyte and ovarian tissue cryopreservation and its application

J Assist Reprod Genet

American Society of Clinical Oncology recommendations on fertility preservation in cancer patients

J Clin Oncol

A strategy for fertility services for survivors of childhood cancer

Hum Fertil (Camb)

Fertility preservation and reproduction in cancer patients

Fertil Steril

Relating information needs to the cancer experience. Themes from six cancer narratives

Eur J Cancer Care (Engl)

Effective physician–patient communication and health outcomes: a review

CMAJ

Cross sectional survey of patients' satisfaction with information about cancer

Br Med J

Influence of physician communication on newly diagnosed breast cancer patients' psychologic adjustment and decision-making

Cancer

Approaching difficult communication tasks in oncology