blogger delicious digg diigo facebook googleplus linkedin netlog reddit twitter
Skip Navigation Links



Volume 18, Issue 2, Number 71 / April-June
(Commentary, pages 261-263)


The Importance of Fertility Preservation Counseling in Patients with Gynecologic Cancer




Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy

 Corresponding Author
Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy

Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy

Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy


Related Articles
in Google Scholar in PubMed

 

Other Format
pdfPDF Full Text (En) pdfPDF Full Text (Fa) pdfePUB Full Text (En) pdfPDF Abstract (En) pdfPDF Abstract (Fa) pdf BibTeX pdfRefMan pdfEndNote xmlPMC XML online readerPMC Reader

 



To cite this article:


Full Text

It is estimated that gynecologic cancer has an incidence of 17% in the world (1). The most common gynecologic cancer is endometrial cancer with an incidence of 53% (2, 3). Although in most cases endometrial cancer manifests during menopause, in 25% of cases it can affect women in premenopausal age and in 2% of cases under the age of 40 (2). The treatment of this type of gynecological cancer is usually surgical and includes hysterectomy and bilateral salpingo oophorectomy (4-6). Adjuvant chemotherapy and/or radiotherapy is recommended in cases at high risk of recurrence and in the later stages of cancer (2, 6).
Ovarian cancer is the second most common gynecological malignancy and the leading cause of death for gynecologic cancer in Western countries (2). In most cases, it is diagnosed in advanced stages and mainly affects women aged between 55 and 65. The treatment of ovarian cancer usually involves a combination of surgery and chemotherapy (7-9).
Cervical cancer is the second cancer in women worldwide. However, in Western countries, thanks to the diffusion of prevention campaigns through systematic screening program for women aged between 25 and 65, the incidence of this cancer has been greatly reduced (10). Cervical cancer is often diagnosed in reproductive age and surgical treatment may be placed alongside radiation therapy (2, 11).
Thanks to progress made in the field of gynecologic oncology, the survival rate for women with gynecologic cancer is greatly increased over the years. Consequently, a primary objective in these cases is to gradually improve the quality of life of patients. Indeed, the experience of a gynecological cancer has a very strong impact on the psychological well-being of women; surgical treatment and chemotherapy can impair female identity and also sexual functioning (2, 3, 12-14).
Several studies confirm that women with gynecologic cancer experience low levels of quality of life, anxiety and depressive symptoms, suicidal thoughts, feelings of anger and shame, and low self-esteem (1, 3, 12-17).
Moreover, when cancer affects women in child-bearing age, treatments can jeopardize reproductive capacity. The possible infertility due to cancer in women can be more devastating than the cancer itself and the possibility to have a child after cancer can be an important incentive in the therapeutic process (18-20).
In the light of these general considerations, techniques for fertility preservation in women with gynecologic cancer can be very important for the improvement of quality of life of these patients (19-21). In Italy, according to the Guidelines for the preservation of fertility in cancer patients published in 2003, a conservative therapy for fertility preservation may be proposed in case of good prognosis and only in the presence of close follow-up and in cancer centers with experience and adequate follow-up protocols (22).
Several international studies have shown that an adequate counseling about the fertility preservation treatments is associated with an improved quality of life of women who survive from a gynecological cancer (19-22). However, in many cases, there is not adequate information about this type of treatment. The aforementioned Guidelines recommend that reproductive counseling should be offered immediately after the cancer diagnosis in order to come to an agreement with the patient about the best fertility preservation technique which varies depending on the cancer and reproductive prognosis (22).
Reproductive counseling requires a multidisciplinary approach since it is necessary not only to choose the most appropriate preservation technique according to the prognosis and the risk of infertility related to cancer treatments, but also to assess the real motivation of woman to face a pregnancy and to become mother (22, 23).
Therefore, the presence of the psychologist, along with the oncologist and the specialist in reproductive medicine, is important to convey correct information to patients with gynecological cancer who wish to preserve their procreative capacity (24, 25).
In conclusion, it is appropriate to conduct further research about this topic in order to minimize the impact of cancer treatments on quality of life and psychological well-being of women with gynecological cancer.

Conflict of Interest
The authors report no conflicts of interest.

Acknowledgement
The authors alone are responsible for the content and writing of the paper. No specific funding was obtained.



References
  1. Carter J, Stabile C, Gunn A, Sonoda Y. The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med. 2013;10 Suppl 1:21-34.   [PubMed]
  2. Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol. 2016;140(2):359-68.   [PubMed]
  3. Jeppesen MM, Mogensen O, Dehn P, Jensen PT. Needs and priorities of women with endometrial and cervical cancer. J Psychosom Obstet Gynaecol. 2015;36(3):122-32.   [PubMed]
  4. Rossetti D, Bogani G, Carnelli M, Vitale SG, Gros-so G, Frigerio L. Efficacy of IVF following con-servative manage-ment of endometrial cancer. Gyne-col Endocrinol. 2014;30(4):280-1.   [PubMed]
  5. Vitale SG, Valenti G, Gulino FA, Cignini P, Biondi A. Surgical treatment of high stage endometrial can-cer: current perspectives. Updates Surg. 2016;68(2):149-54.   [PubMed]
  6. Rossetti D, Vitale SG, Gulino FA, Cignini P, Rapi-sarda AMC, Biondi A, et al. Concomitant chemo-radiation treatment in selected stage I endometrioid endometrial cancers. Eur J Gynaecol Oncol. 2016;37(5):657-61.
  7. Vitale SG, Marilli I, Lodato M, Tropea A, Cianci A. The role of cytoreductive surgery in advanced-stage ovarian can-cer: a systematic review. Updates Surg. 2013;65(4):265-70.   [PubMed]
  8. Bellia A, Vitale SG, Laganà AS, Cannone F, Hou-venaeghel G, Rua S, et al. Feasibility and surgical outcomes of con-ventional and robot-assisted laparo-scopy for early-stage ovarian cancer: a retrospective, multicenter analysis. Arch Gynecol Obstet. 2016;294(3):615-22.   [PubMed]
  9. Rossetti D, Vitale SG, Gulino FA, Rapisarda AMC, Valenti G, Zigarelli M, et al. Laparoendoscopic single-site surgery for the assessment of peritoneal carcinomatosis resectability in patients with ad-vanced ovarian cancer. Eur J Gynaecol Oncol. 2016;37(5):671-3.
  10. Thigpen SC, Geraci SA. Cancer Screening 2016. Am J Med Sci. 2016;352(5):493-501.   [PubMed]
  11. Kokka F, Bryant A, Brockbank E, Powell M, Oram D. Hysterectomy with radiotherapy or chemo-therapy or both for women with locally advanced cervical cancer. Cochrane Database Syst Rev. 2015;(4):CD010260.   [PubMed]
  12. Iżycki D, Woźniak K, Iżycka N. Consequences of gynecological cancer in patients and their partners from the sexual and psychological perspective. Prz Menopauzalny. 2016;15(2):112-6.   [PubMed]
  13. Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS. Comment on: "The consequences of gynaec-ological cancer in patients and their partners from the sexual and psychological perspective". Prz Menopauzalny. 2016;15(3):186-7.   [PubMed]
  14. Becker M, Malafy T, Bossart M, Henne K, Gitsch G, Denschlag D. Quality of life and sexual func-tioning in endome-trial cancer survivors. Gynecol Oncol. 2011;121(1):169-73.   [PubMed]
  15. Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS. Comment on: "Anxiety and depression in pa-tients with advanced ovarian cancer: a prospective study". J Psychosom Obstet Gynaecol. 2017;38(1):83-84.   [PubMed]
  16. Mielcarek P, Nowicka-Sauer K, Kozaka J. Anxiety and depression in patients with advanced ovarian cancer: a prospective study. J Psychosom Obstet Gynaecol. 2016;37(2):57-67.   [PubMed]
  17. Laganà AS, La Rosa VL, Rapisarda AM, Vitale SG. Comment on: "Needs and priorities of women with endometrial and cervical cancer". J Psycho-som Obstet Gynaecol. 2017;38(1):85-86.   [PubMed]
  18. Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS. Psychology of infertility and assisted repro-ductive treatment: the Italian situation. J Psycho-som Obstet Gynaecol. 2017;38(1):1-3.   [PubMed]
  19. Angarita AM, Johnson CA, Fader AN, Christian-son MS. Fertility Preservation: A Key Survivorship Issue for Young Women with Cancer. Front Oncol. 2016;6:102.   [PubMed]
  20. Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, et al. Pretreatment fertility counsel-ing and fertility preservation improve quality of life in reproductive age women with cancer. Can-cer. 2012;118(6):1710-7.   [PubMed]
  21. Reh AE, Lu L, Weinerman R, Grifo J, Krey L, No-yes N, et al. Treatment outcomes and quality-of-life assessment in a university-based fertility pre-servation program: results of a registry of female cancer patients at 2 years. J Assist Reprod Genet. 2011;28(7):635-41.   [PubMed]
  22. AIOM: Scientific Documents [Internet]. Milan: Italian Association of Medical Oncology. c2017. Guidelines "Preserva-tion of fertility in cancer patients"; 2015 [cited 2016 Dec 1]; [about 2 screens]. Available from: http://www.aiom.it/ professionisti/documenti-scientifici/linee-guida/preservazione-fertilita/1,713,1,#
  23. Baysal Ö, Bastings L, Beerendonk CC, Postma SA, IntHout J, Verhaak CM, et al. Decision-making in female fertility preservation is balancing the ex-pected burden of fertility preservation treatment and the wish to conceive. Hum Reprod. 2015;30 (7):1625-34.   [PubMed]
  24. Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR. Psychological Counseling of Female Fertility Preservation Pa-tients. J Psychosoc Oncol. 2015;33(4):333-53.   [PubMed]
  25. Bastings L, Baysal Ö, Beerendonk CC, IntHout J, Traas MA, Verhaak CM, et al. Deciding about fer-tility preservation after specialist counselling. Hum Reprod. 2014;29(8):1721-9.   [PubMed]



Home | About Us | Current Issue | Past Issues | Submit a Manuscript | Instructions for Authors | Subscribe | Search | Contact Us

"Journal of Reproduction & Infertility" is owned, published, and copyrighted by Avicenna Research Institute .
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

Journal of Reproductoin and Infertility (JRI) is a member of COMMITTEE ON PUBLICATION ETHICS . Verify here .

©2016 - eISSN : 2251-676X, ISSN : 2228-5482, For any comments and questions please contact us.