Psychological Aspects of Fertility Preservation - B·Debate

What do we know?InfertilityThe existing literature showsthat fertility is an importantissue for cancer patients andthat there is considerableconcern regarding the fertilityimpairment due to cancer andits treatment ?Fertility Preservation, Barcelona, June 2011

Infertility ConcernsSurvivors often have exaggerated concerns abouttheir children's health risks, but still prefer to havebiological children if possible 1More research is needed on whether participatingin fertility preservation reduces long-term distressabout cancer-related fertility. Better evidencebasedprograms to educate families and reducedecisional conflict are needed1.Schover, 2009

What do we know?Fertility Preservation, Barcelona, June 2011

The psychology of cancer experience of the child/youthand the parentsDestructionFear, Anxiety, PanicEmotionalCopingDisfigurementDisabilityAnger, Rumination,JealousyCognitiveCopingDeathDependenceSadness, Depression,DesperationBehavirouralCoping

Bodurka-Bevers, D et al., 2000; Trask, P.C et al., 2002; Ganz, P.A. et al., 2002; Brown,K.W. et al., 2003Fertility Preservation- the possible “counterpart”• Life threatening• Fear of death• Loss of the child• Loss of life perspective• Damage to the family concept• Hopelessness• Preserve autonomy• Preservation of life• Hope for life• Value, Sense in life• Joy and Pride• Optimism, Strength

The possible “counterpart”Fertility !Fertility Preservation, Barcelona, June 2011

What do we know?• Recently, Tschudin and Bitzer reviewedthe literature from 1998 to 2008• They identified only 24 studies that mettheir inclusion criteria on the psychologicalaspects of fertility preservationTschudin, S. and Bitzer,J.( 2009),Hum Reprod.15, 5: 587–597

Knowledge about, attitude towards and use offertility preservation by patients and professionals• Cancer did not influence the desire for pregnancy in71% of women and 68% of men 1• 29% of breast cancer survivors claimed that concernsabout future fertility had an impact on their decisionwith regard to therapy 2• Parents from pubertal boys would have given consentin 60% . There were no significant differences whencomparing responses from mothers with responsesfrom fathers 31.Schover, 2002; Zanagnolo, 2005. 2.Patridge, 2004. 3. Van den Berg et al, 2007

Knowledge about, attitude towards and use offertility preservation by patients and professionals• The majority of breast cancer (86%) reported knowing atdiagnosis that adjuvant chemotherapy might affect fertility 1• Women who were diagnosed more recently were morelikely to know about the impact of treatment on fertility thanwomen diagnosed several years ago 1• Existing literature suggests that most cancer survivorsemphasized the need for health professionals to be clearand directive in addressing the risk for infertility associatedwith cancer treatment regimes 21. Partridge et al, 2004. 2. Schover et al, 2002. Rosen et al, 2011

Knowledge about, attitude towards and use offertility preservation by patients and professionals• Health professionals as well as patients and their parentsconsider fertility preservation an important option for youngcancer patients, although for the patients themselves, theperceived relevance seems to depend on factors such asthe stage of life at cancer diagnosis 1• All parties involved are shown to have knowledge andinformation deficits. Counseling regarding fertility issues isfar from being offered globally to all patients at risk, and theprovision of information by health professionals as well aspatient and parental recall of having been informed seemsto be selective 2• 1. Goodwin et al, 2007. 2 Quinn et al, 2007

Fertility Preservation CounselingIt depends on…The percentage of patientsrecalling counseling aboutthe impact of cancer onfertility ranges from 34% to72%Schover et al, 1999. Duffy et al, 2005

Most common health professionals to discusscancer-related infertilityWho?• Treating physicians 55%• Nurses 21%• Family physicians 8%• Sperm banking: oncologyphysicians 40%Fertility Preservation, Barcelona, June 2011

Information about Fertility Preservation• Lack of knowledge amongphysicians?Why?• Oncologist‟s Attitudes?• Specific challenges in dealingwith cancer and fertility at thesame time?• Short time period betweendiagnosis and treatmentstarts?

Mental Health ProvidersWhat canwe do?• Facing Complex decisionswhen considering FertilityPreservation• mood changes• sexual difficulties• self-esteem problems• other life stressors

Models of CounselingImplications Counseling• Assess the present emotional,cognitive and physical state of thepatientAssess!• Assess the partner/family support• Assess the patient´s wish for a child• Assess the patient´s perception andinterpretation of the “frozen embryo”• Anticipate different possiblescenarios and discuss copingstrategies

Predictors of Psychosocial DistressTake care!• Women with past histories oftrauma, previouspsychological distress• Women experiencingadditional stressful events• Younger women with childrenat homeGreen at al,2005

Models of CounselingShared Decision Making• Inform and educate patients abouttherapeutic optionsCounsel!• Describe in simple words and withabsolute numbers• Support patients in attributing theirpersonal value to these numbers• When emotional needs of patients areaddressed, normalized and consideredstandard care, patients may feelunderstood and most fully cared for

Coping styles in malignant diseases• Internal or personal locus -ofcontrolPersonalitytraits• Being optimistic• Taking a minimizingperspective• Problem solving• Seeking social support• Actively processing• Expressing emotions

To ConcludeCounseling is necessary for all patients confronted withcancer/malignant diseases during their reproductive lifeThis is primarily intended to provide clear and preciseinformation on ART and discuss all existing options,including cryopreservation of oocytes, PNs or ovariantissue or refusal of fertility preserving methods

To ConcludeThe team can provide better care by understandingemotional needs, psychosocial predictors of distress andmethods of copingCounseling offers support for young people or couplesconfronted with stressful cancer/malignant diseases andfertility issues and helps them through their sometimesdifficult decision-making process

The Future?!!!!!Guidelinesand TeamimplicationClose collaborationbetween the differenttherapeutic teams involved(onco-gynaecologists,oncologists, radiotherapyspecialists, ART specialistsand counselors) is of theutmost importanceFertility Preservation, Barcelona, June 2011

diana.guerra@ivi.esRda Gral Mitre, 14Barcelonawww.ivi.esFertility Preservation, Barcelona, June 2011PÁG.21