Perspectives of Young Women With Gynecologic Cancers on Fertility and Fertility Preservation: A Systematic Review

Vânia Gonçalves; Pedro L Ferreira; Mona Saleh; Christina Tamargo; Gwendolyn P Quinn

doi:10.1093/oncolo/oyab051

Perspectives of Young Women With Gynecologic Cancers on Fertility and Fertility Preservation: A Systematic Review

Oncologist. 2022 Mar 11;27(3):e251-e264. doi: 10.1093/oncolo/oyab051.

Authors

Vânia Gonçalves¹, Pedro L Ferreira¹, Mona Saleh², Christina Tamargo³, Gwendolyn P Quinn⁴

Affiliations

¹ Centre for Health Studies and Research of the University of Coimbra (CEISUC), Faculty of Economics, University of Coimbra, Coimbra, Portugal.
² Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
⁴ Departments of Obstetrics and Gynecology and Population Health, Grossman School of Medicine, New York University, New York, NY, USA.

Abstract

Background: Gynecologic cancers standard treatment often requires the removal of some reproductive organs, making fertility preservation a complex challenge. Despite heightened oncofertility awareness, knowledge about fertility attitudes and decisions of young patients with gynecologic cancer is scarce. The aim of this systematic review was to highlight what is currently known about knowledge, attitudes, and decisions about fertility, fertility preservation, and parenthood among these patients.

Methods: Peer-reviewed journals published in English were searched in PubMed, Web of Science and EMBASE from January 1, 2000 to July 1, 2020. Childbearing, fertility, fertility preservation, pregnancy, and parenthood attitudes/decisions after gynecologic cancer from women's perspective were evaluated.

Results: A total of 13 studies comprised the review. Most of the women valued fertility preservation procedures that could be regarded as a means to restore fertility. A unique feature identified was that fertility preservation was seen also as a way to restore gender identity perceived to be lost or threatened during diagnosis and treatment. Fertility counseling was suboptimal, with wide variability among studies reviewed. Comparisons between gynecologic cancers and other cancer types about fertility counseling rates were inconclusive. The potential negative impact of impaired fertility on patients' mental health and quality of life was also documented.

Conclusions: Fertility and parenthood were important matters in patients' lives, with the majority of patients expressing positive attitudes toward future childbearing. Results confirm that the inclusion of patients with gynecologic cancer in research studies focusing on this topic still remains low. Additionally, the provision of fertility counseling and referral by health professionals is still suboptimal.

Keywords: attitudes; fertility; fertility counseling; fertility preservation; gynecological cancer; young women.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Female
Fertility
Fertility Preservation* / methods
Gender Identity
Genital Neoplasms, Female* / complications
Genital Neoplasms, Female* / therapy
Humans
Male
Pregnancy
Quality of Life