Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors

Catherine Benedict; Julia Stal; Ali Davis; Anna Zeidman; Devon Pons; Lidia Schapira; Michael Diefenbach; Jennifer S Ford

doi:10.1002/pon.6212

Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors

Psychooncology. 2023 Oct;32(10):1606-1615. doi: 10.1002/pon.6212. Epub 2023 Sep 11.

Authors

Catherine Benedict^{1

2}, Julia Stal³, Ali Davis^{1

4}, Anna Zeidman¹, Devon Pons⁵, Lidia Schapira², Michael Diefenbach⁶, Jennifer S Ford⁷

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
² Stanford Cancer Institute, Stanford, California, USA.
³ Department off Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
⁴ Department of Clinical Psychology, Palo Alto University, Palo Alto, California, USA.
⁵ University of San Francisco, San Francisco, California, USA.
⁶ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.
⁷ Hunter College and The Graduate Center, City University of New York (CUNY), New York, New York, USA.

PMID: 37695291
PMCID: PMC10591918 (available on 2024-10-01)
DOI: 10.1002/pon.6212

Abstract

Background: Many adolescent and young adult female (AYA-F) cancer survivors face decisions about family building using reproductive medicine or adoption to achieve parenthood. This study evaluated associations among reproductive distress, avoidance, and family-building decision making and identified sociodemographic and clinical characteristics related to high distress and avoidance.

Methods: A cross-sectional survey assessed AYA-F survivors' oncofertility experiences. Measures included an investigator-designed Unmet Information Needs scale, Reproductive Concerns After Cancer Scale, Impact of Events Scale-Avoidance subscale, Decision Self-Efficacy scale, and Decision Conflict Scale. Two linear regression models evaluated correlates of decision self-efficacy and decisional conflict about family building after cancer. Bivariate analyses evaluated correlates of avoidance using Pearson's correlation, t-test, and ANOVA.

Results: AYA-Fs (N = 111) averaged 31-years-old (SD = 5.49) and 3 years post-treatment (range: 1-23 years); 90% were nulliparous. Most common diagnoses were leukemia (24%) and breast cancer (22%). Average decisional conflict was 52.12 (SD = 23.87, range: 0-100); 74% of the sample reported DCS scores within the clinically significant range. Higher levels of reproductive distress (B = -0.23, p = 0.04) and avoidance (B = -0.24, p = 0.02) related to lower decision self-efficacy. Younger age (B = -0.18, p = 0.03), greater unmet information needs (B = 0.33, p < 0.001), and higher levels of reproductive distress (B = 0.34, p = 0.001) related to worse decisional conflict. Predictors of distress and avoidance were identified.

Conclusions: After cancer treatment, high fertility distress and avoidant coping were associated with poorer quality decision making about family building after cancer. Fertility counseling post-treatment should support self-efficacy and constructive coping skills to counteract high distress, maladaptive coping, and facilitate values-based decision making.

Keywords: adolescent and young adult cancer; decision making; fertility; infertility; oncofertility; reproductive distress.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Breast Neoplasms* / complications
Cross-Sectional Studies
Decision Making
Female
Fertility
Fertility Preservation* / psychology
Humans
Neoplasms* / psychology
Survivors / psychology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding