Factors associated with pregnancy attempts among female young adult cancer survivors

Little is known about pregnancy attempts among female young cancer survivors (YCS). We sought to determine fertility preservation (FP), demographic, cancer and reproductive characteristics associated with pregnancy attempts after cancer

Contraceptive Practices Among Female Cancer Survivors of Reproductive Age

To compare rates of contraception between reproductive-aged cancer survivors and women in the general U.S. population. Among survivors, the study examined factors associated with use of contraception and emergency contraception

The psychosocial impact of lymphedema-related distress among breast cancer survivors in the WHEL Study.

ObjectiveLymphedema is a distressing and chronic condition affecting up to 30% of breast cancer survivors. Using a cross-sectional study design, we examined the impact of self-reported lymphedema-related distress on psychosocial functioning among breast cancer survivors in the Women's Healthy Eating and Living Study. The Women's Healthy Eating and Living Study has a dataset that includes self-report data on lymphedema status, symptoms, and distress.MethodsChi-square tests and binary logistic regression models were used to examine how specific participant characteristics, including lymphedema-related distress, were associated with physical health and mental health as measured by the SF-36-Item Health Survey and depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale screening form.ResultsOf the 2431 participants included in the current study population, 692 (28.5%) self-reported ever having lymphedema. A total of 335 (48.9%) women reported moderate to extreme distress as a result of their lymphedema and were classified as having lymphedema-related distress. The logistic regression models showed that women with lymphedema-related distress had 50% higher odds of reporting poor physical health (p = 0.01) and 73% higher odds of having poor mental health (p < 0.01) when compared with women without lymphedema. In contrast, even though lymphedema-related distress was significantly associated (p = 0.03) with elevated depressive symptoms in the bivariate analyses, it was not significant in the logistic regression models.ConclusionBreast cancer survivors with lymphedema-related distress had worse physical health and mental health outcomes than women with lymphedema who were not distressed and women with no lymphedema. Our findings provide further evidence of the relationship between lymphedema and psychosocial outcomes in breast cancer survivors

Patient compliance with a health care provider referral for an occupational therapy lymphedema consult.

PurposeLimited information exists on breast cancer patients' compliance to attend outpatient appointments with an occupational therapy (OT) lymphedema specialist. The objectives of this study were (1) to examine patient compliance with a health care provider referral for an OT lymphedema consult and (2) to identify potential barriers to compliance.MethodsA retrospective chart review of female breast cancer patients at the UC San Diego Health System was conducted. Electronic medical records were queried for breast cancer patients, who received a health care provider referral for an OT lymphedema consult between June 1, 2010 and December 31, 2011. Descriptive statistics and Fisher's exact chi-square tests were used to examine how specific participant characteristics were associated with attending an OT appointment.ResultsA total of 210 female patients received an OT referral from a health care provider related to their breast cancer diagnosis. Forty-three (20.5%) patients did not attend an OT appointment. Non-attenders were more likely to have had fewer lymph nodes removed (P<0.01) when compared to attenders. The two most common barriers to attendance were the presence of health problems and undergoing chemotherapy and/or radiation at the time of the OT referral.ConclusionsWhile most breast cancer patients attended recommended OT lymphedema consults, a substantial number of women might benefit from further education about OT for lymphedema prevention following breast cancer treatment. Further research to understand barriers to attendance is recommended, particularly among women with only sentinel nodes removed

A Diversified Recruitment Approach Incorporating Social Media Leads to Research Participation Among Young Adult-Aged Female Cancer Survivors

Purpose: Cancer survivors in their adolescent and young adult (AYA) years are an understudied population, possibly in part because of the high effort required to recruit them into research studies. The aim of this paper is to describe the specific recruitment strategies used in four studies recruiting AYA-aged female cancer survivors and to identify the highest yielding approaches. We also discuss challenges and recommendations. Methods: We recruited AYA-aged female cancer survivors for two studies conducted locally and two conducted nationally. Recruitment strategies included outreach and referral via: healthcare providers and clinics; social media and the internet; community and word of mouth; and a national fertility information hotline. We calculated the yield of each recruitment approach for the local and national studies by comparing the number that participated to the number of potential participants. Results: We recruited a total of 534 participants into four research studies. Seventy-one percent were diagnosed as young adults and 61% were within 3 years of their cancer diagnosis. The highest-yielding local recruitment strategy was healthcare provider and clinic referral. Nationally, social media and internet outreach yielded the highest rate of participation. Overall, internet-based recruitment resulted in the highest number and yield of participants. Conclusion: Our results suggest that outreach through social media and the internet are effective approaches to recruiting AYA-aged female cancer survivors. Forging collaborative relationships with survivor advocacy groups' members and healthcare providers also proved beneficial

A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors.

PurposeConcerns about fertility and parenthood are important to many young adult (YA) female cancer survivors and are associated with poorer quality of life. We aimed to develop a new scale to comprehensively measure these concerns so that they can be better addressed.MethodsScale development involved: (1) seven focus groups to identify reproductive concerns among YA female cancer survivors and develop potential scale items followed by pilot testing and cognitive interviews to refine items, (2) administering surveys to 204 YA female survivors and conducting principal components analysis (PCA) with oblique rotation to identify underlying factors in the multidimensional scale, and (3) identification of preliminary construct validity evidence.ResultsWe subjected 37 potential scale items to PCA, which indicated a six-factor solution. After removing low-loading and cross-loading items, we selected the three top loading items representing each factor. The 18-item Reproductive Concerns After Cancer scale (α = 0.82) assesses concerns about fertility potential, partner disclosure, child's health, personal health, acceptance, and becoming pregnant. As hypothesized, women who wanted to have a baby (p < 0.001) and those for whom having a biological child was very important (p < 0.05) had higher mean scores, indicating higher concerns.ConclusionsThe scale demonstrated good internal consistency and evidence of construct validity and holds promise for future clinical and research applications.Implications for cancer survivorsAn effective tool to identify concerns related to fertility and parenthood is essential for meeting the long-term reproductive health needs of young women who have survived cancer

A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors.

PurposeConcerns about fertility and parenthood are important to many young adult (YA) female cancer survivors and are associated with poorer quality of life. We aimed to develop a new scale to comprehensively measure these concerns so that they can be better addressed.MethodsScale development involved: (1) seven focus groups to identify reproductive concerns among YA female cancer survivors and develop potential scale items followed by pilot testing and cognitive interviews to refine items, (2) administering surveys to 204 YA female survivors and conducting principal components analysis (PCA) with oblique rotation to identify underlying factors in the multidimensional scale, and (3) identification of preliminary construct validity evidence.ResultsWe subjected 37 potential scale items to PCA, which indicated a six-factor solution. After removing low-loading and cross-loading items, we selected the three top loading items representing each factor. The 18-item Reproductive Concerns After Cancer scale (α = 0.82) assesses concerns about fertility potential, partner disclosure, child's health, personal health, acceptance, and becoming pregnant. As hypothesized, women who wanted to have a baby (p < 0.001) and those for whom having a biological child was very important (p < 0.05) had higher mean scores, indicating higher concerns.ConclusionsThe scale demonstrated good internal consistency and evidence of construct validity and holds promise for future clinical and research applications.Implications for cancer survivorsAn effective tool to identify concerns related to fertility and parenthood is essential for meeting the long-term reproductive health needs of young women who have survived cancer