Diana Richter

Psychosocial interventions for adolescents and young adult cancer patients: A systematic review and meta-analysis.

Adolescent and young adult (AYA) cancer patients experience unique psychosocial needs and developmental challenges. A cancer diagnosis can stress this development and disrupt AYAs in their normal life. The aim of this systematic review and meta-analysis was to assess the impact of psychosocial interventions on mental health in AYAs. A literature research was conducted, which resulted in twelve eligible studies. The standardized mean difference between intervention and control conditions was 0.13 (95% CI: -0.16 to 0.42) for quality of life, 0.27 (95% CI: -0.22 to 0.76) for cancer-related knowledge and -0.16 (95% CI: -0.73 to 0.42) on psychological distress indicating, small and non-significant effects for interventions improving mental health. This work strengthens the need for age-appropriated interventions in psycho-oncology. Future research should develop interventions more graduated by age. Randomized intervention studies with larger samples and focusing psychosocial outcomes are needed to establish evidence-based psycho-oncological interventions for AYAs.

Motivations for having children after cancer--a systematic review of the literature.

Over the last decade, fertility-related issues have come to the fore of clinical oncology. The majority of research though has focused on a medical perspective without considering reproductive motivations that influence decisions on fertility-preserving options. In order to identify specific parenthood motivations in young survivors of various types of cancer, a systematic review of the literature was conducted. Relevant literature was searched manually and using databases (Medline/PubMed, PsycInfo). Of 4848 articles retrieved, 20 studies met a priori defined inclusion criteria. Cancer was found to have a likely effect on reproductive intentions. All studies reported on specific reproductive concerns, mostly related to negative consequences for the patient or on the future child. Pregnancy concerns were overrepresented in breast cancer survivors. Practical barriers to post-cancer parenthood were financial or partner-referred. Overall, fewer incentives than disincentives for post-cancer parenthood were reported. They included the importance of parenthood, achieving normality and a desire to focus on the positive. As reproductive motivations and concerns affect the majority of cancer survivors of reproductive age, they should be assessed as early as possible post-diagnosis. While researchers should focus on the development of appropriate assessment methods, clinicians might address specific reproductive concerns.

Die Thematisierung des Kinderwunsches und der Fertilität in der Hämato-Onkologie – eine qualitative Ärztebefragung

OBJECTIVES Adolescent and young adult patients in hemato-oncology have often not fulfilled their desire to have a child, which is threatened by the malignancy and its treatment. The oncologists have to inform their patients about possible infertility and fertility preservation. METHODS 25 oncologists were interviewed to discuss the desire to have a child and fertility issues with the patients. Afterwards the semi-structured interviews were transcribed and analyzed according to the qualitative content analysis of Mayring. RESULTS The following issues could be identified in the interviews: current desire to have a child; possible threat of fertility; fertility preservation and their implementation; contact to a reproduction facility; sexuality and contraception during therapy. Most of the oncologists (n=19) stated to discuss the fertility aspects in the first session. 14 oncologists stated that they have enough knowledge about fertility preservation. To improve the conditions for a discussion the oncologists wished to have more information (n=10) or patient leaflets (n=11) about fertility preservation. DISCUSSION Addressing the desire to have a child and fertility aspects of adolescent and young adult patients in hemato-oncology have already a high priority. Further studies should analyze the discussion from patient perspective and determine patient needs in this regard.