Eike Adams

Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes

Background:Around 1 in 10 of all cancer cases occur in adults of reproductive age. Cancer and its treatments can cause long-term effects, such as loss of fertility, which can lead to poor emotional adjustment. Unmet information needs are associated with higher levels of anxiety. US research suggests that many oncologists do not discuss fertility. Very little research exists about fertility information provision in the United Kingdom. This study aimed to explore current knowledge, practice and attitudes among oncologists in the United Kingdom regarding fertility preservation in patients of child-bearing age.Methods:A national online survey of 100 oncologists conducted online via medeconnect, a company which has exclusive access to the doctors.net.uk membership of GMC registered doctors.Results:Oncologists saw fertility preservation (FP) as mainly a women’s issue, and yet only felt knowledgeable about sperm storage, not other methods of FP; 87% expressed a need for more information. Most reported discussing the impact of treatment on fertility with patients, but only 38% reported routinely providing patients with written information, and 1/3 reported they did not usually refer patients who had questions about fertility to a specialist fertility service. Twenty-three per cent had never consulted any FP guidelines. The main barriers to initiating discussions about FP were lack of time, lack of knowledge, perceived poor success rates of FP options, poor patient prognosis and, to a lesser extent, if the patient already had children, was single, or could not afford FP treatment.Conclusion:The findings from this study suggest a deficiency in UK oncologist’s knowledge about FP options and highlights that the provision of information to patients about FP may be sub-optimal. Oncologists may benefit from further education, and further research is required to establish if patients perceive a need for further information about FP options.

The experiences, needs and concerns of younger women with breast cancer: a meta-ethnography

Objective: This meta‐ethnography synthesises the evidence on the experiences, needs and concerns of younger women with breast cancer.

Partners and close family members of long-term cancer survivors: Health status, psychosocial well-being and unmet supportive care needs

A cancer diagnosis can have a profound impact on partners and close family members of patients. Little is currently known about the long‐term impact.

The Effects of Pelvic Radiotherapy on Cancer Survivors: Symptom Profile, Psychological Morbidity and Quality of Life

AIMS As cancer survival rates continue to increase, it is important to maximise the quality of life of cancer survivors. Pelvic radiotherapy is a common cancer treatment. Bladder, bowel and sexual dysfunction are recognised side-effects of treatment, and yet relatively little is known of the extent to which they remain problems in the longer term when patients are often managed by primary care, nor of the psychological impact of symptoms and effects on quality of life. Therefore, the aims of this study were to estimate the prevalence of bladder, bowel and sexual dysfunction late effects in a sample of cancer survivors; assess the impact of time since treatment on symptom prevalence; and explore the relationship between symptoms, psychological morbidity and quality of life. MATERIALS AND METHODS A questionnaire was given to a sample of cancer survivors treated in Oxford who had pelvic radiotherapy 1-11 years previously. The questionnaire measured patient-reported toxicity (Common Toxicity Criteria of Adverse Events/Late Effects of Normal Tissues--Subjective, Objective, Management and Analytic Measure), psychological morbidity (Hospital Anxiety and Depression Scale) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30). RESULTS In total, 418 (57.1%) completed questionnaires were received. Moderate/severe problems with bowel, urinary and sexual functioning were relatively common: bowel urgency (59% women, 45% men); urine urgency (49% women, 46% men); ability to have a sexual relationship affected (24% women, 53% men). Symptoms were just as frequent in those 6-11 years after treatment as in those 1-5 years after treatment. Symptom severity was significantly associated with poorer overall quality of life and higher levels of depression. CONCLUSIONS Late effects are common among long-term cancer survivors who have had pelvic radiotherapy, and are associated with reduced quality of life and psychological morbidity. It is imperative due attention is paid to this issue during the follow-up phase--both in secondary and primary care. Health care professionals providing follow-up care need to be aware of the importance of assessing and monitoring symptoms, and need to be adequately informed on the most appropriate management strategies.

Reply: Comment on ‘Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes’ – Oncologists must not allow personal attitudes to influence discussions on fertility preservation for cancer survivors

Reply: Comment on ‘Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes’ – Oncologists must not allow personal attitudes to influence discussions on fertility preservation for cancer survivors

The supportive care needs of the partners and family members of long-term survivors of breast, colorectal and prostate cancer

Abstract Introduction and aims There are an estimated 2 million cancer survivors in the UK today, with earlier diagnosis and improved treatments leading to an increasing number of long-term survivors. Partners and/or close family members are often a key source of support to the patient, and yet they themselves may experience significant levels of distress and have unmet needs. The main aim of this study was to describe the supportive care needs of the partners/ family members of patients who had survived breast, colorectal or prostate cancer for at least 5 years. Method This study was linked to a study of cancer survivors, recruited via cancer registries in the Thames Valley and North Yorkshire areas. Patients were asked to invite their partner or close family member to participate in a postal questionnaire. The questionnaire measured health status (EQ5D), levels of anxiety and depression (HADS), unmet needs (CASPUN) and positive outcomes. Results 257 (78%) completed questionnaires were returned. Overall, levels of anxiety and depression were comparable with population norms. Accessible hospital parking (20%), information about familial risk (18%), managing fear of recurrence (16%) and co-ordination of care (14%) were the most cited unmet needs. Conclusions Most partners/family members of long term survivors report few ongoing issues. However, a minority do have high levels of anxiety and/or moderate or strong unmet needs. Strategies are required to identify and support those with needs, while allowing the majority to resume normal life beyond cancer.

The role of primary care in cancer care: the views and experiences of patients and family members

Abstract Introduction and aims The role of primary care in the provision of cancer care is poorly defined. Practices in are offered a financial incentive to conduct a review with new patients within 6 months of diagnosis, but the extent to which these reviews occur and their scope and perceived usefulness is unknown. The purpose of this study was to explore the role of primary care in caring for and supporting cancer patients and their families. Method Semi-structured interviews were conducted with 38 patients, diagnosed within the last 3 years. Patients were stratified by time since diagnosis, and a maximum variation sampling strategy was employed to achieve heterogeneity in terms of cancer type and socio-demographic variables. We interviewed 19 males and 19 females, with a range of 14 different cancers. Patients were invited to ask their partner/close relative to participate – 24 family members were interviewed. Results Although generally satisfied with their GP practice, most patients were unaware of having had a review or any specific discussion of their cancer-related care, despite records indicating the contrary. Most patients and family members would have welcomed pro-active involvement from their GP practice and felt that a designated review appointment would provide a good opportunity to raise any concerns. Conclusions Although patients and family members see an important role for primary care in cancer follow-up care this is not universally being delivered at present and there is real scope for improving practice in this area.