Gleneara E. Bates

Fertility and Cancer Treatment

Effects of Cancer Treatment on Fertility The strictly regulated processes that lead to conditions of fertilization andhealthydevelopmentofaneggintheuterusrequireprecisebalance. Chemotherapy, hormonal therapies, targeted therapies, or irradiation involving the reproductive organs may disrupt the balance of hormonal influences or lead to DNA damage during egg or sperm development. For both men and women, effects of chemotherapy on fertility depend on the specific therapy given, the dose, and the patient’s age.

Cancer-Related Anxiety

Anxiety After Cancer Diagnosis Experiencing anxiety after diagnosis is not unusual and often begins as a temporary worry or fear after treatment or a visit to the doctor. In severe cases, a person’s capacity to lead a normal life may be compromised and the ability to function severely impacted. In addition, many patients experience “scanxiety,” which can occur days or weeks before and after follow-up scans (x-ray, CT scan, or MRI).

Approach to offering remote support to mesothelioma patients: the mesothelioma survivor project

BACKGROUND From the moment of diagnosis, malignant mesothelioma (MM) decreases health-related quality of life (QOL) in patients and their caregivers. In addition to symptoms of disease, aggressive treatments such as surgery, radiation, and chemotherapy can cause extreme side effects-chemotherapy specifically is associated with chronic fatigue, unremitting nausea, vomiting, and systemic pain. These side effects of treatments can be burdensome enough to lead to noncompliance or outright refusal of continuation of care. METHODS The platform for the support group was remote, consisting of online and telephone domains. Participants would utilize both online and phone systems during sessions held once a week for a total of six weeks. Sessions were guided and kept closed, available only to those affected by mesothelioma. Follow-up information and session summaries were provided online after support meetings. RESULTS Using a 0-5 Likert Scale, consistent attendees reported support groups as very helpful. Irregular attendees had mixed feelings ranging from extremely helpful to neutral. Eighty per cent of attendees participated in support groups prior to this project. CONCLUSIONS Active participation in a guided and closed support group allowed participants to share their experiences and concerns about their diagnoses comfortably, supporting transition beyond active-treatment. Online space gave participants a place to provide more reflective responses outside the main dialogue of support sessions.

Approach to offering remote support to mesothelioma patients: The Mesothelioma Survivor Project.

82 Background: From the moment of diagnosis, malignant mesothelioma (MM), decreases health-related quality-of-life (QOL) in patients and their caregivers. In addition to symptoms of disease, aggressive treatments such as surgery, radiation, and chemotherapy can cause extreme side effects - specifically, chemotherapy is associated with chronic fatigue, unremitting nausea, vomiting, and systemic pain. These side effects of treatments can be burdensome enough to lead to noncompliance or outright refusal of continuation of care.[1] Data from 13 frequently cited QOL studies focus on chest pain and shortness of breath as the two chief symptoms of pleural mesothelioma. The largest QOL study to date enrolled 495 patients, evaluated MM using the LCSS (lung cancer symptom scale). Investigators reported MMs most common symptoms as: fatigue (94%), dyspnea (89%), loss of appetite (86%), chest pain (85%), cough (75%), and hemoptysis (24%). In addition, mesothelioma has a number of emotional consequences. A study by the British Lung Foundation (BLF) reported significant impairment of emotional function and/or emotional state in patients with mesothelioma and their family members.[2] Methods: The platform for the support group was remote, consisting of both online and telephone domains. Participants would utilize both online and phone systems during sessions, held once a week for a total of 6 weeks. Sessions were guided and kept closed, available only to those affected by mesothelioma. Participants completed surveys after each support group. Session summaries and follow-up information were provided online after support meetings. RESULTS Using a 0-5 Likert Scale, consistent attendees reported support groups as very helpful (4). Irregular attendees had mixed feelings ranging from extremely helpful (5) to neutral (3). 80% of attendees participated in support groups prior to ours. CONCLUSIONS Active participation in a guided and closed support group allowed participants to share their experiences and concerns about their diagnoses, comfortably - supporting transition beyond active-treatment. The online portion of the platform was helpful in assuaging common negative concerns.

Survival and fertility in women with malignant peritoneal mesothelioma.

111 Background: The prognosis of malignant peritoneal mesothelioma (MPM) has improved over the past decade in patients undergoing operative extirpation and intraperitoneal chemotherapy (IC). This study investigates the time from diagnosis to treatment intervention in premenopausal women and its impact on fertility and childbearing options. METHODS A retrospective analysis of 195 patients diagnosed with peritoneal mesothelioma between 1995 and 2015. Patients with unresectable or bicavity disease were not excluded. Kaplan-Meier curves and univariate cox proportional hazards model were used to estimate survival and significant treatment and prognosis factors. RESULTS The median survival time of all peritoneal mesothelioma patients (n = 195) was 3.21 years with (95% CI: 2.38- 5.53), with median follow-up of 3.44 years (SD = 3.4, minimum = 0.014 and maximum = 16.752) years from first operation. Patient set included 111 men (57%) and 84 women (43.1%) with female sex having favorable survival [HR: 0.442 95% CI: 0.296-0.659), p < 0.001] of 110.1 months with (95% CI: lower bond: 48.3). Of these women, their mean age at diagnosis was 52 years, (SD = 14.5, minimum = 14.7 - maximum = 79.9), with a mean time of 8.20 months from diagnosis to the start of treatment (SD = 18.6, minimum = 0 and maximum = 128.6 months). Overall survival of premenopausal women (N = 23) during follow-up was 72.2% (SE = 27.8%). Mean age at time of diagnosis was 34.7 years, (SD = 9.26, minimum = 14.7, maximum = 48.1), with a mean time of 10.6 months from diagnosis to treatment (SD = 17.9, minimum = 0.63, maximum = 86.7). Of the 195 patients who received a full treatment course, 66 (33.8% CI: 95%) were still alive at the median follow-up, of those alive 37 are female: 7 are premenopausal and have presented with gynecological symptoms, and 17 are premenopausal and have presented with abdominal discomfort. CONCLUSIONS This data suggests that women preparing for treatment of MPM should not be precluded from exploring fertility options. With a mean time of 10.6 months from diagnosis to treatment, it is possible for premenopausal women to take advantage of fertility preservation before starting treatment.

Intimacy, Body Image, and Cancer.

Remaining Whole During and After Cancer Treatment This difficult disease and its therapies can make patients’ relationships with their partners, spouses, and even themselves seem like a tangle of fear, fatigue, depression, shame, and vulnerability. They may struggle to discuss their changed bodies and strain to define the shifting dynamics and needs of their sex lives. Factors like these make it challenging to discuss posttreatment changes in sexuality, rebuilding a healthy body image, and reestablishing intimacy.