Karrie Ann Snyder

Oncofertility · Fertility Preservation for Cancer Survivors

The Emergence of a New Interdiscipline: Oncofertility.- Fertility Risk and Treatment Options.- Fertility Management for Women With Cancer.- Fertility Preservation in Adult Male Cancer Patients.- Managing Fertility in Childhood Cancer Patients.- Fertility Risk in Pediatric and Adolescent Cancers.- Oncofertility Techniques and Research.- Bioengineering and the Ovarian Follicle.- The Science of Cryobiology.- Ovarian Tissue Cryopreservation and Transplantation: Banking Reproductive Potential for the Future.- Progress, History and Promise of Ovarian Cryopreservation and Transplantation for Pediatric Cancer Patients.- Health Care Decision-Making.- Oncofertility and the Social Sciences.- Shared Decision Making: Fertility and Pediatric Cancers.- Ethical and Psychosocial Impact of Cancer-Related Infertility.- Todays Research, Tomorrows Cures: The Ethical Implications of Oncofertility.- The Psychosocial Context of Cancer-Related Infertility.- Childhood Cancer: Fertility and Psychosocial Implications.- Fertility Preservation and Adolescent Cancer Patients: Lessons from Adult Survivors of Childhood Cancer and Their Parents.- Training in a New Medical Discipline and Medical Guidelines.- Oncofertility: A New Medical Discipline and the Emerging Scholar.- Oncofertility Consortium Consensus Statement: Guidelines for Ovarian Tissue Cryopreservation.- Patient Stories and Oncofertility.- Personal Accounts of Cancer and Infertility.

Crisis, Social Support, and the Family Response: Exploring the Narratives of Young Breast Cancer Survivors

This article explores how 70 younger women diagnosed with breast cancer draw on social support resources. The authors found that most respondents’ core support networks were their families, and social support came in several forms including emotional, tangible, and informational. However, the authors also found that many respondents relied on a distinct form of social support, experiential support, which has not been identified in current research. Experiential support is defined as a relationship with someone who has gone through a similar illness and can help provide firsthand information, insight, and even hope. The authors conclude that experiential support is an important area for future research on social support and health outcomes.

Discussing Fertility Preservation Options With Patients With Cancer

IN JUNE 2006, THE AMERICAN SOCIETY OF CLINICAL ONcology published a series of recommendations on fertility preservation for patients with cancer, concluding that “To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.” These guidelines reflect the greater attention that has been given in recent years to the fertility complications that can occur as a result of cancer treatment (eg, chemotherapies and radiation). Other professional and collaborative societies, including the Oncofertility Consortium, Fertile Hope, the American Academy of Pediatrics, and the American Society for Reproductive Medicine, also have developed best-practice guidelines and educational resources to provide patients and physicians with the most recent research on fertility preservation treatments. Investigators within the field of oncofertility have examined how patients with a cancer diagnosis learn about the potential of cancer-related infertility, including how such patients weigh fertility preservation options. In understanding this information exchange and medical decision, researchers and best-practice guidelines have looked to the patient-physician relationship, particularly those relationships between patients and oncologists, as the primary opportunity for patients to become aware of potential fertility complications related to cancer treatment. However, a distressing information gap has been identified in which oncologists often do not discuss the issue of possible infertility with patients prior to initiating potentially damaging cancer treatments. Research (including studies of men and women patients and of patients diagnosed when younger than 18 years) has consistently shown that patients diagnosed with cancer do not routinely discuss cancer-related infertility with their physicians. This information gap severely limits the ability of patients with cancer to take proactive steps to help safeguard their future fertility potential prior to fertility-compromising cancer treatments (TABLE). In light of these findings, researchers have begun to examine factors that may have prevented this exchange of information between patient and oncologist. Some research has suggested that oncologists may not be aware of bestpractice guidelines, including ASCO recommendations, and that their knowledge on the topic may not be up to date. The lack of interprofessional networks with reproductive endocrinologists and fertility preservation facilities may further hinder oncologists from raising the issue. Another inhibiting factor is the nature of the relationship between patient and oncologist. For example, Rieker et al have suggested that oncologists may be more likely to discuss sperm banking with patients with whom they share a perceived similar status (eg, highly educated patients). Physicians have reported that certain patient characteristics can influence the likelihood that they would discuss fertility preservation, including a patient’s prognosis, sex, parenting status, marital status, age/pubertal status, ability to pay for such treatments, and even whether a patient is homosexual or is infected with human immunodeficiency virus. The inability of cancer survivors to become parents is an increasing concern within the oncofertility community, and, as the above research suggests, some patient groups may have less access to fertility preservation options prior to cancer treatment. More research is needed to identify additional constituents who may be missing this information, and best-practice guidelines would benefit from highlighting potentially vulnerable groups and suggesting strategies to meet their unique fertility concerns. Research is needed to examine the conditions under which this sensitive issue is effectively discussed in the clinical setting. Among patients who do discuss potential infertility, many feel their concerns are not adequately addressed. The topic of fertility preservation may be understated when it is presented along with myriad other potential adverse effects. Additionally, more effective educational materials may be required to help facilitate these conversations. Researchers also should consider how other health care professionals can be integrated into these discussions, along with an understanding of what fertility concerns may remain fol-

Gender Segregation in the Hidden Labor Force: Looking at the Relationship between the Formal and Informal Economies

By synthesizing case studies on the informal economy throughout the world, I show that women and men specialize in different tasks, work in separate settings, and have differing access to positions of economic power in the informal economy. Moreover, women are more likely than their male counterparts to seek employment in the informal sector. I also explore why gender segregation is such a marked feature of the informal economy by examining characteristics of the informal sector that encourage such gender segregation including the relationship between the informal and formal economies and the social status of informal work.

Working off the books: Patterns of informal market participation within New York's East Village

Most research on the informal economy concentrates on how the informal economy operates at the international and regional levels along with the formal economy and the state. This article departs from current research on the informal economy by looking at how the informal economy operates within the lives of its participants. It considers how informal workers use informal work as both an economic and an identity resource. Informal workers create informal careers and informal work environments in accordance with financial and identity goals and needs. The intersection of informal work as an identity resource and as an economic resource creates a typology of informal market participation types. Among a group of self-employed workers in New York Citys East Village neighborhood, four patterns of informal market participation emerge: Entrepreneur, Occupier, Avocationalist, and Allowance Seeker.

What to do now? How women with breast cancer make fertility preservation decisions

Objectives There has been increased attention paid to cancer-related infertility and fertility preservation. However, how cancer patients decide whether or not to pursue fertility preservation has not been fully examined. Methods The data come from 34 interviews with women in the USA diagnosed with breast cancer prior to 40 years of age who contemplated fertility preservation prior to cancer treatment. Fully transcribed interviews were coded through a three-staged inductive process. Results Three sets of factors that shaped the decision-making process of the respondents regarding fertility preservation treatment options were identified: perceived benefits (e.g. ability to use ‘younger’ eggs in the future), inhibiting concerns (e.g. success rates) and influential relationships (e.g. physicians, parents and partners). Conclusions Respondents saw their main fertility preservation decision as choosing whether or not to pursue egg/embryo banking. The decision-making process was complicated and included both health-related and personal considerations, with many respondents reporting a lack of support services for fertility issues. Findings suggest that greater attention needs to be placed on presenting patients with a wider range of options. Those who counsel patients regarding fertility preservation decisions should be aware of the influence of relationship dynamics, broader health care concerns, and fertility histories on these decisions. Key message points While fertility preservation has garnered greater attention, less is known about how cancer patients make fertility preservation decisions. Despite the range of choices for fertility preservation, respondents identified egg/embryo banking as their primary option. Many factors outside of cancer concerns inhibit and facilitate fertility preservation decisions including fertility history and family relationship dynamics.

Oncofertility and the Social Sciences

Due to breakthroughs in medical technology and more aggressive forms of cancer treatment, today most people diagnosed with cancer survive. In 2000, over 2.5 million adults of childbearing age were survivors of cancer [1,2]. And by 2010, it is estimated that one out of every 250 adults will be a survivor of childhood cancer [3,4]. The more aggressive forms of treatment that have made it possible for more people, particularly those diagnosed at younger ages, to survive cancer, however, also often impair an individual’s fertility. The field of oncofertility has emerged as a way to address lost or impaired fertility in those with a history of cancer. Biomedical research in this area is active in developing new ways to help those afflicted preserve their ability to have biological children. Oncofertility is also an interdisciplinary field that bridges biomedical and social sciences and examines issues regarding an individual’s fertility concerns, options, and choices in light of cancer diagnosis, treatment, and survivorship. Although the potential effects of cancer treatment on an individual’s fertility are well documented, the rate and extent of fertility impairment among those who have undergone cancer treatment are not fully known. Similarly, within the social sciences, how cancer patients are affected by infertility in their day-to-day lives and the impact on their sense of self have been largely overlooked. Improved survivorship rates over the last several decades, however, mean that cancer-related infertility is an issue that will become a concern for an increasing portion of the population along with their partners and families. Biomedical and social science research have largely been separate areas of scholarship with little discussion or inquiry across fields. However, a recent issue of Science implored that “the successful application of new knowledge and breakthrough technologies, which are likely to occur with ever-increasing frequency, will require an entirely new interdisciplinary approach” (p. 1847) [5]. Similarly, the interdisciplinary nature of oncofertility recognizes that understanding the social dynamics, institutional behaviors, and structural factors that envelop emerging technologies are not secondary research issues but require careful empirical inquiry as technologies are developed because the surrounding social environment influences and is affected by how those technologies are integrated into society and used by individuals and institutions. Including social science research as a constitutive part of oncofertility will help to broaden understanding within the

Gender and Education in Global Perspective

Education is a key institution for understanding gender in society because it mirrors social relationships in societies as well as being a fulcrum for struggles and changes occurring within them. Is education a source of liberation, empowerment, and advancement for women, as liberal feminists tend to assume, or does education tend to reproduce gender inequalities in society, as some gender-centered theorists argue? Our thesis is that education both empowers women and reproduces gender inequalities. The question is. In what ways and in what situations is education liberating and when is it more likely to reproduce unequal power relations between men and women? This more general concern with gender and education raises two distinct but interrelated questions: (1) What is the relationship between gender and educational access, experiences, achievement, and attainment? and (2) Does education affect gender equity in society, and if so, how? We address the first question in Sections 1 and 2 of this chapter, and the third in Section 3. Historically, womens limited social roles were reflected in their highly restricted access to education. As societies changed and as women and cross-national influences shaped conceptions of the state and citizenship, the education of women began to change

Insider Knowledge and Male Nurses: How Men become Registered Nurses

This chapter examines the process by which men enter registered nursing. Research on mens entrance into atypical fields has looked at either motivational or career paths differences between men and women. I integrate these approaches by examining how mens prior work experience influences their subsequent career decisions and motivations. I find that men who are nurses are more likely to have had a prior health-care job, and this exposure helps them to recast nursing from a “female-only” job to an acceptable career choice. This reorientation job experience is a way for men to overcome informal barriers of “social control” (Jacobs, 1989) to entering a female-dominated occupation. These findings have implications for current efforts by many states and organizations that seek to expand the registered nursing workforce.

How do cancer patients learn about fertility preservation? five trajectories of experience

Several organizations—including the American Society of Clinical Oncology (ASCO) and the American Society for Reproductive Medicine (ASRM)—have developed guidelines for physicians and cancer care centers so they may more effectively educate patients regarding cancer-related fertility impairment as well as available treatment options. Despite this, studies of both cancer patients and oncologists reveal an information gap where many patients are not being informed of potential impairment or what can be done. Moreover, there is a lack of understanding of how these discussions between patients and oncologists unfold, what information is discussed, and what factors shape these conversations. Our aim in this chapter is to describe our efforts to gain a nuanced understanding of how women of reproductive age with cancer learn about the potential threats to their fertility and available fertility preservation options. Drawing on interviews with women diagnosed with breast cancer prior to 40 years of age, we identify five trajectories of experience among the respondents in our sample. These trajectories differentiate across respondents by whether or not the topic was discussed with their oncologist, who initiated the topic (patient or oncologist), and whether or not fertility preservation treatment options were discussed. We also examine barriers/facilitators to the exchange of this information, including patient knowledge and empowerment and an oncologist’s network with fertility specialists. We suggest future research directions and considerations for best-practice guidelines, including greater examination of the networks between oncologists and fertility specialists, determinants of patient empowerment, and potential sources of inequality in the exchange of fertility-related information.