Abstract
BackgroundAlthough there is a recognition of the importance of fertility to young women with cancer, we do not know who is at risk of distress related to fertility issues following diagnosis. We investigated the determinants of fertility-related distress adopting a cross-cultural perspective and using the Common Sense Model (CSM). We chose the CSM as a theoretical framework as it allows to explore how individuals conceptualise illness within the socio-cultural context.MethodsBritish and Polish women with breast or gynaecological cancer were recruited through outpatient clinics or online outlets and completed a questionnaire. Linear regression, mediation and moderated mediation methods were performed.ResultsOne hundred sixty-four women participated (mean age 34.55 (SD = 6.66); 78.7% had gynaecological cancer). The determinants of fertility-related distress were: country of origin, recruitment site, negative affect, desire to have children, treatment regret, and total illness perception score. The impact of the desire to have children on fertility-related distress was mediated by psychological value of children, perceived consequences of cancer on one’s life, emotional representation, and treatment-related regret. Country of origin moderated the relationship between the desire to have children and fertility-related distress when mediated by treatment-related regret.ConclusionsThe CSM proved useful in investigating predictors of fertility-related distress, with emotional, rather than cognitive representation of illness determining its levels. Socio-cultural background played a role in determining one’s fertility-related distress and contributed to the explanation of the relationship between one’s desire to have children, treatment-related regret, and fertility-related distress.
Highlights
There is a recognition of the importance of fertility to young women with cancer, we do not know who is at risk of distress related to fertility issues following diagnosis
These include the need for age-appropriate cancer information and state-of-the-art treatments that fit within young people’s lifestyles, information about health behaviours, complementary, and alternative therapies, information about access to peer support, as well as fertility-related needs such as the desire to be provided with information about the impact of cancer treatments on fertility and counselling regarding fertility issues
Women with breast cancer were significantly older than women with gynaecological cancer both at the time of enrolment and diagnosis (t = − 3.26, p < 0.01 and t = − 2.96, p < 0.01, respectively), and they were less likely to choose the answer ‘prefer not to say’ when asked about their average monthly income (0 vs. 13.39%, p ≤ 0.05)
Summary
There is a recognition of the importance of fertility to young women with cancer, we do not know who is at risk of distress related to fertility issues following diagnosis. While the prevalence of cancer in young people (aged 15–49) remains relatively low [2], evidence suggests that when diagnosed, young patients present with distinctive, age-specific information and supportive care needs [3,4,5,6] These include the need for age-appropriate cancer information and state-of-the-art treatments that fit within young people’s lifestyles, information about health behaviours, complementary, and alternative therapies, information about access to peer support, as well as fertility-related needs such as the desire to be provided with information about the impact of cancer treatments on fertility and counselling regarding fertility issues. Fertility-related issues are expressed by both men and women with cancer, the burden of reproductive concerns affects female cancer patients in particular. This could be due to the fact that while there are fertility preservation methods available to women diagnosed with cancer, including egg or embryo storage, these are more, personally engaging, time consuming, and costly than sperm storage accessible to men
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