AYAs and Cancer Care Article Quantitative Research Fact Sheet

AYAs and Cancer Care Article Quantitative Research Fact Sheet AYAs and Cancer Care Article Quantitative Research Fact Sheet Locate an online report or poll that uses a quantitative study within Human Services and/or the social sciences. I attached the article I found to prepare the Fact Sheet on. If you feel it is not a good article you are free to search for another. However, it needs to be on my research interest which is AYA’s and cancer care . Prepare a fact sheet that focuses on the article you select. Answer the following questions: What is/are the research question(s) being asked in the study? Who is the target population? What theory is being used to guide this study, if any? What measurement tools are being used; what specifics are given regarding the methodology? What did the results show or not show? How is this applicable to something within the Human Services field? Your fact sheet should contain 1-2 pages of content. In addition, you must create your own image (chart or graph) that aligns with a portion of the content. The fact sheet does not require APA in-text citations, but a reference list should be included that provides all the citation information for the article. The reference sheet (not included in the page count) must adhere to APA requirements. If you are not familiar with developing a fact sheet, please review the following information: Human Services Council Fact Sheet (Links to an external site.) . fridgen2017_article_contraceptiontheneedforexpansi.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS J Canc Educ (2017) 32:924–932 DOI 10.1007/s13187-016-1003-8 Contraception: the Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care Olivia Fridgen 1 & Ivana Sehovic 2 & Meghan L Bowman 2 & Damon Reed 3 & Christina Tamargo 2 & Susan Vadaparampil 3,4 & Gwendolyn P Quinn 3,4 Published online: 15 February 2016 # American Association for Cancer Education 2016 Abstract Little is known about oncology provider recommendations regarding best practices in contraception use during cancer treatment and through survivorship for adolescent and young adult (AYA) cancer patients. This review examined the literature to identify related studies on contraception recommendations, counseling discussions, and methods of contraception in the AYA oncology population. A literature review was conducted using PubMed, including all peerreviewed journals with no publication date exclusions. A systematic review of the literature was conducted using combinations of the following phrases or keywords: Boncology OR cancer^ AND Bcontraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agents, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization^ AND Byoung adult OR adolescent^ AND Byoung adult AND adolescent^. Reviewers assessed articles using the BQuality Assessment Tool for Quantitative Studies^ which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. A total of five articles were included and all studies were quantitative. Results showed no consistent recommendations among providers, references to guidelines, or methods of contraceptive types. Provider guidelines for discussions with AYA patients should be expanded to provide comprehensive, consistent, and quality cancer care in the AYA population. Keywords Adolescent and young adult . Contraception . Cancer . Oncology . Quality of life . Quality of care Introduction * Gwendolyn P Quinn [email protected] 1 Adolescent and Young Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL 33612, USA 2 Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL 33612, USA 3 Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL 33612, USA 4 University of South Florida, Morsani College of Medicine University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA The National Cancer Institute and the LIVESTRONG Foundation define adolescents and young adults (AYAs) with cancer as those aged 15–39 years [1, 2]. However, other researchers and organizations examine contraception within the context of reproductive age, thus contraception studies may include patients up to the age of 45. AYAs with cancer experience many unique challenges and quality of life (QoL) issues throughout their cancer diagnosis, treatment, and into survivorship including issues with infertility [3, 4], body image dissatisfaction [5], difficulty establishing relationships [5, 6], and other aspects of physical and social functioning [7–9]. FIU AYAs and Cancer Care Article Quantitative Research Fact Sheet Cancer treatments can impact fertility in the AYA population by causing temporary or permanent damage to reproductive organs, sperm, or egg functioning. The likelihood of damage depends on cancer site, treatment, and age of the patient, J Canc Educ (2017) 32:924–932 with younger patients less likely to have permanent damage. Leading US health and professional organizations such as the National Comprehensive Cancer Network [10] (NCCN) and the American Society for Clinical Oncology [11, 12] (ASCO) have established guidelines on fertility and preservation for the AYA population. These recommendations include: discussing the potential impact of treatment on fertility, fertility preservation options, and referrals to reproductive endocrinologists. It is recommended that patients receive this information as early as possible upon diagnosis to allow optimal time for decision-making. These guidelines, as well as education and training on discussing fertility and reproductive health and cancer for AYA, are available for health care professionals. However, there is little information or guidance specific to contraception during active cancer treatment and through survivorship. The World Health Organization’s definition of reproductive health includes Bthe right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice [13].^ With this definition in mind, there is a clear need for provider recommendations and guidelines regarding contraception for AYA cancer patients and survivors. There are several barriers to the discussion of contraception with AYAs. First, the message of infertility due to cancer treatment may be oversold and patients may assume they are infertile. Second, there is a misperception among providers that cancer patients are too ill to engage in or be interested in sex. AYAs are not asexual simply because of their diagnosis, nor are they unanimously infertile during or after treatment. AYAs with cancer are found to engage in sexual behaviors at similar rates as their cancer-free peers [14]. Further, the AYA population may engage in sexual risk-taking behavior more often than their older, cancer-free peers and may be at a greater risk to use unreliable methods of contraception such as withdrawal, or may not use any form of contraception [15]. Pregnancy risks are substantial for female patients on active treatment, and patients with compromised immune systems are at a higher risk for sexually transmitted infections (STI) and other diseases [14, 16]. Several studies suggest AYA survivors are at a higher risk for unintended pregnancy than the general population since they are often unaware of their fertility status or assume they are infertile [17–21]. AYA patients need counseling not only on the proper and consistent use of contraceptives, but also on the risks and benefits associated with each contraceptive method to make personal and informed decisions [22]. FIU AYAs and Cancer Care Article Quantitative Research Fact Sheet Many cancer treatments pose teratogenic risks to a fetus, and females who conceive during active treatment may be faced with the decision of pregnancy termination. QoL is impacted by a cancer diagnosis but can be exacerbated by unplanned pregnancies, pregnancy termination, or a child born with special needs. One way to prevent these unnecessary stressors is to provide directed contraceptive counseling to AYAs with cancer. 925 A few studies have identified that sexual health and sexuality were desired discussion and education topics by AYA cancer patients and survivors, yet limited information exists on best practices for these discussions [14, 15, 23]. A recent study identified that women who received directed counseling on reproductive issues had a higher QoL and less regret than those who did not receive counseling prior to initiating cancer treatment [24]. Contraception conversations may be unlikely to happen in a clinic room as providers are focused on cancer treatment plans and outcomes and patients may be uncomfortable initiating questions or unaware of the need to discuss concerns with providers [25, 26]. The discomfort surrounding contraception is exacerbated if family members are present, the provider is of the opposite gender, or the patient is sexually inactive [27, 28]. The objectives of this review were to examine the available literature on contraception in the AYA oncology population and to identify studies related to contraceptive methods and contraception counseling. Methods Search Strategy and Study Selection A review of available literature was conducted through the PubMed database using PRISMA guidelines. The search included all peer-reviewed journals and publications dates. The MeSH terms used included: Boncology OR cancer^ AND Bcontraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agenda, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization^ AND Byoung adult OR adolescent^ AND Byoung adult AND adolescent.^ Selection criteria then excluded: oral contraceptive use for reasons other than disease and pregnancy prevention, contraception with any populations other than AYA cancer patients or survivors, studies in any language other than English, and unoriginal research (reviews, commentaries, and abstracts). A total of 289 articles were identified in PubMed (Fig. 1). Articles were originally filtered by title and type of article, which removed articles exclusively focused on advance care planning (n = 10), prevention and educational studies on contraception (n = 19), HPV (n = 30), surgery cancellations (n = 1), sun exposure (n = 2), hypertension (n = 2), tobacco (n = 2), tattoo risks (n = 1) and the psychosocial impact of cancer on patients and families (n = 6) as well as unoriginal research including abstracts (n = 2), commentaries (n = 4), and reviews (n = 5). Remaining articles were then filtered by abstract and full text to determine subsequent elimination, including articles that spoke only to gynecologic issues within the AYA population (n = 58), sexual behaviors and family 926 Fig. 1 Flow diagram illustrating the search strategy for articles included in the review J Canc Educ (2017) 32:924–932 289 articles identified through database search (Pubmed) 84 articles excluded based on titles and type of article 10 Advanced Care Planning 19 Prevention and Educational Studies on Contraception 30 HPV 1 Surgery Cancellations 2 Sun Exposure 2 Hypertension 2 Tobacco 1 Tattoo Risks 6 Psychosocial Impact of Cancer on Patients and Families 2 Abstract 4 Commentary 5 Review 205 articles screened for further evaluation 200 articles excluded based on abstracts and full text review 58 Gynaecologic Issues within the AYA population 21 Sexual Behaviors and Family Planning in AYAs w/out Cancer 3 Oral Contraception for use other than Pregnancy Prevention 38 Cancer in AYAs with no mention of Contraceptive Use 20 Contraception Use in Populations without Cancer 60 Health Risks Associated with the use of Contraception 5 articles included in the review planning in young people without cancer (n = 21), oral contraception for use other than pregnancy prevention (n = 3), cancer in AYAs with no mention of contraception use (n = 35), contraception usage in populations without cancer (n = 20), and health risks associated with the use of contraception (n = 60). v The search was made complete by adding any relevant articles from reference lists included in the original query. A total of 5 articles were included in this review. Three reviewers assessed each article using the BQuality Assessment Tool for Quantitative Studies^ which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. Articles were ranked as strong (no weak ratings in any of the six categories), moderate (one allowable weak rating in one of the six categories) or weak (two or more weak ratings in one of the six categories) [29]. Differences or incongruities in scoring between reviewers were discussed until a conclusion was reached. The included articles were all rated in the strong or moderate categories. Data Synthesis Table 1 details the extracted data from each article included in the review. Data extracted included authors, evidence criteria, contraception methods, AYA population definition, study population, cancer type, sample size, study aims, methods, outcomes and measures, and key findings. All authors appraised the articles and confirmed the inclusion of articles in this review. The information included for each article was reviewed by all authors until consensus was reached. Results Study Information The majority of articles included in the review defined AYA as between the ages of 15–45 (n = 4) while one article defined its population as reproductive age only. The study participants were AYA cancer patients and survivors (n = 4) and teenage/ pediatric oncology providers (n = 1). All cancer types were included in four articles, while one article focused on nongynecologic cancers only. Cancer stages included in this review ranged from a cancer diagnosis within the past 5 years (n = 2) to cancer survivorship without any limitations (n = 2). Sample sizes for these studies range from 15–1041. All methods of contraception were included in the reviewed articles and all five studies were quantitative. None specified Natural methods (none, withdrawal, periodic abstinence), oral contraceptives (oral combined pill, progestin-only pill, emergency contraception), injectable 18– 40 years of age Laurence V, Quantitative, Gbolade Survey BA, Morgan SJ, Glaser A (UK) Barrier, hormonal, tubal ligation, vasectomy intrauterine device and other Nongynecologic cancers Teenage All cancer units or pediatric oncology units within the UK AYA All cancer patients treated within the past 5 years AYA cancer survivors AYA Study Cancer type Definition population Cancer-specific 15– concerns 25 yerelated to STDs ars of and age contraception Quantitative, survey Quinn MM, Letourneau JM, Rosen MP (USA) Contraception methods Quantitative, Canada AL, intervenSchover LR, tion Li Y (USA) Evidence criteria Reviewed Articles Authors (country) Table 1 Study aim(s) Methods Outcomes Key findings (1) To describe 1041 non-gynecologic cancer survivors, 918 women (88 %) received treatment Sexually active cancer survivors are at contraceptive who had resumed menstrual bleedwith potential to affect fertility a threefold increased risk of methods ing following treatment and had not (chemotherapy, radiation or unintended pregnancy compared to utilized by undergone surgical sterilization, sterilizing surgery). Of 476 women the US population. Contraceptive young female responded to a survey on their younger than 40 years old who still counseling in this high-risk cancer contraceptive methods utilized had menses, 58 % did not want to population is recommended survivors and and history of fertility counseling conceive; of these 275 women, 21 % post-treatment (2) before treatment began. Subjects reported unprotected intercourse in determine were defined at risk of unintended the prior month and were defined at whether pregnancy if they reported unprotected risk of unintended pregnancy. This pretreatment vaginal intercourse within the last compared to the 7.3 % risk of fertility month and did not desire conception unintended pregnancy reported by counseling the National Center for Health decreases Statistics. Increasing age was unintended associated with greater risk of pregnancy risk unintended pregnancy (odds ratio 1.07, P = 0.006). FIU AYAs and Cancer Care Article Quantitative Research Fact Sheet The following contraceptive methods were reported: barrier (25.5 %), hormonal (24.5 %), tubal ligation (21.3 %), vasectomy (17.5 %), intrauterine devices (7.2 %), and other (4.0 %). 67 % of women received pretreatment fertility counseling. Counseling prior to treatment did not decrease risk of unintended pregnancy (P = 0.93). (1) Develop and A total of 21 patients, aged 15–25 years, 21/24 participants who entered the Addressing issues of reproductive AYA test an and treated for cancer within the past study, completed the prehealth in the adolescent/young cancer intervention 5 years, completed the counseling intervention questionnaire(s), both adult with cancer can and should patients designed intervention. Patients were counseling sessions, and at least one be offered as a part of and to enhance adaptively randomized to begin the follow-up questionnaire. Participant comprehensive pediatric cancer survipsychosexual intervention immediately, or to be stress levels increased while on the care. vors development placed on a 3-month wait list, after waiting list to begin intervention (N = 2in adolescents which time, they were reassessed (P = 0.046). Data gathered from the 1, and young and began the intervention. waitlisted group compared to the 57.25 adults with Questionnaires were completed at intervention group showed % cancer baseline, post-waitlist (half of the improvements including: more Female) sample), post-treatment, and at 3knowledge about the effects of month follow-up. cancer on sexuality and fertility (P = 0.040), greater confidence in dating situations (P = .004) and less emotional distress (P < 0.001). Gains were maintained through the 3-month follow-up. Pediatric (1) To determine 21 respondents were asked to fill out a All (100 %) of the 15 respondents stated Contraceptive issues need to be prowhether UK questionnaire asking whether they that they did not have any policies highlighted with teenage and viders pediatric had a policy regarding contraception regarding contraception issues for young adult patients with cancer (N = 1cancer units issues for their potentially sexually their potentially sexually active this demands the awareness and 5, not had active teenage patients. 15 responses teenage patients. education of the oncology teams, availpredetermined were collected. and collaboration with family able) contraception planning units. policies for their AYA patients AYA cancer survivors (N = 1041, 100 % female) Sample size (M/F, %) J Canc Educ (2017) 32:924–932 927 Evidence criteria Quantitative, crosssectional survey Quantitative, crosssectional survey Authors (country) Patel A, Sreedevi M, Malapati R, Sutaria R, Schoenhage MB, Patel AR, Radeke EK, Zaren HA (USA) Maslow BL, Morse CB, Schanne A, Loren A, Domchek SM, Gracia CR (USA) Table 1 (continued) All forms of contraception 18–45 All (90 % breast, 10 % other) AYA All patients and survivors within 5 years of a diagnosis AYA patients AYA Study Cancer type Definition population contraceptives, implant contraceptives, IUDs, barrier methods (diaphragm, cervical cap, vaginal sponge, female condom, male condom, vaginal spermicides) Abstinence, barrier 15– methods 44 ye(foam, ars of condoms), age other Contraception methods AYA patients and survivors (N = 107, 100 % female) AYA patients (N = 20, 100 % female) Sample size (M/F, %) Methods Outcomes Key findings The purpose of Cross-sectional pilot survey study of 20 Of the 20 patients whose cases were The results of this pilot study this study women who were diagnosed with surveyed, the mean age was demonstrate the need for was to pilot a various types of cancers at the 36.6 years and 90 % of the women reproductive health counseling in survey oncology clinic of Stroger Hospital had breast cancer. 10 % of patients women with cancer; the range of instrument and of Cook County, Chicago, from would continue pregnancy, if they discussion must include fertility to develop January-July 2006. became pregnancy while receiving interest, contraception, and fertility descriptive treatment. Contraception was used preservation. data about the by 55 % of patients (n = 11), of reproductive whom 55 % of the women (n = 6) goals of were using abstinence. reproductiveaged women with cancer Cross-sectional, survey study of 107 women completed the survey. 82 Reproductive-aged women diagnosed (1) To reproductive-aged women at a large women reported 101 different with cancer underutilized Tier I/II characterize tertiary health care system with a contraceptive choices. 27 % of all contraceptive agents, especially contraceptive recent cancer diagnosis (less than methods used were Tier I/II and IUDs. Contraceptive counseling by choices in a 5 years). 35 % were Tier II/IV. 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AYAs and Cancer Care Article Quantitative Research Fact Sheet

AYAs and Cancer Care Article Quantitative Research Fact Sheet AYAs and Cancer Care Article Quantitative Research Fact Sheet Locate an online report or poll that uses a quantitative study within Human Services and/or the social sciences. I attached the article I found to prepare the Fact Sheet on. If you feel it is not a good article you are free to search for another. However, it needs to be on my research interest which is AYA’s and cancer care . Prepare a fact sheet that focuses on the article you select. Answer the following questions: What is/are the research question(s) being asked in the study? Who is the target population? What theory is being used to guide this study, if any? What measurement tools are being used; what specifics are given regarding the methodology? What did the results show or not show? How is this applicable to something within the Human Services field? Your fact sheet should contain 1-2 pages of content. In addition, you must create your own image (chart or graph) that aligns with a portion of the content. The fact sheet does not require APA in-text citations, but a reference list should be included that provides all the citation information for the article. The reference sheet (not included in the page count) must adhere to APA requirements. If you are not familiar with developing a fact sheet, please review the following information: Human Services Council Fact Sheet (Links to an external site.) . fridgen2017_article_contraceptiontheneedforexpansi.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS J Canc Educ (2017) 32:924–932 DOI 10.1007/s13187-016-1003-8 Contraception: the Need for Expansion of Counsel in Adolescent and Young Adult (AYA) Cancer Care Olivia Fridgen 1 & Ivana Sehovic 2 & Meghan L Bowman 2 & Damon Reed 3 & Christina Tamargo 2 & Susan Vadaparampil 3,4 & Gwendolyn P Quinn 3,4 Published online: 15 February 2016 # American Association for Cancer Education 2016 Abstract Little is known about oncology provider recommendations regarding best practices in contraception use during cancer treatment and through survivorship for adolescent and young adult (AYA) cancer patients. This review examined the literature to identify related studies on contraception recommendations, counseling discussions, and methods of contraception in the AYA oncology population. A literature review was conducted using PubMed, including all peerreviewed journals with no publication date exclusions. A systematic review of the literature was conducted using combinations of the following phrases or keywords: Boncology OR cancer^ AND Bcontraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agents, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization^ AND Byoung adult OR adolescent^ AND Byoung adult AND adolescent^. Reviewers assessed articles using the BQuality Assessment Tool for Quantitative Studies^ which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. A total of five articles were included and all studies were quantitative. Results showed no consistent recommendations among providers, references to guidelines, or methods of contraceptive types. Provider guidelines for discussions with AYA patients should be expanded to provide comprehensive, consistent, and quality cancer care in the AYA population. Keywords Adolescent and young adult . Contraception . Cancer . Oncology . Quality of life . Quality of care Introduction * Gwendolyn P Quinn [email protected] 1 Adolescent and Young Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL 33612, USA 2 Health Outcomes and Behavior Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC CANCONT, Tampa, FL 33612, USA 3 Adolescent and Young Adult Oncology Program, Sarcoma Oncology Program, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB1, Tampa, FL 33612, USA 4 University of South Florida, Morsani College of Medicine University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA The National Cancer Institute and the LIVESTRONG Foundation define adolescents and young adults (AYAs) with cancer as those aged 15–39 years [1, 2]. However, other researchers and organizations examine contraception within the context of reproductive age, thus contraception studies may include patients up to the age of 45. AYAs with cancer experience many unique challenges and quality of life (QoL) issues throughout their cancer diagnosis, treatment, and into survivorship including issues with infertility [3, 4], body image dissatisfaction [5], difficulty establishing relationships [5, 6], and other aspects of physical and social functioning [7–9]. FIU AYAs and Cancer Care Article Quantitative Research Fact Sheet Cancer treatments can impact fertility in the AYA population by causing temporary or permanent damage to reproductive organs, sperm, or egg functioning. The likelihood of damage depends on cancer site, treatment, and age of the patient, J Canc Educ (2017) 32:924–932 with younger patients less likely to have permanent damage. Leading US health and professional organizations such as the National Comprehensive Cancer Network [10] (NCCN) and the American Society for Clinical Oncology [11, 12] (ASCO) have established guidelines on fertility and preservation for the AYA population. These recommendations include: discussing the potential impact of treatment on fertility, fertility preservation options, and referrals to reproductive endocrinologists. It is recommended that patients receive this information as early as possible upon diagnosis to allow optimal time for decision-making. These guidelines, as well as education and training on discussing fertility and reproductive health and cancer for AYA, are available for health care professionals. However, there is little information or guidance specific to contraception during active cancer treatment and through survivorship. The World Health Organization’s definition of reproductive health includes Bthe right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice [13].^ With this definition in mind, there is a clear need for provider recommendations and guidelines regarding contraception for AYA cancer patients and survivors. There are several barriers to the discussion of contraception with AYAs. First, the message of infertility due to cancer treatment may be oversold and patients may assume they are infertile. Second, there is a misperception among providers that cancer patients are too ill to engage in or be interested in sex. AYAs are not asexual simply because of their diagnosis, nor are they unanimously infertile during or after treatment. AYAs with cancer are found to engage in sexual behaviors at similar rates as their cancer-free peers [14]. Further, the AYA population may engage in sexual risk-taking behavior more often than their older, cancer-free peers and may be at a greater risk to use unreliable methods of contraception such as withdrawal, or may not use any form of contraception [15]. Pregnancy risks are substantial for female patients on active treatment, and patients with compromised immune systems are at a higher risk for sexually transmitted infections (STI) and other diseases [14, 16]. Several studies suggest AYA survivors are at a higher risk for unintended pregnancy than the general population since they are often unaware of their fertility status or assume they are infertile [17–21]. AYA patients need counseling not only on the proper and consistent use of contraceptives, but also on the risks and benefits associated with each contraceptive method to make personal and informed decisions [22]. FIU AYAs and Cancer Care Article Quantitative Research Fact Sheet Many cancer treatments pose teratogenic risks to a fetus, and females who conceive during active treatment may be faced with the decision of pregnancy termination. QoL is impacted by a cancer diagnosis but can be exacerbated by unplanned pregnancies, pregnancy termination, or a child born with special needs. One way to prevent these unnecessary stressors is to provide directed contraceptive counseling to AYAs with cancer. 925 A few studies have identified that sexual health and sexuality were desired discussion and education topics by AYA cancer patients and survivors, yet limited information exists on best practices for these discussions [14, 15, 23]. A recent study identified that women who received directed counseling on reproductive issues had a higher QoL and less regret than those who did not receive counseling prior to initiating cancer treatment [24]. Contraception conversations may be unlikely to happen in a clinic room as providers are focused on cancer treatment plans and outcomes and patients may be uncomfortable initiating questions or unaware of the need to discuss concerns with providers [25, 26]. The discomfort surrounding contraception is exacerbated if family members are present, the provider is of the opposite gender, or the patient is sexually inactive [27, 28]. The objectives of this review were to examine the available literature on contraception in the AYA oncology population and to identify studies related to contraceptive methods and contraception counseling. Methods Search Strategy and Study Selection A review of available literature was conducted through the PubMed database using PRISMA guidelines. The search included all peer-reviewed journals and publications dates. The MeSH terms used included: Boncology OR cancer^ AND Bcontraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agenda, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization^ AND Byoung adult OR adolescent^ AND Byoung adult AND adolescent.^ Selection criteria then excluded: oral contraceptive use for reasons other than disease and pregnancy prevention, contraception with any populations other than AYA cancer patients or survivors, studies in any language other than English, and unoriginal research (reviews, commentaries, and abstracts). A total of 289 articles were identified in PubMed (Fig. 1). Articles were originally filtered by title and type of article, which removed articles exclusively focused on advance care planning (n = 10), prevention and educational studies on contraception (n = 19), HPV (n = 30), surgery cancellations (n = 1), sun exposure (n = 2), hypertension (n = 2), tobacco (n = 2), tattoo risks (n = 1) and the psychosocial impact of cancer on patients and families (n = 6) as well as unoriginal research including abstracts (n = 2), commentaries (n = 4), and reviews (n = 5). Remaining articles were then filtered by abstract and full text to determine subsequent elimination, including articles that spoke only to gynecologic issues within the AYA population (n = 58), sexual behaviors and family 926 Fig. 1 Flow diagram illustrating the search strategy for articles included in the review J Canc Educ (2017) 32:924–932 289 articles identified through database search (Pubmed) 84 articles excluded based on titles and type of article 10 Advanced Care Planning 19 Prevention and Educational Studies on Contraception 30 HPV 1 Surgery Cancellations 2 Sun Exposure 2 Hypertension 2 Tobacco 1 Tattoo Risks 6 Psychosocial Impact of Cancer on Patients and Families 2 Abstract 4 Commentary 5 Review 205 articles screened for further evaluation 200 articles excluded based on abstracts and full text review 58 Gynaecologic Issues within the AYA population 21 Sexual Behaviors and Family Planning in AYAs w/out Cancer 3 Oral Contraception for use other than Pregnancy Prevention 38 Cancer in AYAs with no mention of Contraceptive Use 20 Contraception Use in Populations without Cancer 60 Health Risks Associated with the use of Contraception 5 articles included in the review planning in young people without cancer (n = 21), oral contraception for use other than pregnancy prevention (n = 3), cancer in AYAs with no mention of contraception use (n = 35), contraception usage in populations without cancer (n = 20), and health risks associated with the use of contraception (n = 60). v The search was made complete by adding any relevant articles from reference lists included in the original query. A total of 5 articles were included in this review. Three reviewers assessed each article using the BQuality Assessment Tool for Quantitative Studies^ which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. Articles were ranked as strong (no weak ratings in any of the six categories), moderate (one allowable weak rating in one of the six categories) or weak (two or more weak ratings in one of the six categories) [29]. Differences or incongruities in scoring between reviewers were discussed until a conclusion was reached. The included articles were all rated in the strong or moderate categories. Data Synthesis Table 1 details the extracted data from each article included in the review. Data extracted included authors, evidence criteria, contraception methods, AYA population definition, study population, cancer type, sample size, study aims, methods, outcomes and measures, and key findings. All authors appraised the articles and confirmed the inclusion of articles in this review. The information included for each article was reviewed by all authors until consensus was reached. Results Study Information The majority of articles included in the review defined AYA as between the ages of 15–45 (n = 4) while one article defined its population as reproductive age only. The study participants were AYA cancer patients and survivors (n = 4) and teenage/ pediatric oncology providers (n = 1). All cancer types were included in four articles, while one article focused on nongynecologic cancers only. Cancer stages included in this review ranged from a cancer diagnosis within the past 5 years (n = 2) to cancer survivorship without any limitations (n = 2). Sample sizes for these studies range from 15–1041. All methods of contraception were included in the reviewed articles and all five studies were quantitative. None specified Natural methods (none, withdrawal, periodic abstinence), oral contraceptives (oral combined pill, progestin-only pill, emergency contraception), injectable 18– 40 years of age Laurence V, Quantitative, Gbolade Survey BA, Morgan SJ, Glaser A (UK) Barrier, hormonal, tubal ligation, vasectomy intrauterine device and other Nongynecologic cancers Teenage All cancer units or pediatric oncology units within the UK AYA All cancer patients treated within the past 5 years AYA cancer survivors AYA Study Cancer type Definition population Cancer-specific 15– concerns 25 yerelated to STDs ars of and age contraception Quantitative, survey Quinn MM, Letourneau JM, Rosen MP (USA) Contraception methods Quantitative, Canada AL, intervenSchover LR, tion Li Y (USA) Evidence criteria Reviewed Articles Authors (country) Table 1 Study aim(s) Methods Outcomes Key findings (1) To describe 1041 non-gynecologic cancer survivors, 918 women (88 %) received treatment Sexually active cancer survivors are at contraceptive who had resumed menstrual bleedwith potential to affect fertility a threefold increased risk of methods ing following treatment and had not (chemotherapy, radiation or unintended pregnancy compared to utilized by undergone surgical sterilization, sterilizing surgery). Of 476 women the US population. Contraceptive young female responded to a survey on their younger than 40 years old who still counseling in this high-risk cancer contraceptive methods utilized had menses, 58 % did not want to population is recommended survivors and and history of fertility counseling conceive; of these 275 women, 21 % post-treatment (2) before treatment began. Subjects reported unprotected intercourse in determine were defined at risk of unintended the prior month and were defined at whether pregnancy if they reported unprotected risk of unintended pregnancy. This pretreatment vaginal intercourse within the last compared to the 7.3 % risk of fertility month and did not desire conception unintended pregnancy reported by counseling the National Center for Health decreases Statistics. Increasing age was unintended associated with greater risk of pregnancy risk unintended pregnancy (odds ratio 1.07, P = 0.006). FIU AYAs and Cancer Care Article Quantitative Research Fact Sheet The following contraceptive methods were reported: barrier (25.5 %), hormonal (24.5 %), tubal ligation (21.3 %), vasectomy (17.5 %), intrauterine devices (7.2 %), and other (4.0 %). 67 % of women received pretreatment fertility counseling. Counseling prior to treatment did not decrease risk of unintended pregnancy (P = 0.93). (1) Develop and A total of 21 patients, aged 15–25 years, 21/24 participants who entered the Addressing issues of reproductive AYA test an and treated for cancer within the past study, completed the prehealth in the adolescent/young cancer intervention 5 years, completed the counseling intervention questionnaire(s), both adult with cancer can and should patients designed intervention. Patients were counseling sessions, and at least one be offered as a part of and to enhance adaptively randomized to begin the follow-up questionnaire. Participant comprehensive pediatric cancer survipsychosexual intervention immediately, or to be stress levels increased while on the care. vors development placed on a 3-month wait list, after waiting list to begin intervention (N = 2in adolescents which time, they were reassessed (P = 0.046). Data gathered from the 1, and young and began the intervention. waitlisted group compared to the 57.25 adults with Questionnaires were completed at intervention group showed % cancer baseline, post-waitlist (half of the improvements including: more Female) sample), post-treatment, and at 3knowledge about the effects of month follow-up. cancer on sexuality and fertility (P = 0.040), greater confidence in dating situations (P = .004) and less emotional distress (P < 0.001). Gains were maintained through the 3-month follow-up. Pediatric (1) To determine 21 respondents were asked to fill out a All (100 %) of the 15 respondents stated Contraceptive issues need to be prowhether UK questionnaire asking whether they that they did not have any policies highlighted with teenage and viders pediatric had a policy regarding contraception regarding contraception issues for young adult patients with cancer (N = 1cancer units issues for their potentially sexually their potentially sexually active this demands the awareness and 5, not had active teenage patients. 15 responses teenage patients. education of the oncology teams, availpredetermined were collected. and collaboration with family able) contraception planning units. policies for their AYA patients AYA cancer survivors (N = 1041, 100 % female) Sample size (M/F, %) J Canc Educ (2017) 32:924–932 927 Evidence criteria Quantitative, crosssectional survey Quantitative, crosssectional survey Authors (country) Patel A, Sreedevi M, Malapati R, Sutaria R, Schoenhage MB, Patel AR, Radeke EK, Zaren HA (USA) Maslow BL, Morse CB, Schanne A, Loren A, Domchek SM, Gracia CR (USA) Table 1 (continued) All forms of contraception 18–45 All (90 % breast, 10 % other) AYA All patients and survivors within 5 years of a diagnosis AYA patients AYA Study Cancer type Definition population contraceptives, implant contraceptives, IUDs, barrier methods (diaphragm, cervical cap, vaginal sponge, female condom, male condom, vaginal spermicides) Abstinence, barrier 15– methods 44 ye(foam, ars of condoms), age other Contraception methods AYA patients and survivors (N = 107, 100 % female) AYA patients (N = 20, 100 % female) Sample size (M/F, %) Methods Outcomes Key findings The purpose of Cross-sectional pilot survey study of 20 Of the 20 patients whose cases were The results of this pilot study this study women who were diagnosed with surveyed, the mean age was demonstrate the need for was to pilot a various types of cancers at the 36.6 years and 90 % of the women reproductive health counseling in survey oncology clinic of Stroger Hospital had breast cancer. 10 % of patients women with cancer; the range of instrument and of Cook County, Chicago, from would continue pregnancy, if they discussion must include fertility to develop January-July 2006. became pregnancy while receiving interest, contraception, and fertility descriptive treatment. Contraception was used preservation. data about the by 55 % of patients (n = 11), of reproductive whom 55 % of the women (n = 6) goals of were using abstinence. reproductiveaged women with cancer Cross-sectional, survey study of 107 women completed the survey. 82 Reproductive-aged women diagnosed (1) To reproductive-aged women at a large women reported 101 different with cancer underutilized Tier I/II characterize tertiary health care system with a contraceptive choices. 27 % of all contraceptive agents, especially contraceptive recent cancer diagnosis (less than methods used were Tier I/II and IUDs. Contraceptive counseling by choices in a 5 years). 35 % were Tier II/IV. 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