Risk–benefit perception of pregnancy among breast cancer survivors
P.-L. Hsieh PhD
Assistant Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Search for more papers by this authorCorresponding Author
S.-M. Huang PhD
Assistant Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Correspondence
Sheng-Miauh Huang, Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
Email: [email protected]
Search for more papers by this authorL.-Y. Chien ScD
Professor
Institute of Community Health care, National Yang-Ming University, Taipei, Taiwan
Search for more papers by this authorC.-F. Lee PhD
Associate Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Search for more papers by this authorY. Hsiung PhD
Assistant Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Search for more papers by this authorC.-J. Tai MD, PhD
Director, Professor
Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taipei, Taiwan
Department of OB/GYN, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorP.-L. Hsieh PhD
Assistant Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Search for more papers by this authorCorresponding Author
S.-M. Huang PhD
Assistant Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Correspondence
Sheng-Miauh Huang, Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
Email: [email protected]
Search for more papers by this authorL.-Y. Chien ScD
Professor
Institute of Community Health care, National Yang-Ming University, Taipei, Taiwan
Search for more papers by this authorC.-F. Lee PhD
Associate Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Search for more papers by this authorY. Hsiung PhD
Assistant Professor
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
Search for more papers by this authorC.-J. Tai MD, PhD
Director, Professor
Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taipei, Taiwan
Department of OB/GYN, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorAbstract
Helping breast cancer patients who desire a pregnancy after cancer treatment is a vital issue. Little is known about the complex context of the decision to become pregnant after breast cancer treatment. The purpose of this study was to understand the risk–benefit perception of choosing conception or contraception after treatment in Taiwan. We applied grounded theory to guide this exploratory qualitative study. Data were collected through in-depth interviews with 16 breast cancer patients. Pregnancy was addressed in the context of cancer as a potentially life-threatening diagnosis and its treatment. The verbatim transcriptions were analysed using constant comparative analysis and methods of open, axial and selective coding. The core theme that described the risk perception of pregnancy among patients with breast cancer after treatment focused on “reaching the balance of life.” Seven dimensions of risk–benefit perception of pregnancy, including perceived health status, safety, expected gain, harm, loading, support and time were explored among women treated for breast cancer. We found that women treated for breast cancer applied risk–benefit perceptions to decide whether to become pregnant. Implementing contextual counselling could help to decrease perceived barriers to choose pregnancy and increase the quality of pregnancy care.
References
- Agrawal, S. (2014). Late effects of cancer treatment in breast cancer survivors. South Asian Journal of Cancer, 3(2), 112–115.
- Armuand, G., Wettergren, L., Rodriguez-Wallberg, K., & Lampic, C. (2014). Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis. Supportive Care in Cancer, 22(10), 2805–2812.
- Bahrami, M., Taleghani, F., Loripoor, M., & Yousefy, A. (2015). Positive changes after breast cancer: A qualitative study. Journal of Education and Health Promotion, 4(55), 1–8. doi:10.4103/2277-9531.162353
- Baysal, Ö., Bastings, L., Beerendonk, C. C., Postma, S. A., IntHout, J., Verhaak, C. M., … Nelen, W. L. (2015). Decision-making in female fertility preservation is balancing the expected burden of fertility preservation treatment and the wish to conceive. Human Reproduction, 30(7), 1625–1634.
- Brown, M. C., Pearce, M. S., Bailey, S., & Skinner, R. (2015). The long-term psychosocial impact of cancer: The views of young adult survivors of childhood cancer. European Journal of Cancer Care, 25(3), 428–439. doi:10.1111/ecc.12380
- Canada, A., & Schover, L. (2012). The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology, 21(2), 134–143.
- Casey, P., Faubion, S., MacLaughlin, K., Long, M., & Pruthi, S. (2014). Caring for the breast cancer survivor's health and well-being. World Journal of Clinical Oncology, 5(4), 693–704.
- Corney, R., Puthussery, S., & Swinglehurst, J. (2014). The stressors and vulnerabilities of young single childless women with breast cancer: A qualitative study. European Journal of Oncology Nursing, 18(1), 17–22.
- Crozier, J. A., Swaika, A., & Moreno-Aspitia, A. (2014). Adjuvant chemotherapy in breast cancer: To use or not to use, the anthracyclines. World Journal of Clinical Oncology, 5(3), 529–538.
- Davies, C., Pan, H., Godwin, J., Gray, R., Arriagada, R., Raina, V., … Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group. (2013). Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomized trial. Lancet, 381, 805–816.
- de Pedro, M., Otero, B., & Martín, B. (2015). Fertility preservation and breast cancer: A review. Ecancermedicalscience, 9(503), 1–20. doi:10.3332/ecancer.2015.503
- Evans, C., Hamilton, R. J., Tercyak, K. P., Peshkin, B. N., Rabemananjara, K., Isaacs, C., & O'Neill, S. C. (2016). Understanding the needs of young women regarding breast cancer risk assessment and genetic testing: Convergence and divergence among patient-counselor perceptions and the promise of peer support. Healthcare (Basel), 4(3), E35. doi:10.3390/healthcare4030035
- Ganz, P., Greendale, G., Petersen, L., Kahn, B., & Bower, J. (2003). Breast cancer in younger women: Reproductive and late health effects of treatment. Journal of Clinical Oncology, 21, 4184–4193.
- Garvelink, M., Ter, K. M., Fischer, M., Louwé, L., Hilders, C., Kroep, J., & Stiggelbout, A. (2013). Development of a Decision Aid about fertility preservation for women with breast cancer in the Netherlands. Journal of Psychosomatic Obstetrics and Gynecology, 34(4), 170–178.
- Gelber, S., Coates, A., Goldhirsch, A., Castiglione-Gertsch, M., Marini, G., Lindtner, J., … International Breast Cancer Study Group. (2001). Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer. Journal of Clinical Oncology, 19(6), 1671–1675.
- Gnaneswaran, S., Deans, R., & Cohn, R. (2012). Reproductive late effects in female survivors of childhood cancer. Obstetrics and Gynecology International, 2012, 564794. doi:10.1155/2012/564794
- Gonçalves, V., Sehovic, I., & Quinn, G. (2014). Childbearing attitudes and decisions of young breast cancer survivors: A systematic review. Human Reproduction Update, 20(2), 279–292.
- Goossens, J., Delbaere, I., Beeckman, D., Verhaeghe, S., & Van Hecke, A. (2015). Communication difficulties and the experience of loneliness in patients with cancer dealing with fertility issues: A qualitative study. Oncology Nursing Forum, 42(1), 34–43.
- Goossens, J., Delbaere, I., Van Lancker, A., Beeckman, D., Verhaeghe, S., & Van Hecke, A. (2014). Cancer patients’ and professional caregivers’ needs, preferences and factors associated with receiving and providing fertility-related information: A mixed-methods systematic review. International Journal Nursing Studies, 51(2), 300–319.
- Gorman, J., Malcarne, V., Roesch, S., Madlensky, L., & Pierce, J. (2010). Depressive symptoms among young breast cancer survivors: The importance of reproductive concerns. Breast Cancer Research and Treatment, 123(2), 477–485.
- Gorman, J., Usita, P., Madlensky, L., & Pierce, J. (2011). Young breast cancer survivors: Their perspectives on treatment decisions and fertility concerns. Cancer Nursing, 34(1), 32–40.
- Hansen, A. T., Kesmodel, U. S., Juul, S., & Hvas, A. M. (2014). Increased venous thrombosis incidence in pregnancies after in vitro fertilization. Human Reproductive, 29(3), 611–617.
- Hartman, M., Liu, J., Czene, K., Miao, H., Chia, K., Salim, A., & Verkooijen, H. (2013). Birth rates among female cancer survivors: A population-based cohort study in Sweden. Cancer, 119(10), 1892–1899.
- Hershberger, P., Finnegan, L., Altfeld, S., Lake, S., & Hirshfeld-Cytron, J. (2013). Toward theoretical understanding of the fertility preservation decision-making process: Examining information processing among young women with cancer. Research and Theory for Nursing Practice, 27(4), 257–275.
- Hershberger, P., Finnegan, L., Pierce, P., & Scoccia, B. (2013). The decision-making process of young adult women with cancer who considered fertility cryopreservation. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 42(1), 59–69.
- Hortobagyi, G., Buzdar, A., Marcus, C., & Smith, T. (1986). Immediate and long-term toxicity of adjuvant chemotherapy regimens containing doxorubicin in trials at M.D. Anderson Hospital and Tumor Institute. National Cancer Institute Monograph, 1, 105–109.
- Huang, S. Y., Sheu, S. J., Tai, C. J., Chiang, C. P., & Chien, L. Y. (2013). Decision-making process for choosing an elective cesarean delivery among primiparas in Taiwan. Maternal and Child Health Journal, 17(5), 842–851.
- Huang, S. M., Tai, C. J., Lin, K. C., Tai, C. J., Tseng, L. M., & Chien, L. Y. (2013). A comparative study of symptoms and quality of life among patients with breast cancer receiving target, chemotherapy, or combined therapy. Cancer Nursing, 36(4), 317–325.
- Janz, N. K., Mujahid, M., Chung, L. K., Lantz, P. M., Hawley, S. T., Morrow, M., … Katz, S. J. (2007). Symptom experience and quality of life of women following breast cancer treatment. Journal of Women's Health, 16(9), 1348–1361.
- Kelvin, J., Kroon, L., & Ogle, S. (2012). Fertility preservation for patients with cancer. Clinical Journal of Oncology Nursing, 16(2), 205–210.
- Kirkman, M., Winship, I., Stern, C., Neil, S., Mann, G. B., & Fisher, J. R. (2015). Women's reflections on fertility and motherhood after breast cancer and its treatment. European Journal of Cancer Care, 23(4), 502–513.
- Letourneau, J., Smith, J., Ebbel, E., Craig, A., Katz, P., Cedars, M., & Rosen, M. (2012). Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer. Cancer, 118(18), 4579–4588.
- Litton, J. (2012). Breast cancer and fertility. Current Treatment Options in Oncology, 13(2), 137–145.
- Mailliez, A., Decanter, C., & Bonneterre, J. (2011). Adjuvant chemotherapy for breast cancer and fertility: Estimation of the impact, options of preservation and role of the oncologist. Bulletin du Cancer, 98(7), 741–751.
- Marcus, P. M., Broski, K. G., Buys, S. S., Childs, J., Church, T. R., Gohagan, J. K., … Yurgalevitch, S. (2015). Building successful relationships in the PLCO cancer screening trial. Reviews on Recent Clinical Trials, 10(3), 181–186.
- McCreaddie, M., & Payne, S. (2010). Evolving grounded theory methodology: Towards a discursive approach. International Journal of Nursing Studies, 47(6), 781–793.
- Mehrabi, E., Hajian, S., Simbar, M., Houshyari, M., & Zayeri, F. (2015). Post-traumatic growth: A qualitative analysis of experiences regarding positive psychological changes among Iranian women with breast cancer. Electronic Physician, 7(5), 1239–1246.
- Mertes, H., & Pennings, G. (2012). Elective oocyte cryopreservation: Who should pay? Human Reproduction, 27(1), 9–13.
- Ministry of Health and Welfare, Executive Yuan, Taiwan. (2014). The mortality of cancer in Taiwan. Retrieved from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=1715
- Missmer, S. A., Seifer, D. B., & Jain, T. (2011). Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. Fertility and Sterility, 95(6), 1943–1949.
- Nachtigall, R. D., MacDougall, K., Davis, A. C., & Beyene, Y. (2012). Expensive but worth it: Older parents’ attitudes and opinions about the costs and insurance coverage for in vitro fertilization. Fertility and Sterility, 97(1), 82–87.
- Osmundson, S. S., Gould, J. B., Butwick, A., Yeaton-Massey, A., & El-Sayed, Y. Y. (2015). Labor outcome at extremely advanced maternal age. American Journal of Obstetrics and Gynecology, 214(3), 362, e1-7. doi: 10.1016/j.ajog.2015.09.103
- Penrose, R., Beatty, L., Mattiske, J., & Koczwara, B. (2012). Fertility and cancer–a qualitative study of Australian cancer survivors. Supportive Care in Cancer, 20(6), 1259–1265.
- Quinn, G. P., Zebrack, B. J., Sehovic, I., Bowman, M. L., & Vadaparampil, S. T. (2015). Adoption and cancer survivors: Findings from a learning activity for oncology nurses. Cancer, 121(17), 2993–3000.
- Raphael, J., Trudeau, M., & Chan, K. (2015). Outcome of patients with pregnancy during or after breast cancer: A review of the recent literature. Current Oncology, 22(1), S8–S18.
- Ronn, R., & Holzer, H. E. (2013). Oncofertility in Canada: The impact of cancer on fertility. Current Oncology, 20(4), e338–e344.
- Ronn, R., & Holzer, H. (2015). Breast cancer and fertility: An update. Current Opinion Supportive and Palliative Care, 9(3), 285–293.
- Ruddy, K., Gelber, S., Tamimi, R., Ginsburg, E., Schapira, L., Come, S., … Partridge, A. (2014). Prospective study of fertility concerns and preservation strategies in young women with breast cancer. Journal of Clinical Oncology, 32(11), 1151–1156.
- Schmidt, R., Richter, D., Sender, A., & Geue, K. (2016). Motivations for having children after cancer - a systematic review of the literature. European Journal of Cancer Care, 25(1), 6–17. doi:10.1111/ecc.12276
- Sercekus, P., & Okumus, H. I. (2009). Fears associated with childbirth among nulliparous women in Turkey. Midwifery, 25(2), 155–162.
- Strauss, A. L., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory ( 2nd edn). California: Sage.
- Su, H. (2010). Measuring ovarian function in young cancer survivors. Minerva Endocrinologica, 35(4), 259–270.
- Tsui, M. H., Pang, M. W., Melender, H. L., Xu, L., Lau, T. K., & Leung, T. N. (2006). Maternal fear associated with pregnancy and childbirth in Hong Kong Chinese women. Women and Health, 44(4), 79–92.
- U.S. Cancer Statistics Working Group (2014). United States Cancer Statistics: 1999-2011 Incidence and Mortality Web-based Report. Retrieved from http://www.cdc.gov/uscs
- Ussher, J. M., Cummings, J., Dryden, A., & Perz, J. (2016). Talking about fertility in the context of cancer: Health care professional perspectives. European Journal of Cancer Care, 25(1), 99–111. doi:10.1111/ecc.12379
- Vannuccini, S., Clifton, V. L., Fraser, I. S., Taylor, H. S., Critchley, H., Giudice, L. C., & Petraglia, F. (2016). Infertility and reproductive disorders: Impact of hormonal and inflammatory mechanisms on pregnancy outcome. Human Reproduction Update, 22(1), 104–115. doi:10.1093/humupd/dmv044
- Wiklund, I., Edman, G., & Andolf, E. (2007). Cesarean section on maternal request: Reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Acta Obstetricia et Gynecologica Scandinavica, 86(4), 451–456.
- Winer, E., Hudis, C., Burstein, H., Wolff, A., Pritchard, K., Ingle, J., … Somerfield, M. (2005). American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: Status report 2004. Journal of Clinical Oncology, 23(3), 619–629.
- World Health Organization (2015). Breast cancer: Prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en/