年轻乳腺癌女性生育需求现况调查
发布时间：2018-07-16 09:29
【摘要】：目的：在中国,乳腺癌的发病正呈现年轻化的趋势,发病时间比西方国家早10-15年,而在患乳腺癌后部分患者仍有生育需求。此项调查旨于探讨我国年轻乳腺癌女性患者在诊断和治疗后的生育需求现状,包括影响患者生育需求的因素,患病后怀孕情况、妊娠结局以及生育咨询情况,以期在今后的临床工作中为患者提供更加个体化的治疗和咨询,以利于患者在乳腺癌诊治后的生育问题上有更多的选择空间和成功机会,减少患者在生育问题上的焦虑担忧,最终提升患者的生活质量。患者和方法：这项研究是单中心、随机抽样、回顾性的横断面调查,以中国医学科学院肿瘤医院作为样本来源现场。对年轻乳腺癌女性(首次诊断时小于等于40岁)进行问卷调查。用SPSS20.0统计软件建立数据库并完成统计分析。单因素和多因素二元logistic回归分析被用来研究影响生育需求的因素。结果：308例年轻乳腺癌女性回答了调查问卷,总作答率为82%。81(26%)例患者在乳腺癌诊断和治疗后有生育需求,其中48人有生第一胎需求,33人有生第二胎需求。在有生育意愿的患者中,6(7%)人采取积极措施保留生育能力,6人全部都曾在化疗期间同时使用GnRHα(促性腺激素释放激素类似物)；其中1人还在化疗前冷冻保存过卵子。8例患者在诊治后曾尝试怀孕,7例成功怀孕,怀孕成功率为87.5%；其中4人婴儿安全出生,另3人人工流产。多因素分析显示,年龄较小、受教育程度较高、接受保乳手术以及在患癌前未生育子女的患者在患乳腺癌后更倾向于有生育需求。在患癌后无生育需求的主要原因包括已有子女(196人次),计划生育政策影响(53人次),担心疾病复发(48人次),已有乳腺癌复发转移(42人次)以及担心抗肿瘤治疗结束后不具备生育能力(19人次)等。共72(23%)例患者在患癌后曾接受来自临床医生的生育咨询。结论：这项研究是首次以回顾性、横断面分析的方法来调查国内年轻乳腺癌女性在乳腺癌诊断和治疗后的生育需求、怀孕情况、生育咨询等方面问题的研究。从中可以看出,在中国,年轻乳腺癌女性在癌症诊断和治疗后的生育需求是巨大的,但患者在面对生育问题时,有着各种各样的担忧,而目前临床医生为年轻乳腺癌患者提供的生育咨询明显不足,少有患者在乳腺癌诊断后采取措施保存生育能力,因而在乳腺癌诊断后尝试怀孕和成功受孕的患者较少。临床医务工作者应与年轻乳腺癌患者在生育问题上进行充分的咨询沟通,寻求保存患者生育能力的方法,提升患者的生活质量。
[Abstract]:Objective: in China, the incidence of breast cancer is becoming younger, the onset time is 10-15 years earlier than that in western countries, but after breast cancer some patients still have reproductive needs. The purpose of the survey was to explore the status of reproductive needs of young women with breast cancer after diagnosis and treatment, including factors affecting their reproductive needs, pregnancy after illness, pregnancy outcomes and fertility counselling. In order to provide patients with more individualized treatment and counseling in future clinical work, in order to help patients have more choices and chances of success in post-diagnosis and treatment of breast cancer, and reduce anxiety and anxiety of patients with reproductive problems. Ultimately improve the patient's quality of life. Patients and methods: this study was a single center, random sampling, retrospective cross-sectional survey using the Cancer Hospital of the Chinese Academy of Medical Sciences as the source of the sample. A questionnaire survey was conducted among young women with breast cancer (less than 40 years of age at the time of first diagnosis). SPSS 20.0 statistical software was used to establish the database and complete the statistical analysis. Univariate and multivariate logistic regression analysis was used to study the factors affecting fertility demand. Results 308 young women with breast cancer answered the questionnaire. The total answer rate was 82.81 (26%). After diagnosis and treatment of breast cancer, 48 patients had the need of first birth and 33 had the need of second child. Among the patients with fertility intention, 6 (7%) had taken active measures to retain their fertility. All of them had used GnRH 伪 (gonadotropin releasing hormone analogue) simultaneously during chemotherapy. One of them also had cryopreserved eggs before chemotherapy in 8 patients who had tried to conceive after diagnosis and treatment, and the success rate of pregnancy was 87.5. Among them, 4 infants were born safely and 3 were aborted. Multivariate analysis showed that patients with younger age, higher education, breast conserving surgery and childless children before cancer were more likely to have reproductive needs after breast cancer. The main causes of childlessness after cancer include existing children (196), the impact of family planning policies (53), fear of recurrence (48), recurrence and metastasis of breast cancer (42), and fear of the end of antitumor treatment After the lack of fertility (19 people) and so on. A total of 72 (23%) patients received fertility counseling from clinicians after cancer. Conclusion: this study is the first time to investigate the reproductive needs, pregnancy status and fertility counseling of young breast cancer women in China after diagnosis and treatment of breast cancer by retrospective and cross-sectional analysis. From this, we can see that in China, young women with breast cancer have a huge need for fertility after cancer diagnosis and treatment, but patients have various concerns when faced with fertility problems. But at present, the clinical doctor offers the young breast cancer patient the fertility consultation obviously insufficient, the few patients take the measure to preserve the fertility after the breast cancer diagnosis, therefore after the breast cancer diagnosis attempts the pregnancy and the successful conceive the patient is relatively few. In order to improve the quality of life of patients with breast cancer, clinical medical workers should consult and communicate with young breast cancer patients on reproductive issues, and seek ways to preserve their fertility.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R737.9
，
本文编号：2125959
[Abstract]:Objective: in China, the incidence of breast cancer is becoming younger, the onset time is 10-15 years earlier than that in western countries, but after breast cancer some patients still have reproductive needs. The purpose of the survey was to explore the status of reproductive needs of young women with breast cancer after diagnosis and treatment, including factors affecting their reproductive needs, pregnancy after illness, pregnancy outcomes and fertility counselling. In order to provide patients with more individualized treatment and counseling in future clinical work, in order to help patients have more choices and chances of success in post-diagnosis and treatment of breast cancer, and reduce anxiety and anxiety of patients with reproductive problems. Ultimately improve the patient's quality of life. Patients and methods: this study was a single center, random sampling, retrospective cross-sectional survey using the Cancer Hospital of the Chinese Academy of Medical Sciences as the source of the sample. A questionnaire survey was conducted among young women with breast cancer (less than 40 years of age at the time of first diagnosis). SPSS 20.0 statistical software was used to establish the database and complete the statistical analysis. Univariate and multivariate logistic regression analysis was used to study the factors affecting fertility demand. Results 308 young women with breast cancer answered the questionnaire. The total answer rate was 82.81 (26%). After diagnosis and treatment of breast cancer, 48 patients had the need of first birth and 33 had the need of second child. Among the patients with fertility intention, 6 (7%) had taken active measures to retain their fertility. All of them had used GnRH 伪 (gonadotropin releasing hormone analogue) simultaneously during chemotherapy. One of them also had cryopreserved eggs before chemotherapy in 8 patients who had tried to conceive after diagnosis and treatment, and the success rate of pregnancy was 87.5. Among them, 4 infants were born safely and 3 were aborted. Multivariate analysis showed that patients with younger age, higher education, breast conserving surgery and childless children before cancer were more likely to have reproductive needs after breast cancer. The main causes of childlessness after cancer include existing children (196), the impact of family planning policies (53), fear of recurrence (48), recurrence and metastasis of breast cancer (42), and fear of the end of antitumor treatment After the lack of fertility (19 people) and so on. A total of 72 (23%) patients received fertility counseling from clinicians after cancer. Conclusion: this study is the first time to investigate the reproductive needs, pregnancy status and fertility counseling of young breast cancer women in China after diagnosis and treatment of breast cancer by retrospective and cross-sectional analysis. From this, we can see that in China, young women with breast cancer have a huge need for fertility after cancer diagnosis and treatment, but patients have various concerns when faced with fertility problems. But at present, the clinical doctor offers the young breast cancer patient the fertility consultation obviously insufficient, the few patients take the measure to preserve the fertility after the breast cancer diagnosis, therefore after the breast cancer diagnosis attempts the pregnancy and the successful conceive the patient is relatively few. In order to improve the quality of life of patients with breast cancer, clinical medical workers should consult and communicate with young breast cancer patients on reproductive issues, and seek ways to preserve their fertility.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R737.9
，
本文编号：2125959
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