年輕乳腺癌女性生育需求現(xiàn)況調(diào)查
發(fā)布時(shí)間：2018-07-16 09:29
【摘要】：目的：在中國(guó),乳腺癌的發(fā)病正呈現(xiàn)年輕化的趨勢(shì),發(fā)病時(shí)間比西方國(guó)家早10-15年,而在患乳腺癌后部分患者仍有生育需求。此項(xiàng)調(diào)查旨于探討我國(guó)年輕乳腺癌女性患者在診斷和治療后的生育需求現(xiàn)狀,包括影響患者生育需求的因素,患病后懷孕情況、妊娠結(jié)局以及生育咨詢情況,以期在今后的臨床工作中為患者提供更加個(gè)體化的治療和咨詢,以利于患者在乳腺癌診治后的生育問(wèn)題上有更多的選擇空間和成功機(jī)會(huì),減少患者在生育問(wèn)題上的焦慮擔(dān)憂,最終提升患者的生活質(zhì)量。患者和方法：這項(xiàng)研究是單中心、隨機(jī)抽樣、回顧性的橫斷面調(diào)查,以中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院作為樣本來(lái)源現(xiàn)場(chǎng)。對(duì)年輕乳腺癌女性(首次診斷時(shí)小于等于40歲)進(jìn)行問(wèn)卷調(diào)查。用SPSS20.0統(tǒng)計(jì)軟件建立數(shù)據(jù)庫(kù)并完成統(tǒng)計(jì)分析。單因素和多因素二元logistic回歸分析被用來(lái)研究影響生育需求的因素。結(jié)果：308例年輕乳腺癌女性回答了調(diào)查問(wèn)卷,總作答率為82%。81(26%)例患者在乳腺癌診斷和治療后有生育需求,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%)人采取積極措施保留生育能力,6人全部都曾在化療期間同時(shí)使用GnRHα(促性腺激素釋放激素類似物)；其中1人還在化療前冷凍保存過(guò)卵子。8例患者在診治后曾嘗試懷孕,7例成功懷孕,懷孕成功率為87.5%；其中4人嬰兒安全出生,另3人人工流產(chǎn)。多因素分析顯示,年齡較小、受教育程度較高、接受保乳手術(shù)以及在患癌前未生育子女的患者在患乳腺癌后更傾向于有生育需求。在患癌后無(wú)生育需求的主要原因包括已有子女(196人次),計(jì)劃生育政策影響(53人次),擔(dān)心疾病復(fù)發(fā)(48人次),已有乳腺癌復(fù)發(fā)轉(zhuǎn)移(42人次)以及擔(dān)心抗腫瘤治療結(jié)束后不具備生育能力(19人次)等。共72(23%)例患者在患癌后曾接受來(lái)自臨床醫(yī)生的生育咨詢。結(jié)論：這項(xiàng)研究是首次以回顧性、橫斷面分析的方法來(lái)調(diào)查國(guó)內(nèi)年輕乳腺癌女性在乳腺癌診斷和治療后的生育需求、懷孕情況、生育咨詢等方面問(wèn)題的研究。從中可以看出,在中國(guó),年輕乳腺癌女性在癌癥診斷和治療后的生育需求是巨大的,但患者在面對(duì)生育問(wèn)題時(shí),有著各種各樣的擔(dān)憂,而目前臨床醫(yī)生為年輕乳腺癌患者提供的生育咨詢明顯不足,少有患者在乳腺癌診斷后采取措施保存生育能力,因而在乳腺癌診斷后嘗試懷孕和成功受孕的患者較少。臨床醫(yī)務(wù)工作者應(yīng)與年輕乳腺癌患者在生育問(wèn)題上進(jìn)行充分的咨詢溝通,尋求保存患者生育能力的方法,提升患者的生活質(zhì)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 偽 (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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R737.9
，
本文編號(hào)：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 偽 (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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R737.9
，
本文編號(hào)：2125959
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