Publication Date

2016-05-06

Availability

Open access

Embargo Period

2016-05-06

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2016-03-25

First Committee Member

Victoria Mitrani

Second Committee Member

Rosa Gonzalez-Guarda

Third Committee Member

Deborah Salani

Fourth Committee Member

Gwendolyn Quinn

Abstract

Female Adolescent and Young Adult (AYA) cancer survivors often face potential fertility impairment due to cancer treatment. The purpose of this dissertation was to explore the experiences of female AYA cancer survivors regarding fertility preservation (FP) during the early stage of cancer diagnosis and treatment, a critical time for FP decision-making, and their experience regarding fertility during the survivorship stage. To date The Model for Care Across the Cancer Continuum (Hudson, 2005) has not been used in the context of fertility and FP. The model suggests there are three types of care an individual diagnosed with cancer transitions through, cancer diagnosis, long-term survival and survivor health and resilience. The Model for Care Across the Cancer Continuum was chosen as the framework for this study because fertility and fertility preservation are relevant throughout the cancer trajectory suggested by the model and allow the results of this study to inform clinical practice and policy and ultimately, improve care across the cancer continuum for AYA cancer survivors. Semi-structured interviews focused on the fertility and FP experience of eighteen women aged 21-39 in-person or via Skype or Facetime. A qualitative approach using descriptive design and thematic analysis was used to explore the views of AYA cancer survivors regarding their fertility, their experiences regarding FP, and the impact FP has had on their lives thus far. Four themes emerged from young women cancer survivors’ experiences with fertility and fertility preservation: 1) Unpredictability of Life, 2) Loss: The Toughest Pill to Swallow, 3) Relationships: Struggling to Meet Societal and Familial Expectations, and 4) Moving on with Life. Although the focus of this dissertation was fertility and fertility preservation, other salient issues such as hair loss, sexual health, and transitioning from independence to dependence and re-integration to work or school were frequently discussed. The findings from this dissertation suggest fertility and FP is an important piece of the AYA cancer care continuum and has implications at various points across the care continuum for AYAs and their healthcare providers. Accounts of uncertainty, loss, grief, and envy were frequently discussed and impacted relationships with family and friends. Support from family, friends and faith positively impacted their fertility experiences. The implications from these accounts suggest improving access to resources and mental health support are important and impactful on the fertility and FP experience. These findings inform researchers and clinicians as they work to improve care across the cancer continuum, specifically FP discussions at cancer diagnosis, FP decisions before and after cancer treatment, and managing fertility after cancer treatment.

Keywords

Fertility; Fertility Preservation; Cancer Survivors

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