Being confronted with cancer is a life-changing event, with major impact to well-being, quality of life and relationships. Cancer treatments and outcomes have improved, but possess the potential to... Show moreBeing confronted with cancer is a life-changing event, with major impact to well-being, quality of life and relationships. Cancer treatments and outcomes have improved, but possess the potential to impair reproductive and sexual function. International guidelines highlight the importance of timely discussion of sexual function and fertility deterioration resulting from treatments. In spite of these developments, practice behaviour and attitudes of health professionals have been reported to vary.The first part of this thesis demonstrates barriers among oncology professionals in the Netherlands in discussing sexual function during daily practice. In general, consensus exists regarding responsibility for addressing sexual dysfunction. Despite, the implementation of discussing sexual function as a standard of care is not carried out structural.Part two describes practice routines concerning the counselling on impaired fertility and fertility preservation for cancer patients of reproductive age. Medical oncologists and oncology nurses both reported discussing the impact of treatment on fertility. However, it was not performed in all cases and depending on factors like educational level, experience, type of hospital, prognosis and chances of fertility recovery.Furthermore, testicular cancer patients were evaluated on specific items concerning the discussion, referral and process of semen cryopreservation. Long term reproductive concerns were identified among survivors. Show less
In dit proefschrift worden verschillende methodes onderzocht en uitgevoerd om de ovariële functie te sparen bij vrouwen die een behandeling moeten ondergaan als chemotherapie en/ of radiotherapie,... Show moreIn dit proefschrift worden verschillende methodes onderzocht en uitgevoerd om de ovariële functie te sparen bij vrouwen die een behandeling moeten ondergaan als chemotherapie en/ of radiotherapie, die de ovaria kunnen aantasten.Een behandeling is het invriezen van ovariumweefsel en indien een vrouw daadwerkelijk in de overgang is geraakt kan dit weefsel weer in haar eigen lichaam terug geplaatst worden. Het percentage vrouwen dat na ovarium cryopreservatie vervroegd in de overgang komt, is laag. Wij adviseren daarom enkel ovarium cryopreservatie aan te bieden aan vrouwen die door een gonadotoxische behandeling een hoog risico hebben op het ontwikkelen van vervroegde overgang. De autotransplantatie zelf is een effectieve methode met 86% herstel van ovariele functie en 57% levendgeborenen. Het risico van uitzaaiingen van de primaire ziekte in de ovaria bij patiënten met kanker is in onze studie zeer klein gebleken en is deze techniek dus een veilige methode.Ovariumtranspositie voorafgaand aan radiotherapie op het bekken is een veilige en zinvolle behandeling ter preventie van vervroegde overgang en zou standaard aangeboden moeten worden bij vrouwen tot 35 jaar.Met betrekking tot de reeds geaccepteerde techniek van vitrificatie dient men zicht te realiseren, dat alvorens deze techniek te implementeren, er een steile leercurve is. Show less
Autotransplantation of ovarian tissue can be used to restore fertility in cancer patients following gonadotoxic treatment. Whether this procedure is safe remains unclear, as current tumor... Show moreAutotransplantation of ovarian tissue can be used to restore fertility in cancer patients following gonadotoxic treatment. Whether this procedure is safe remains unclear, as current tumor detection methods (e.g. PCR analysis, immunohistochemistry) render the ovarian tissue unsuitable for transplantation. As a result, the current tumor detection approach includes assessment of only one or two cortical ovarian fragments that are not transplanted, whereas cortical ovarian tissue fragments that are placed back remain unchecked. The studies described in this thesis focused on determining the risk of reintroducing malignant tumor cells following ovarian tissue autotransplantation using the current tumor detection approach, and novel detection methods by which metastatic disease can be detected in the cortical ovarian fragments that are actually transplanted. These novel detection methods include near-infrared fluorescence (NIRF) imaging, a noninvasive imaging technique by which tumor cells can be specifically illuminated using tumor-targeting probes in the near-infrared range (λ = 700-900 nm), and full field optical coherence tomography, an imaging modality that rapidly produces high-resolution histology-like images without the need to fix, freeze, or stain the tissue. Show less
In the Netherlands, information provision about fertility preservation (FP) for young women with breast cancer is not sufficient. Since an increasing number of Dutch breast cancer patients will... Show moreIn the Netherlands, information provision about fertility preservation (FP) for young women with breast cancer is not sufficient. Since an increasing number of Dutch breast cancer patients will face this preference-sensitive decision each year, there is a clear need for improvement of information provision about FP. The overall aim of this thesis was therefore to (a) develop and (b) evaluate a Decision Aid (DA) about FP that is targeted to improve information provision and decision making about FP for young women with breast cancer. This thesis describes consecutively the development and evaluation of such a DA with values clarification exercise (VCE) Show less
