Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors

Abstract

AbstractBackgroundMany adolescent and young adult female (AYA‐F) cancer survivors face decisions about family building using reproductive medicine or adoption to achieve parenthood. This study evaluated associations among reproductive distress, avoidance, and family‐building decision making and identified sociodemographic and clinical characteristics related to high distress and avoidance.MethodsA cross‐sectional survey assessed AYA‐F survivors' oncofertility experiences. Measures included an investigator‐designed Unmet Information Needs scale, Reproductive Concerns After Cancer Scale, Impact of Events Scale—Avoidance subscale, Decision Self‐Efficacy scale, and Decision Conflict Scale. Two linear regression models evaluated correlates of decision self‐efficacy and decisional conflict about family building after cancer. Bivariate analyses evaluated correlates of avoidance using Pearson's correlation, t‐test, and ANOVA.ResultsAYA‐Fs (N = 111) averaged 31‐years‐old (SD = 5.49) and 3 years post‐treatment (range: 1–23 years); 90% were nulliparous. Most common diagnoses were leukemia (24%) and breast cancer (22%). Average decisional conflict was 52.12 (SD = 23.87, range: 0–100); 74% of the sample reported DCS scores within the clinically significant range. Higher levels of reproductive distress (B = −0.23, p = 0.04) and avoidance (B = −0.24, p = 0.02) related to lower decision self‐efficacy. Younger age (B = −0.18, p = 0.03), greater unmet information needs (B = 0.33, p < 0.001), and higher levels of reproductive distress (B = 0.34, p = 0.001) related to worse decisional conflict. Predictors of distress and avoidance were identified.ConclusionsAfter cancer treatment, high fertility distress and avoidant coping were associated with poorer quality decision making about family building after cancer. Fertility counseling post‐treatment should support self‐efficacy and constructive coping skills to counteract high distress, maladaptive coping, and facilitate values‐based decision making.