Background/Objectives: With growing survival rates for Adolescent and Young Adults (AYAs) diagnosed with gynecological cancer, the focus shifted to Quality of Life (QoL). Fertility-sparing surgery offers a viable alternative to standard, usually fertility-impairing treatments. Treatment choice remains difficult and renders perspectives of AYAs on decision-making and psychological outcomes afterwards. This review examines the impact of (in)fertility on psychological well-being both during cancer treatment, and in the long term. Methods: A systematic review of the peer-reviewed literature was conducted by searching Pubmed, Web of Science, Cochrane Trial database and PsycINFO on 30 November 2023. The review included studies with a focus on gynecological cancer, fertility and pregnancy related psychological outcomes, QoL, and psychosocial factors influencing decision-making. Case reports and reviews were excluded. Quality was assessed with the Mixed Methods Appraisal Tool (MMAT). Results: 15 studies, published between 2005 and 2023, involving 1328 participants, were included. Key findings highlight the significance of informing all AYAs about cancer treatment effects on fertility and discussing fertility preservation options. Feeling time-pressured and conflicted between choosing the best oncological outcomes and preserving fertility were common. Factors such as younger age at diagnosis, time pressure, and inadequate counseling by healthcare workers increased reproductive concerns which contributed to long term psychological distress. Research on AYAs with gynecological cancer without fertility preservation possibilities is limited and should be prioritized. Conclusions: This review shows that both Shared Decision-Making (SDM) and follow-up processes can be improved by addressing fertility-related questions and concerns, therefore increasing long-term QoL. This review is registered in PROSPERO (ID 448119).
背景/目的：随着青少年和年轻成人（AYAs）妇科癌症患者生存率的提高，研究重点已转向生活质量（QoL）。保留生育功能的手术为通常损害生育能力的标准治疗方案提供了可行替代方案。治疗选择仍然困难，且涉及AYAs群体在决策过程及后续心理结局的视角。本综述旨在探讨（不）孕状态对癌症治疗期间及长期心理健康的双重影响。方法：通过系统检索2023年11月30日的Pubmed、Web of Science、Cochrane试验数据库及PsycINFO，对同行评审文献进行系统性综述。纳入研究聚焦于妇科癌症、生育与妊娠相关心理结局、生活质量及影响决策的社会心理因素。排除病例报告及综述类文献，采用混合方法评估工具（MMAT）进行质量评价。结果：共纳入2005年至2023年间发表的15项研究，涉及1328名参与者。核心发现强调：需向所有AYAs患者告知癌症治疗对生育能力的影响，并讨论生育力保存方案；患者在追求最佳肿瘤学结局与保留生育功能之间常面临时间压力与决策冲突；诊断年龄较小、时间压力及医护人员咨询不足等因素会加剧生育忧虑，进而导致长期心理困扰。针对无生育保存可能的妇科癌症AYAs患者研究仍显不足，应作为优先研究方向。结论：本综述表明，通过针对性解决生育相关问题与顾虑，可优化共同决策（SDM）与随访流程，从而提升长期生活质量。本综述已在PROSPERO注册（ID 448119）。
肿瘤(癌症)患者之家