***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To prospect ively assess anxiety , depression , coping , and appraisal in female fertility preservation ( FP ) patients compared with infertile patients . DESIGN Prospect i ve pre- and post-treatment survey . SETTING Academic medical center . PATIENT(S ) Forty-seven women with cancer ( FP patients ) and 91 age-matched infertile patients . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Depression , anxiety , coping , infertility-related stress , appraisal of treatment , and medical outcomes . RESULT ( S ) FP patients reported more symptoms of anxiety and depression than infertile patients , but infertile patients ' symptoms worsened over time ; 44 % of FP and 14 % of infertile patients ' scores exceeded the clinical cutoff for depression before treatment . The interval between surveys and medical treatment data did not predict changes in mood symptoms . Coping strategies and infertility-related stress did not differ between groups , and avoidant coping predicted higher depression and anxiety scores . CONCLUSION ( S ) FP patients reported more anxiety and depression than infertile patients at enrollment in treatment , with more than one-third of FP patients reporting clinical ly significant depressive symptoms . However , infertile patients ' anxiety and depressive symptoms increased across treatment . This increase was not related to time between registration for IVF and oocyte retrieval or the medical aspects of treatment . FP and infertile patients should be provided psychologic consultation before treatment to identify mood and anxiety symptoms and to refer patients for counseling as needed to prevent worsening of symptoms PURPOSE This paper reports on a phenomenological study of women 's experiences 1 - 10 years following a radical vaginal trachelectomy  and describes the impact on health , sexuality , fertility and perceived supportive care needs . METHOD AND SAMPLE Qualitative telephone interviews employing a descriptive phenomenological approach were conducted using a purposive sample of 12 women . KEY RESULTS Several felt their cancer experience was positive ; bringing them closer to family and changed their outlook on life . A few experienced delayed psychological reactions and /or fears of recurrence . Many experienced isolation and the desire to contact others with similar experiences . Women recovered well but a few experienced fears/concerns about lymphoedema and intermenstrual bleeding . Sexual function was not a long-term issue for most . Some that could feel the cerclage ( stitch ) during intercourse , developed techniques to reduce this . Single women felt vulnerable in new relationships . Pregnancy was an anxious time , especially for those that experienced a miscarriage or pre-term birth . Sources of support included the clinical nurse specialist , family/friends , surgical consultant , online patient forums and a support group . Women needed more information on trachelectomy statistics , pregnancy care recommendations as well as access to counselling , peer support , being seen by the same person and increased public awareness . CONCLUSIONS This study has provided an interesting and detailed insight into women 's experiences in the years following a trachelectomy , with results that have important considerations for practice such as provision of statistical information ; counselling ; peer support ; consistent pregnancy recommendations ; increased public awareness and increased identification and management or prevention of long-term physical effects OBJECTIVE To report the reproductive concerns of women treated for stage I cervical cancer with fertility-preserving surgery .  MATERIAL S AND METHODS Newly diagnosed cervical cancer patients undergoing radical trachelectomy  were enrolled in this study preoperatively and assessed over time . Preliminary data from the preoperative analysis and 3-month and 6-month assessment points addressing reproductive concerns are presented . RESULTS Between February 2004 and June 2006 , 29 patients were enrolled in the study . Three patients were excluded because they did not undergo the planned surgery and 6 patients were excluded because they required adjuvant therapy .  Future childbearing was the main reason most women chose to undergo the procedure ; however , treatment choice was also guided by conversations with their doctors ( 41 % , n=12 ) . Twenty-six ( 90 % ) initially expressed concern over future conception and childbearing , but this increased to all patients by 6 months . At enrollment , the majority of the patients had high expectations for future conception and childbearing but this declined over time . Despite this , patients ' distress gradually decreased over time . CONCLUSIONS Our results show that many women who have undergone a radical trachelectomy  present with distress and reproductive concerns that persist for up to 6 months postoperatively . Concerns about conception appear to decrease following surgery ; however , concerns about pregnancy appear to increase post trachelectomy itself . This pilot study reflects the first preliminary data from an active ongoing study prospect ively collecting information over 2 years from newly diagnosed stage I cervical cancer patients undergoing radical trachelectomy OBJECTIVE To prospect ively assess and describe the emotional , sexual , and QOL concerns of women with early-stage cervical cancer undergoing radical surgery .  METHODS Seventy-one women who were consented for radical trachelectomy ( RT ) or radical hysterectomy ( RH )  were enrolled preoperatively in this 2-year study ; 52 women ( 33 RT ; 19 RH ) were actively followed . Patients completed self-report surveys composed of 4 empirical measures in addition to exploratory items . Data analyses for the 2 years of prospect i ve data are presented . RESULTS At preoperative assessment , women choosing RH reported greater concern about cancer recurrence ( x=7.27 [ scale from 0 to 10 ] ) than women choosing RT ( x=5.66 ) ( P=0.008 ) . Forty-eight percent undergoing RH compared to 8.6 % undergoing RT reported having adequate " time to complete childbearing " ( P<0.001 ) . Both groups demonstrated scores suggestive of depression ( based on the CES-D scale ) and distress ( based on the IES scale ) preoperatively ; over time , however , CES-D and IES scores generally improved . Scores on the Female Sexual Functioning Inventory ( FSFI ) for the total sample were below the mean cut-off ( 26.55 ) , suggestive of sexual dysfunction ; however , the means increased from 16.79 preoperatively to 23.78 by 12 months and 22.20 at 24 months . CONCLUSION Measurements of mood , distress , sexual function , and QOL did not differ significantly by surgical type , and instead reflect the challenges faced by young cervical cancer patients treated by RT or RH without adjuvant treatment . Points of vulnerability were identified in which patients may benefit from preoperative consultation or immediate postoperative support . Overall , patients improved during the first year , reaching a plateau between Year-1 and Year-2 , which may reflect a new level of functioning in survivorship Introduction : To present a qualitative data analysis of items exploring the treatment , adjustment , and recovery of 33 patients who underwent radical trachelectomy ( RT )  , and to determine the feasibility of using a physician checklist ( PCL ) as a model for survivorship assessment . Methods : This prospect i ve study was approved by the Memorial Sloan-Kettering Cancer Center 's Institutional Review Board . Participants completed a survey including exploratory items focused on fertility issues and reproductive concerns , treatment , adjustment , and recovery over 2 years . All responses to the exploratory questions were transcribed verbatim ; thematic analysis was used to identify , evaluate , and show patterns within the data set ; and descriptive statistics were calculated for thematic categories . A limited waiver of authorization was obtained for medical chart review of these patients ( who underwent RT ) for 2years before ( January 2006 to December 2007 ) and 2 years after ( January 2008 to December 2009 ) implementation of the checklist to evaluate its feasibility . Results : In response to " how successful you feel you will be at conceiving in the future ? " on a scale of 0 % to 100 % , scores ranged from 54 % to 60 % . Approximately 70 % of the patients reported concerns about conceiving ; however , these lessened with time-88 % at 6months to 73 % at 24 months . Six percent of women were trying to conceive by 12 months ; this increased to 21 % by 24 months . Five primary themes emerged from the qualitative analysis that were found to be prevalent across all exploratory items inquiring about difficulties or the hardest adjustment to treatment , recovery , and problems associated with RT ; these included menstrual/vaginal issues , emotional impact , life interruptions/return to normalcy , general pain , and recovery process . The PCL identified higher rates of neocervical stenosis ( 58 % ) , encroachment ( 54 % ) , vaginal scarring ( 50 % ) , and dyspareunia ( 33 % ) than medical charts , and increased documentation of reproductive consults ( 54 % ) and assistance ( 21 % ) . Conclusion : Global themes expressed by our patients are consistent with those of other cancer survivors . The PCL is an excellent supplement to medical charts by documenting important survivorship issues BACKGROUND Evidence suggests that cancer diagnosed during adolescence and young adulthood may present considerable challenges to what would otherwise be a relatively smooth developmental trajectory , particularly in areas related to reproductive health . We created and pilot tested a two-session , individually-delivered , counseling intervention to enhance psychosexual development in this unique population . PROCEDURES A total of 21 patients , aged 15 to 25 years and treated for cancer within the past 5 years , completed the counseling intervention .  Patients were adaptively r and omized to begin the intervention immediately , or to be placed on a 3-month waitlist , after which time , they were reassessed and began the intervention . The content of the intervention included education , dialog , and support regarding cancer and such issues as sexual development and function , body image , fertility , prevention of sexually transmitted disease and unwanted pregnancy , and romantic relationships ( e.g. , dating , sexual communication ) . A 1-month follow-up booster call followed the intervention . Question naires were completed at baseline , post-waitlist ( for half the sample ) , post-treatment , and at 3-month follow-up . RESULTS Participation in the intervention increased cancer-specific knowledge regarding sexual issues ; improved body image ; lessened anxiety about sexual and romantic relationships ; and decreased overall level of psychological distress . Gains were maintained through the 3-month follow-up . CONCLUSIONS Addressing issues of reproductive health in the adolescent/young adult with cancer can and should be offered as a part of comprehensive pediatric cancer care PURPOSE Orchiectomy followed by infradiaphragmatic irradiation is the st and ard treatment for Stage I-II testicular seminoma in The Netherl and s. Because body image and sexual functioning can be affected by treatment , a retrospective study was carried out to assess treatment outcome , body image , and changes in sexuality after orchiectomy and radiotherapy . METHODS AND MATERIAL S The medical charts of 166 patients with Stage I-II testicular seminoma were review ed . A question naire on body image and current sexual functioning regarding the frequency and quality of erections , sexual activity , significance of sex , and changes in sexuality was sent to 157 patients ( at a mean of 51 months after treatment ) . RESULTS Seventy-eight percent ( n = 123 , mean age 42 years ) completed the question naire . During irradiation , almost half of patients experienced nausea and 19 % nausea and vomiting . Only 3 patients had disease relapse . After treatment , about 20 % reported less interest and pleasure in sex and less sexual activity . Interest in sex , erectile difficulties , and satisfaction with sexual life did not differ from age-matched healthy controls . At the time of the survey , 17 % of patients had erectile difficulties , a figure that was significantly higher than before treatment , but which correlated also with age . Twenty percent expressed concerns about fertility , and 52 % found their body had changed after treatment . Cancer treatment had negatively influenced sexual life in 32 % of the patients . CONCLUSIONS Orchiectomy with radiotherapy is an effective and well-tolerated treatment for Stage I-II testicular seminoma . Treatment-induced changes in body image and concerns about fertility were detected , but the sexual problems encountered did not seem to differ from those of healthy controls , although baseline data are lacking 
    Output:
    
Fertility-related psychological distress persists from diagnosis through to survivorship , with cancer patients reporting a range of negative emotional experiences brought about by threatened infertility .
In survivorship , reproductive concerns , unfulfilled desire for a child , nulliparous status , and early menopause were linked to higher rates of mental health disorders and psychological distress .
CONCLUSIONS Fertility-related psychological distress is prevalent and persistent in cancer patients and survivors .
As such , patients and survivors would greatly benefit from fertility-related psychological support implemented into st and ard practice from diagnosis through to survivorship .