Quality of Life and Psychological Distress Related to Fertility and Pregnancy in AYAs Treated for Gynecological Cancer: A Systematic Review.

Simple Summary: For Adolescents and Young Adults (AYAs) with gynecological cancer, preserving fertility is crucial for their Quality of Life. This systematic review explores how possible (in)fertility affects treatment choice and psychological well-being during and after treatment. The studies included were evaluated using the Mixed Methods Appraisal Tool (MMAT). A total of 15 studies were analyzed. The key findings emphasize the importance of informing all AYAs about how cancer treatment can impact fertility and discussing available fertility preservation options. This review also highlights that AYAs with gynecological cancer who do not have fertility preservation options are often overlooked. Therefore, research should focus more on this specific group. We recommend improving the Shared Decision-Making (SDM) and follow-up process for AYAs with gynecological cancer by addressing fertility-related questions and concerns, which could enhance their long-term Quality of Life. 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). [ABSTRACT FROM AUTHOR]