Fertility-sparing treatment for endometrial cancer (EC) and related conditions can be medically effective and allow patients to become pregnant. Still, many patients live with reproductive concerns even when outcomes are favorable, according to a study published recently the International Journal of Gynecological Cancer.
This study from Italy found that adolescents and young adults treated for endometrial atypical hyperplasia or early-stage endometrioid EC generally had mild regret about their treatment choice, yet worries about infertility and future children remained common.
The study followed patients aged 15 to 39 years who chose fertility-sparing care instead of immediate hysterectomy for conditions closely related to EC. These approaches aim to control disease while preserving the uterus, an option for select patients with early EC or precancerous changes.
Among the 32 patients included, 93.9% achieved a complete response to treatment, and the response rate reached 100% in those with endometrioid EC. After a median follow-up of 29 months, none had evidence of disease.
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For patients with EC hoping to become pregnant, the reproductive results were encouraging. Twenty patients tried to conceive, and 12 pregnancies occurred in 11 patients, a pregnancy rate of 60.0%. The live birth rate per pregnancy was 66.7%, with two pregnancies ongoing at last follow-up. Most births were full term, babies were healthy and no major pregnancy complications were reported.
Despite these outcomes, emotional concerns persisted. Decision regret was generally low, with a mean score of 16.6 on a 0 to 100 scale. Nearly half of patients reported no regret at all. Still, about 28.1% reported moderate to severe regret, showing that positive medical results do not erase emotional complexity for every patient with EC.
“A comprehensive understanding of decision regret and reproductive concerns in these patients can ultimately guide clinicians in conveying accurate information and providing more directed counseling to patients who need to make a decision on whether or not to undergo fertility-sparing treatment,” explained this study’s authors.
Reproductive worries were more widespread. On a scale of 1 to 5, the average concern score was 2.78. The greatest concerns involved accepting possible infertility, fertility potential and the health of a future child. Patients who had faced cancer before struggled more with the idea of infertility, while those who became pregnant worried more about their child’s health.
For patients with EC considering fertility-sparing treatment, the findings highlight both promise and pressure. The approach can control disease and allow pregnancy, but it does not remove uncertainty. The study suggests that clear counseling, emotional support and ongoing conversations about fertility and parenthood are essential so patients can make informed decisions and feel supported long after treatment ends.
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