年轻乳腺癌患者生育指导的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.18.015

摘要/Abstract

摘要：

目的评价并总结年轻乳腺癌患者生育指导的相关证据,为医护人员对年轻乳腺癌患者开展生育指导提供依据。方法系统检索UpToDate、BMJ Best Practice、Cochrane Library、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、英国国家卫生与临床优化研究所、国际指南网、苏格兰学院间指南网、美国国立指南网、加拿大安大略省注册护士协会、医脉通、中国指南网、美国国立综合癌症网络、美国临床肿瘤协会、欧洲临床肿瘤协会、美国癌症协会、中国抗癌协会、中华护理学会、PubMed、Web of Science、CINHAL、Trip Medical Database、Clinical Trials、Open Grey、Grey Guide、中国知网、万方医学网、维普数据库、中国生物医学文献服务系统等网站或数据库中关于年轻乳腺癌患者生育指导的临床决策、指南、系统评价、证据总结和专家共识等证据,检索时限为建库至2021年11月,由2名具有循证护理研究背景的研究者独立完成文献的质量评价,并结合专业人士的意见,对符合质量标准的文献进行证据提取及总结。结果共纳入9篇文献,包括1篇临床决策、1篇指南、1篇系统评价、6篇专家共识。总结的最佳证据包括生育评估、生育力保存、生育时机、抗肿瘤治疗与生育、哺乳指导、避孕措施、生育与生存情况7个方面的24条最佳证据。结论该研究总结的最佳证据可为临床医护人员开展年轻乳腺癌患者生育指导提供依据。在临床应用时,医护人员需结合临床情境,充分考虑患者意愿,促进患者获益最大化,以进一步提高患者的生活质量。

关键词: 乳腺癌, 生育, 康复护理, 证据总结, 循证护理学

Abstract:

Objective To evaluate and summarize the evidence of pregnancy guidance for young breast cancer patients,and provide the basis for medical staff to provide pregnancy guidance. Methods The guidelines,expert consensuses,evidence summaries,clinical decisions and systematic evaluations of pregnancy guidance of breast cancer patients were systematically searched from BMJ Best Practice,UpToDate,Cochrane Library,JBI,Pubmed,CINAHL,Embase,US National Guidelines Library,International Guidelines Collaborative Network,Scottish Intercollegiate Guidelines Network,Canadian Ontario Registered Nurses Association website,Web of Science,Yimai Tong,China Guidelines.com,CNKI,Wanfang Medical Network,China Biomedical Literature Service and VIP database from the establishment of the database to November 2021. There were 2 researchers with evidence-based nursing research background who independently completed the quality evaluation of the literature,and combined with the opinions of professionals to extract and summarize the literature that met the quality standards. Results A total of 9 articles were included,including 1 clinical decision,1 guideline,1 systematic evaluation and 6 expert consensuses. Conclusion This study summed the best evidence to provide pregnancy guidance to young breast cancer patients. In clinical practice and application,healthcare professionals need to take the clinical context into account and fully consider the patient’s wishes to maximize patient benefits,in order to further improve the quality of life of patients.

Key words: Breast Cancer, Fertility, Rehabilitation Nursing, Evidence Summary, Evidence-Based Nursing

雷静, 李金花, 林琴, 陈婕君, 李旭英, 王童语, 孟令琦, 肖羽乔. 年轻乳腺癌患者生育指导的最佳证据总结[J]. 中华护理杂志, 2022, 57(18): 2268-2275.

LEI Jing, LI Jinhua, LIN Qin, CHEN Jiejun, LI Xuying, WANG Tongyu, MENG Lingqi, XIAO Yuqiao. Best evidence summary for the fertility guidance in young breast cancer patients[J]. Chinese Journal of Nursing, 2022, 57(18): 2268-2275.

图/表 3

图1 文献检索筛选流程图

Figure 1 Flow chart of literature search and screening

表1 纳入文献的基本特征（n=9）

Table 1 The basic characteristics of the included literature（n=9）

表2 年轻乳腺癌患者生育指导的最佳证据总结

Table 2 Summary of evidence of fertility guidance in young breast cancer patients

参考文献 37

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI URL
[2]	Paluch-Shimon S, Cardoso F, Partridge AH, et al. ESO-ESMO 4th international consensus guidelines for breast cancer in young women (BCY4)[J]. Ann Oncol, 2020, 31(6):674-696. DOI PMID
[3]	DeSantis C, Ma JM, Bryan L, et al. Breast cancer statistics,2013[J]. CA Cancer J Clin, 2014, 64(1):52-62. DOI URL
[4]	湖南乳腺癌患者生育力保存专家协作组. 湖南省年轻女性乳腺癌患者生育力保存实施方案专家共识[J]. 中国普通外科杂志, 2018, 27(11):1361-1369.
	Hunan Expert Collaboration Group on Fertility Preservation for Breast Cancer Patients. Hunan expert consensus on implementation plan of fertility preservation for young breast cancer patients[J]. Chin J Gen Surg, 2018, 27(11):1361-1369.
[5]	姚娟, 傅亚富. 不同内分泌治疗方法对激素受体阳性晚期乳腺癌患者疗效的网状Meta分析[J]. 临床药物治疗杂志, 2021, 19(11):41-46.
	Yao J, Fu YF. Efficacy of different endocrine therapy for patients with hormone-sensitive advanced breast cancer:a network Meta-analysis[J]. Clin Med J, 2021, 19(11):41-46.
[6]	巨洁, 张罗欣, 岳健, 等. 年轻乳腺癌患者生育需求现况调查[J]. 中华肿瘤杂志, 2020, 42(5):408-412. PMID
	Ju J, Zhang LX, Yue J, et al. An investigation of the fertility needs of young patients with breast cancer[J]. Chin J Oncol, 2020, 42(5):408-412. DOI PMID
[7]	Benedict C, Thom B, Friedman DN, et al. Young adult female cancer survivors’ unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation[J]. Cancer, 2016, 122(13):2101-2109. DOI URL
[8]	乔婷婷, 陈丹丹, 郑蔚, 等. 癌症后生育忧虑量表的汉化及信效度研究[J]. 中华护理杂志, 2016, 51(12):1509-1514.
	Qiao TT, Chen DD, Zheng W, et al. Translation and reliability and validity of the Chinese version of the Reproductive Concerns after Cancer Scale(RCAC)[J]. Chin J Nurs, 2016, 51(12):1509-1514.
[9]	Ljungman L, Ahlgren J, Petersson LM, et al. Sexual dysfunction and reproductive concerns in young women with breast can-cer:type,prevalence,and predictors of problems[J]. Psychooncology, 2018, 27(12):2770-2777. DOI PMID
[10]	Slepicka PF, Cyrill SL, dos Santos CO. Pregnancy and breast cancer-pathways to understand risk and prevention[J]. Trends Mol Med, 2019, 25(10):866-881. DOI URL
[11]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[12]	AGREE Next Steps Consortium. The AGREE Ⅱ instrument[EB/ OL].(2017-11-30)[2022-04-01]. .
[13]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[14]	张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1):14-18.
	Zhang FY, Shen AM, Zeng XT, et al. An Introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1):14-18.
[15]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[16]	Ruddy KJ, Herrin J, Sangaralingham L, et al. Follow-up care for breast cancer survivors[J]. J Natl Cancer Inst, 2020, 112(1):111-113. DOI URL
[17]	Gerstl B, Sullivan E, Ives A, et al. Pregnancy outcomes after a breast cancer diagnosis:a systematic review and meta-analysis[J]. Clin Breast Cancer, 2018, 18(1):e79-e88. DOI URL
[18]	中国乳腺癌内分泌治疗专家共识专家组. 中国乳腺癌内分泌治疗专家共识(2015年版)[J]. 中国癌症杂志, 2015, 25(9):755-760.
	China Expert Consensus Group on Endocrine Treatment of Breast Cancer. Expert consensus on endocrine therapy for breast cancer in China(2015)[J]. China Oncol, 2015, 25(9):755-760.
[19]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志, 2019, 29(8):609-680.
	China Anti-Cancer Association Breast Cancer Committee. Chinese anti-cancer society guidelines and specifications for breast cancer diagnosis and treatment(2019)[J]. China Oncol, 2019, 29(8):609-680..
[20]	中国年轻乳腺癌诊疗与生育管理专家共识专家委员会. 年轻乳腺癌诊疗与生育管理专家共识[J]. 中华肿瘤杂志, 2019, 41(7):486-495.
	China Guideline Committee of Clinical Practice and Fertility Preservation for Breast Cancer in Young Women. Chinese consensus guidelines for breast cancer in young women:clinical practice and fertility preservation[J]. Chin J Oncol, 2019, 41(7):486-495.
[21]	Cardoso F, Loibl S, Pagani O, et al. The European Society of Breast Cancer Specialists recommendations for the manage-ment of young women with breast cancer[J]. Eur J Cancer, 2012, 48(18):3355-3377. DOI PMID
[22]	Bajpai J, Majumdar A, Satwik R, et al. Practical consensus recommendations on fertility preservation in patients with breast cancer[J]. South Asian J Cancer, 2018, 7(2):110-114. DOI PMID
[23]	吴克瑾, 陈玉芸, 金玉春, 等. 年轻女性早期乳腺癌病人生育相关调查研究[J]. 中国实用外科杂志, 2021, 41(11):1262-1268.
	Wu KJ, Chen YY, Jin YC, et al. Investigation on fertility of young women with early breast cancer[J]. Chin J Pract Surg, 2021, 41(11):1262-1268.
[24]	庞建美, 张青月, 王小媛, 等. 医护人员实施乳腺癌患者决策辅助障碍及促进因素的质性研究[J]. 中华护理杂志, 2021, 56(10):1516-1521. DOI
	Pang JM, Zhang QY, Wang XY, et al. A qualitative study on the obstacles and promoting factors in the implementation of patient-centered decision-making in medical care[J]. Chin J Nurs, 2021, 56(10):1516-1521.
[25]	Gnant M, Beermann B. 8th European breast cancer conference (EBCC-8),Vienna,March 21-24,2012[J]. Breast Care (Basel), 2012, 7(2):170-176. DOI URL
[26]	李珍, 叶志华, 邢孟艳, 等. 欧洲乳腺护理护士培训特色及启示[J]. 中华护理杂志, 2016, 51(11):1405-1408.
	Li Z, Ye ZH, Xing MY, et al. The characteristics and enlight-enment of breast care nurse training in Europe[J]. Chin J Nurs, 2016, 51(11):1405-1408.
[27]	唐榕英, 张欢, 唐红梅, 等. 乳腺专科护士在多学科团队中的培养[J]. 临床与病理杂志, 2018, 38(3):608-613.
	Tang RY, Zhang H, Tang HM, et al. Training of breast specialist nurses in multidisciplinary team[J]. J Clin Pathol Res, 2018, 38(3):608-613.
[28]	Constance ES, Moravek MB, Jeruss JS. Strategies to maintain fertility in young breast cancer patients[J]. Cancer Treat Res, 2018, 173:1-13.
[29]	甘露, 张男, 金玉翡, 等. 乳腺专科护士在多学科讨论中的工作角色定位[J]. 护理学杂志, 2015, 30(24):39-41.
	Gan L, Zhang N, Jin YF, et al. Job roles orientation of specialist breast nurse in multi-disciplinary discussion:a qualitative study[J]. J Nurs Sci, 2015, 30(24):39-41.
[30]	黄美玲, 凌瑞. 青年乳腺癌患者治疗后生育[J]. 中国妇幼健康研究, 2017, 28(11):1480-1483.
	Huang ML, Ling R. Fertility of young patients with breast cancer after treatment[J]. Chin J Woman Child Heal Res, 2017, 28(11):1480-1483.
[31]	Maeda E, Nakamura F, Boivin J, et al. Fertility knowledge and the timing of first childbearing:a cross-sectional study in Japan[J]. Hum Fertil (Camb), 2016, 19(4):275-281. PMID
[32]	肖盼盼, 王璐, 孙倩, 等. 青年癌症患者生育相关心理痛苦的研究进展[J]. 中华护理杂志, 2020, 55(7):1097-1101. DOI
	Xiao PP, Wang L, Sun Q, et al. Research progress on assessment and intervention strategies of fertility-related psychological distress in adolescents and young adults with cancer[J]. Chin J Nurs, 2020, 55(7):1097-1101.
[33]	郑丹萍, 董鑫, 王晓晶. 年轻乳腺癌患者生育计划及知识与治疗决策的研究[J]. 护理学杂志, 2015, 30(22):31-34.
	Zheng DP, Dong X, Wang XJ. Fertility plan,knowledge and decision-making preferences in young breast cancer women[J]. J Nurs Sci, 2015, 30(22):31-34.
[34]	Partridge AH, Ruddy KJ, Gelber S, et al. Ovarian reserve in women who remain premenopausal after chemotherapy for early stage breast cancer[J]. Fertil Steril, 2010, 94(2):638-644. DOI PMID
[35]	Azim HA Jr, Santoro L, Pavlidis N, et al. Safety of pregnancy following breast cancer diagnosis:a meta-analysis of 14 studies[J]. Eur J Cancer, 2011, 47(1):74-83. DOI URL
[36]	Choi M, Han J, Yang BR, et al. Prognostic impact of pregnancy in Korean patients with breast cancer[J]. Oncologist, 2019, 24(12):e1268-e1276. DOI URL
[37]	Komatsu H, Yagasaki K, Yamauchi H. Fertility decision-making under certainty and uncertainty in cancer patients[J]. Sex Reprod Healthc, 2018, 15:40-45. DOI PMID