EC Gynaecology

Research Article Volume 12 Issue 1 - 2023

Reproductive and Psychological Issues in Non-Gynaecological Cancer Survivors of Mongolia

Sainbileg Dorjgotov1, Bolorchimeg Baldandorj1, Serjnyam Sukhbaatar1,2, Tungalagsuvd Altankhuu1, Bayarmanlai Baljinnyam3, Bayarmagnai Lkhagvasuren4, Otgontsetseg Magsarjav5 and Batsuren Choijamts1*

1Obstetrics and Gynecology Department, School of Medicine, Mongolian National University of Medical Science, Mongoliaa

2Department of Midwifery, Maternal and Child Nursing, School of Medicine, Mongolian National University of Medical Science, Mongolia

3Amgalan Maternity Specialized Hospital, Mongolia

4Epidemiology and Biostatistics Department, School of Public Health, Mongolian National University of Medical Science, Mongolia

5Itgel Eruul Mend LLC, Mongolia

*Corresponding Author: Batsuren Choijamts, Department of Obstetrics and Gynecology, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia.
Received: December 05, 2022; Published: December 26, 2022

Introduction: One of the long-term effects of chemotherapy in young adults who have had cancer is impaired fertility. Due to the infertility and fear of having cancer again may develop depression and anxiety.

Objective: To determine the psychological and reproductive status of women with non-gynecological cancer patients who underwent chemotherapy.

Materials and Methods: An observational, descriptive, cross-sectional study was conducted in patients who finished chemotherapy from 2017 to 2021 at Mongolian National Cancer center. Patients were asked for general demographic, reproductive history, menstrual cycle questionnaire, chemotherapy related questionnaire as well as WHO-QOL, HADS questionnaire. To assess the psychological issues healthy, normal menstrual cycled women were asked to give WHOQOL-BREF questionnaire, HADS questionnaire, as well. Women were asked to re-visit the hospital for the purpose of investigating ovarian function, and were subjected to physical examination, AMH measurement and ultrasound examination. Statistical analysis was done using SPSS26.

Results: The average chemotherapy cycle of the non-gynecological cancer patients were 9.91 ± 6.8 times. Gonadotoxic agents were used in 63.64%, low risk chemo-agents were used in 36.36%. The post chemotherapy ovarian median volume was 3.2 ± 3.1 cm on the right and 2.52 ± 1.9 cm on the left, which is relatively close to healthy women, but with a high standard deviation. The number of antral follicles were 1.23 ± 1.3, indicating a marked decrease in ovarian reserve. The average value of anti-Mullerian hormone in the studied women was 0.49 ± 0.59 ng/ml, and the level of anti-Mullerian hormone gradually decreased with increasing frequency of chemotherapy. There was no statistically significant difference between the frequency of chemotherapy and AMH, but there was an inverse relationship between the frequency of chemotherapy and AMH (r = -0.1 p = 0.63). The physical health and psychological health related QOL were significantly reduced in cancer survivors in comparison to healthy women, while no difference was found in social and environmental QOL. Moreover, the prevalence and severity of anxiety and depression is higher among cancer survivors compared to healthy women.

Conclusion: The decrease of ovarian function is related to type and frequency of chemotherapy cycles. Cancer survivors have severe anxiety and depression, suggesting the necessity of appropriate psychological support.

Keywords: Non-Gynecological Cancer Survivors; AMH; Infertility; HADS; WHO-QOL

  1. Mongolian statistical information service (2021).
  2. Gupta S., et al. “Treating Childhood Cancer in Low- and Middle-Income Countries”. Disease Control Priorities, Third Edition Chapter 7 3 (2015).
  3. Lam CG., et al. “Science and health for all children with cancer”. Science363 (2019): 1182-1186.
  4. Mongolian cancer registry surveillance and early detection service (2019).
  5. Mancini J., et al. “Infertility induced by cancer treatment: inappropriate or no information provided to majority of French survivors of cancer”. Fertility and Sterility5 (2008): 1616-1625.  
  6. Peate M., et al. “The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review”. Breast Cancer Research and Treatment2 (2009): 215-223.
  7. Tschudin S., et al. “Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases”. Human Reproduction Update5 (2009): 587-597.
  8. Ethics Committee of the American Society for Reproductive Medicine. “Fertility preservation and reproduction in cancer patients”. Fertility and Sterility6 (2005): 1622-1628.
  9. NICE Fertility Problems: Assessment and Treatment Clinical Guideline [CG156] (2013).
  10. Spears N., et al. “Ovarian damage from chemotherapy and current approaches to its protection”. Human Reproduction Update6 (2019): 673-693.
  11. Gadducci A., et al. “Ovarian function and childbearing issues in breast cancer survivors”. Gynecological Endocrinology11 (2007): 625-631.
  12. Poorvu PD., et al. “Cancer Treatment-Related Infertility: A Critical Review of the Evidence”. JNCI Cancer Spectrum1 (2019): pkz008.
  13. Gadducci A., et al. “Ovarian function and childbearing issues in breast cancer survivors”. Gynecological Endocrinology11 (2007): 625-631.
  14. World Health Organization. Division of Mental Health. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, World Health Organization (1996).
  15. Pandey M., et al. “Distress, anxiety, and depression in cancer patients undergoing chemotherapy”. World Journal of Surgical Oncology4 (2006) 68.
  16. Götze H., et al. “Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis”. Supportive Care in Cancer1 (2020): 211-220.

Batsuren Choijamts., et al. Reproductive and Psychological Issues in Non-Gynaecological Cancer Survivors of Mongolia. EC Gynaecology 12.1 (2023): 82-89.