Research Topics of the Lower Michigan Group

Kim KerridgeMelanie MartinColleen Prevost

Infertility DrugsAnd

Cancer Risks

Articles

"Fertility Drugs Do Not Raise Breast, Ovarian or Uterine Cancer Risk” D. Hollander.

Knowledge and Experience Regarding Cancer, Infertility, and Sperm Banking in Younger Male Survivors. Schover, L., Brey, K., Lipshultz,L., Jeha, S.

"Infertility drugs and the risk of breast cancer: Findings from the National Institute of Child Health & Human Development Women's Contraceptive & Reproductive Experiences Study". Ronald T. Burkman MD., Mei-Tzu C. Tang, Ph.D., Kathleen E. Malone, Ph.D., Polly A. Marchbanks, Ph.D., Jill A. McDonald, Ph.D., Suzanne G. Folger, Ph.D.

"Use of fertility drugs and risk of ovarian cancer” Fabio Parazzini, Claudio Pelucchi, Eva Negri, Sivia Franceschi, Renato Talamini, Maurizio Montella and Carlo La Vecchia.

"Cancer incidence following treatment for infertility at a clinic in the UK” Pat Doyle, Noreen Maconochie, Valerie Beral, Anthony J. Swerdlow and S.L. Tan

"Hormonal Treatment after Cytotoxic Therapy Stimulates Recovery of Spermatogenesis” Marvin L. Meistrich, Gene Wilson, Iipo Hubtaniemi

Statement of the Problem

In five of the six articles critiqued the problem was clearly identified early in the abstract or within the first paragraph of the discussion. The remaining article did not identify the research focus until the conclusion.

In all six articles the problems were specific and narrow enough to be studied.

In five out of six articles the researchers were found to be qualified to conduct the studies. The remaining author did not identify qualifying credentials.

Significance for Nursing Practice

All six articles were found to have significance for nursing practice and patient education

Review of Literature

Four of the articles cited studies and research that were relevant and current.

One article used questionnaires from five metropolitan areas yielding information that was very broad.

One author cited only one reference and used two articles from that reference from which to base the report.

All articles were found to have relevant literature investigated.

Review of LiteratureContinued

All six articles provided supporting evidence to show the need for carrying out the intended research.

Five of the six articles consulted with experts within the field of cancer research or infertility. One author consulted with an analyst group from which to base the study. The group was not identified as an expert in the field of study.

Theoretical Framework or Concepts

Three articles clearly identified the theoretical frameworks and concepts.

Two articles did not clearly identify the frameworks one was able to extract the framework from the discussion.

One article did not identify the framework or concepts.

Theoretical Framework or Conceptscontinued

Five out of the six articles developed concepts used to determine if there was a correlation between fertility drugs and cancer.

One article did not clearly identify concepts to determine any correlation but one could extract them from the report results.

Theoretical Framework or Conceptscontinued

Four of the six articles logically establish rationale for concepts or hypotheses.

The remaining two articles logically provide rationales for the reports but the concepts contradict each other within the study results.

Research Design

Three articles were experimental studies, one non-experimental, one questionnaire, and one comparative descriptive in design.

Five of the six articles contained questions or hypotheses that were clearly stated.

One article did not state questions but provided a hypothesis.

Research Designcontinued

Three articles did not contain dependent or independent variables.

Three articles contained dependent variables and independent variables.

Dependent variables include cytotoxic agents and

hormone therapy. Independent variables include geographical location,

incidence of histologically confirmed epithelial ovarian cancer.

Research Designcontinued

Four of the six articles developed operational definitions within the research reports; The remaining articles did not use operational definitions.

All six articles effectively identified the target populations.

Data Collection and Statistics

Three articles stated that informed consent was obtained. Informed consent was not clearly stated to be obtained in three of the studies.

Five studies out of six could be replicated easily without varying degrees of conclusions. One article may not be replicated easily due to the sample type.

In three reports the research authors collected data. Two of the researchers utilized a research data collection center. One researcher used an analyst group from which to base the report.

Data Collection and Statisticscontinued

Five of the six articles clearly describe measuring tools utilized. In the remaining article the measurement methods and calculations were not described.

Five articles demonstrated reliability and validity of measurement tools. One article did not show reliability or validity of measurements.

Interpretation, Discussion and Clinical application

One research article clearly recommends the use of hormonal treatment to stimulate spermatogenesis (Meistrich, M. et al., 1999).

One research article states that despite the relatively large cohort size, few ovarian and uterine cancers were incident over the follow up period (Doyle, P. et al.,

2002). One research article stated that the consensus that

long term use of certain infertility drugs could adversely affect risk of breast cancer (Burkman, R. et al., 2002).

Interpretation, Discussion and Clinical Application

continued One research article stated the results of the study,

while providing further reassuring evidence on the relation between fertility treatment and ovarian cancer risk, cannot exclude a moderate association between fertility drugs and ovarian cancer, particularly among porous women (Parazzini, F. et al.,

2001).

One author concluded the data suggest that disease may be associated with the women’s responsiveness to ovarian stimulation (Hollander, 2000).

Interpretation, Discussion and Clinical Application

continued

One research group concluded that all men who are about to receive cancer treatment that could impair fertility should be counseled about side effects and given adequate information on sperm banking as an option (Schover, L. et al., 2002).

Future Research Needed Progress research to include human subjects

to determine effect of cytotoxic therapy for therapeutic hormone levels.

Specific information requested to decrease variables and a more narrow data selection; The study was too broad to be conclusive.

Can a link be made to the use of same fertility drugs in cancer? Does duration of drug use increase incidence of cancer?

How best would male cancer survivors breach the subject of infertility?

What are the effects of long-term amenorrhea on the ovulation cycle and the potential for female specific cancer?

Putting it to Practice

Based on the inconclusiveness of two studies it would not be practical for patient education or clinical practice application.

Four of the studies could be directly applied to nursing practice.

References Schover, L., Brey, K., Lichtin, A., Lipshultz, L., Jeha, S. (2002). Knowledge and

Experience Regarding Cancer, Infertility, and Sperm Banking in Younger Male Survivors. Journal of Clinical Oncology, 20, (7): 1880-1889.

Hollander, D. (Mar/Apr 2000). Fertility drugs do not raise breast, ovarian or uterine cancer risk. Family Planning Perspectives, New York: 32, (2): 100.

Doyle, P., Maconochie, N., Beral, V., Swerdlow, A., Tan, S. (2002). Cancer incidence following treatment for infertility at a clinic in the UK. Human Reproduction, 17, (8): 2209-2213.

Parazzini, F., Pelucchi, C., Negri, E., Franceschi, S., Renato, T., Montella, M., La Vecchia, C. (2001). Use of fertility drugs and risk of ovarian cancer. Human Reproduction, 16, (7): 1372-1375.

Referencescontinued

Meistrich, M., Wilson, G., Huhtaniemi, I. (1999). Hormonal Treatment after Cytotoxic Therapy Stimulates Recovery of Spermatogenesis. Cancer Research, 59:3557-3560.

Burkman. R.,Tang, M., Malone, K., Marchbanks, P.,McDonald, J., Folger, S. (2003). Fertility and Sterility,79,(4): 844-851.