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Purpose: The challenges of fertility loss owing to cancer treatment persist long after treatment. However, psychosocial care for fertility among cancer survivors who have completed cancer treatment is insufficient. This systematic review examined psychosocial experiences related to the potential loss of fertility and unsuccessful pregnancy after treatment in cancer survivors of reproductive age to identify psychosocial care needs. Methods: A systematic review was conducted using the online databases PubMed, Cochrane Library, PsycINFO, CINAHL, and Ichushi-Web between August and December 2022 to identify studies that addressed psychosocial experiences after fertility loss or failure to conceive among young cancer survivors. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Forty studies were included, revealing psychosocial experiences across five categories: subjective fear of (potential) fertility loss, impact on romantic relationships, alternative methods for family building, reliance on social support, and specialized care. Only one study addressed the psychosocial aspects after complete loss of fertility in young cancer survivors. Conclusions: The possibility and uncertainty of fertility loss led to stress and depression, loss of identity, decreased opportunities to meet a new partner, and damaged relationships established before diagnosis. The needs encompass fertility preservation, sexuality, approaches to building a family, partner communication, and other diverse needs. [ABSTRACT FROM AUTHOR]

Soluble immune checkpoint molecules are emerging novel mediators of immune regulation. However, it is unclear whether soluble immune checkpoint proteins affect the development of hepatocellular carcinoma (HCC) during nucleos(t)ide analogue (NA) treatment in patients with chronic hepatitis B virus infection. This study included 122 NA-naïve patients who received NA therapy. We assessed the associations of clinical factors, including soluble immune checkpoint proteins, with HCC development during NA treatment. The baseline serum concentrations of 16 soluble immune checkpoint proteins were measured using multiplexed fluorescent bead-based immunoassay. In total, 13 patients developed HCC during the follow-up period (median duration, 4.3 years). Of the 16 proteins, soluble inducible T-cell co-stimulator (≥ 164.71 pg/mL; p = 0.014), soluble programmed cell death-1 (sPD-1) (≤ 447.27 pg/mL; p = 0.031), soluble CD40 (≤ 493.68 pg/mL; p = 0.032), and soluble herpes virus entry mediator (≤ 2470.83 pg/mL; p = 0.038) were significantly associated with HCC development (log-rank test). In multivariate analysis, an sPD-1 level ≤ 447.27 pg/mL (p = 0.014; hazard ratio [HR], 4.537) and α-fetoprotein level ≥ 6.4 ng/mL (p = 0.040; HR, 5.524) were independently and significantly associated with HCC development. Pre-treatment sPD-1 is a novel predictive biomarker for HCC development during NA treatment. [ABSTRACT FROM AUTHOR]

The marriage rate of cancer survivors is lower than that of the general population and their siblings. This appears to be attributable to negative images and stigma in society regarding cancer and cancer survivors. In order to improve images and decrease stigma regarding cancer and cancer survivors, this study aimed to develop an educational program that primarily focuses on dating and marriage after cancer diagnosis. The education program was conducted for university students, and among 67 participants who attended the education program, 61 participants completed a self-report questionnaire both before and after the program. The questionnaire included measures to assess reluctance to date or marry a cancer survivor, attitudes toward marriage and having children, and level of empathy. Scores on most items assessing reluctance decreased after the program; however, only three items showed a significant decrease: reluctance to date a cancer survivor if cancer recurred or metastasized, and reluctance if one's family objects to dating a cancer survivor. Both before and after the program, disease severity was the main cause for reluctance to date. In addition, empathetic concern was associated with reduced reluctance to date or marry a cancer survivor, while conservative attitudes toward marriage were associated with greater reluctance which was a result of familial concerns regarding such relationships. Some of the reluctance could be attributable to sociocultural values in Asia, where the choice of romantic partner is likely to be subject to familial influence. [ABSTRACT FROM AUTHOR]

We experienced two patients with chronic hepatitis C (HCV) in whom it was difficult to distinguish between relapse and reinfection after interferon-free direct-acting antiviral (DAA) therapy. Case 1 was a 55-year-old man infected with HCV genotype 1b, at 5.6 log IU/mL, with a history of injecting drug use. He was treated with ombitasvir/paritaprevir/ritonavir for 12 weeks. After DAA therapy, recurrent HCV showed the genotype 2a differed from the baseline genotype. Close examination for baseline sample showed that he was coinfected with HCV genotype 1b and 2a. Case 2 was a 60-year-old woman with HCV2b, at 5.7 log IU/mL. She was treated with sofosbuvir/ribavirin for 12 weeks and achieved a sustained virological response (SVR) at 24 weeks. Even after SVR24, her serum alanine aminotransferase levels remained fluctuated. HCV RNA was detected again at 48 weeks. She had a sexual partner who was also infected with HCV2b. The phylogenetic tree analysis revealed a high degree of homology among the three strains: pre- and post-HCV treatment, and her partner. After HCV recurrence, HCV RNA level decreased spontaneously below the limit of detection and serum ALT levels normalized. It is important to make a precise diagnosis regarding reemerged HCV after DAA therapy. [ABSTRACT FROM AUTHOR]

Recently, three tyrosine kinase inhibitors (TKIs) have become available for treatment of unresectable hepatocellular carcinoma (HCC). We herein report a case of a 59-year-old man with interstitial pneumonia that was suspected during regorafenib administration and was exacerbated by subsequent lenvatinib treatment for advanced HCC. After sorafenib was discontinued due to progressive HCC, regorafenib treatment was started. Progressive HCC was again noted and reticular shadows were suspected in both lower lung fields at 2 months after starting regorafenib administration. Subsequent treatment with lenvatinib obtained a partial response for HCC, but the reticular shadows became marked and dyspnea on effort emerged, followed by hypoxemia and an increased Krebs von den Lungen-6 (KL-6) value. Because we suspected acute interstitial pneumonia, due to these TKIs, intravenous pulse steroid therapy was started immediately after discontinuing lenvatinib. Within 1 week after starting steroid therapy, the patient's respiratory condition and hypoxemia gradually began improving. No previous case of pulmonary interstitial changes that appeared in association with regorafenib administration for HCC and that were exacerbated by subsequent treatment with lenvatinib has been reported. This case emphasizes that it is necessary to observe the patient's respiratory condition and to perform imaging examinations to monitor for adverse events during TKI treatment. [ABSTRACT FROM AUTHOR]

We encountered two patients with overlapping features of primary biliary cholangitis and autoimmune hepatitis within the same family. A 68-year-old woman presented at our hospital from a previous medical institution because of the diagnosis of primary biliary cholangitis. Her 49-year-old daughter was admitted with liver dysfunction 4 years later. When compared, these two related patients were found to have overlapping features of primary biliary cholangitis and autoimmune hepatitis. Their human leukocyte antigen haplotype was DRB1*04:05/DRB1*15:02. The clinical and biochemical findings of these two patients immediately improved following treatment with a combination of prednisolone and ursodeoxycholic acid, in accordance with the Japanese guidelines. It is extremely important to identify such pathological conditions as quickly as possible, particularly with the appearance of severe liver dysfunction due to liver cirrhosis, as observed in our case. The Japanese guidelines are considered to be a realistic and useful clinical policy for the swift and efficient treatment of patients with overlapping features of primary biliary cholangitis and autoimmune hepatitis. We suggest that our two patients presented with a genetic predisposition to autoimmune liver disease with overlapping features of primary biliary cholangitis and autoimmune hepatitis within the same family. [ABSTRACT FROM AUTHOR]