You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Choice of surgery for early breast cancer: psychosocial considerations.
Abstract 1:
A prospect i ve study was conducted with early breast cancer patients who had either been offered , or not been offered , a choice of surgery for treatment . The choice involved mastectomy or wide excision plus radiotherapy . Available evidence suggests that the medical outcome between these two options is similar ; this study was design ed to investigate selected psychosocial outcomes . It was found that whether or not patients were given a choice was of greater relevance to psychosocial outcomes that was the type of operation performed . Providing a choice led to improved reported adjustments with respect to the ability to undertake work , attitudes towards the future , beliefs about coping , and in physical and psychological functioning


Title 2:
American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.
Abstract 2:
PURPOSE To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer . METHODS An expert panel and a writing committee were formed . The questions to be addressed by the guideline were determined , and a systematic review of the literature from 1987 to 2005 was performed , and included a search of online data bases and consultation with content experts . RESULTS The literature review found many cohort studies , case series , and case reports , but relatively few r and omized or definitive trials examining the success and impact of fertility preservation methods in people with cancer . Fertility preservation methods are used infrequently in people with cancer . RECOMMENDATIONS As part of education and informed consent before cancer therapy , oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists . Clinician judgment should be employed in the timing of raising this issue , but discussion at the earliest possible opportunity is encouraged .  Sperm and embryo cryopreservation  are considered st and ard practice and are widely available ; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise . CONCLUSION Fertility preservation is often possible in people undergoing treatment for cancer . To preserve the full range of options , fertility preservation approaches should be considered as early as possible during treatment planning


Title 3:
Effect of endocrine treatment on sexuality in premenopausal breast cancer patients: a prospective randomized study.
Abstract 3:
PURPOSE To study the sexual effects of the 2-year adjuvant goserelin ( Zoladex [ Zeneca AB , Södertälje , Sweden ] ) alone , tamoxifen alone , and Zoladex and tamoxifen in combination ( ZT ) versus no adjuvant endocrine therapy among premenopausal breast cancer patients with or without chemotherapy in a controlled clinical trial ( a European multicenter trial : Zoladex in Premenopausal Breast Cancer Patients ) . PATIENTS AND METHODS This prospect i ve study examined several aspects of sexuality through the use of self-administered question naires , which were completed by patients at seven points of assessment for 3 years after r and omization . RESULTS Patients treated with chemotherapy  had a higher level of sexual dysfunction than did patients who received no systemic treatment .  The addition of endocrine treatment did not alter this result . In contrast , among patients who did not receive chemotherapy , Zoladex and ZT produced a significantly higher level of dysfunction from 1 to 2 years after inclusion , as compared with those who received no endocrine treatment . Tamoxifen alone did not produce side effects . After termination of endocrine treatment , sexual dysfunction began to diminish . Those with chemotherapy had high and frequently increasing levels of dysfunction even after 2 to 3 years of independent of endocrine treatment . Zoladex had a negative effect on sexual fear , which was reduced by the addition of tamoxifen . CONCLUSION Zoladex increased sexual dysfunction during treatment among patients without chemotherapy , but the disturbances of sexual functioning were reversible . The use of adjuvant chemotherapy was associated with continued sexual problems , even at 3 years after r and omization


Title 4:
Treatment decisions for breast carcinoma
Abstract 4:
Patient autonomy and participation in treatment decision making have been encouraged in recent years . However , patients and physicians frequently disagree with regard to the patient 's needs and perceptions of their illness . To the authors ' knowledge to date only limited research has assessed physicians ' perceptions of patients ' decision‐making preferences . The purpose of the current prospect i ve study was to determine the agreement between patient decision‐making preferences and physician perceptions of those preferences


Title 5:
Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy.
Abstract 5:
PURPOSE Young women who undergo chemotherapy for breast cancer face serious consequences to their reproductive health . Research in this area has previously focused on men , or on childhood cancer survivors . We sought to explore self-report of reproductive health counseling in young women undergoing chemotherapy for breast cancer . PATIENTS AND METHODS A total of 166 premenopausal women aged < or = 50 years were recruited from oncology offices in academic and private practice s in four northeastern states , as part of a r and omized controlled clinical trial aim ed at stress reduction .  Women were asked a variety of questions regarding diagnosis and treatment , including whether they received any counseling regarding early menopause and fertility issues . RESULTS Sixty-eight percent and 34 % of women reported recalling a discussion with a physician regarding early menopause or fertility , respectively . In multivariate analysis , hormonal therapy and early stage of disease were associated with significantly increased odds of recall of a discussion regarding menopause . Difficulty communicating with medical team was associated with increased odds of recalling a discussion regarding fertility , whereas older age and anxiety in medical situations were associated with decreased odds . CONCLUSION Many women fail to recall discussion s regarding the reproductive health impact of chemotherapy . Demographic , psychological , and disease-related variables are related to recalling such discussion s. Counseling about premature menopause and fertility changes is an overlooked aspect of preparation for adjuvant chemotherapy in young premenopausal women with breast cancer . Future research should explore this issue further
Multiple fertility-related information needs specific to this group regarding menstrual changes and potential infertility attitudes to , and actual decisions made regarding , pregnancy breastfeeding and contraception emerged .
Information on fertility-related decisions was rated as important , and the preferred methods for obtaining this information was consultation with a specialist or a decision aid early in the treatment plan .
There is limited research about fertility-related needs , and even less on contraceptive preferences and the attitudes of health care providers towards fertility-related issues .
Young women with early breast cancer have specific fertility- and menopause-related needs and concerns , which are commonly not adequately addressed or discussed prior to commencing adjuvant therapy