Supporting someone with cancer during the COVID-19 pandemic: A mixed methods analysis of cancer carer's health, Quality of Life and need for support.

The COVID-19 pandemic has greatly affected the delivery of cancer care. Due to social restrictions and reductions in health service contact, it is expected that the burdens experienced by informal carers have risen. This study provides an analysis of cancer carer's experiences and needs as a consequence of the pandemic. An online mixed method design was used. The survey included open-ended responses to explore carer's experiences and measures of health status (EQ-5D-5L), Quality of Life (WHOQoL-BREF) and impact of COVID-19. Open-ended responses were analysed thematically according to Miles and Huberman techniques and quantitative data were analysed descriptively. One hundred and ninety-six cancer carers participated in the online survey. Mixed method analysis demonstrated that carers were experiencing major difficulties. Of these n = 142/72.4% experienced challenges related to anxiety and depression; 35.2% rated these problems as slight with 25% rating these as moderate and 11.2% as severe. Qualitative analysis identified significant and sustained negative impacts of the pandemic on psychological health, social isolation, finance and access to health services with carers requiring urgent information and support. Carer's challenges have deepened throughout the COVID-19 pandemic. There is an urgent need to develop innovative ways to provide support for carers to provide palliative and supportive care at home now and during recovery from the pandemic. Due to the need for infection control meaningful development and integration of urgent digital technology might be the most feasible solution.

Mouse ovarian follicles secrete factors affecting the growth and development of like-sized ovarian follicles in vitro.

A series of experiments have been carried out to determine whether follicles secrete factors able to affect the growth and development of other, like-sized follicles. Late preantral mouse ovarian follicles were either cocultured or cultured in media conditioned by previously cultured follicles. In particular, the experiments examined whether follicles do secrete such factors, whether the level of FSH in the culture media can affect that process, and what the nature of such secretory factor(s) might be. First, pairs of follicles were cocultured across a polycarbonate membrane containing pores. This showed that communication between the follicles resulted in the stimulation of growth and that the stimulation was due, at least in part, to the production of secretory factor(s). In subsequent experiments, follicles were cultured in media that had been preconditioned by previously cultured follicles. The concentration of FSH in the cultures determined the effect of the conditioned media: conditioned media was stimulatory to follicle growth when levels of FSH remained high throughout the culture, but inhibitory when FSH levels were dropped midway through the cultures. Heat inactivation removed this inhibitory effect, showing that the factor was likely to be a protein; addition of follistatin to the conditioned media did not alter its effect, indicating that the factor was unlikely to be activin. We have shown through a series of culture experiments that mouse follicles secrete factor(s) that can affect the development of other like-sized follicles when cultured from the late preantral to Graafian stages. Furthermore, we have shown that the effect (or production) of such factors is dependent on the FSH environment of the follicles.

Current perspective on primordial follicle cryopreservation and culture for reproductive medicine.

Mature oocytes are rare and precious cells. A technology which generates larger numbers would be very welcome in clinical practice, animal production technology and research. Since de-novo formation of female germ cells has ceased by the time of birth, the most attractive strategy, in theory, is to harvest and culture primordial follicles, the most abundant stage in the ovary at all ages. So far, there has been more success with cryopreservation of primordial follicles than with culture, and frozen-thawed ovarian tissue grafts have restored fertility to a number of species after oophorectomy. However, in-vitro development of isolated follicles is not sustained beyond the primary follicle stage. To meet their requirements for growth, metabolism and differentiation, a multistage protocol will probably be required for the prolonged period of development to maturity. The mouse is the only model, to date, in which a live offspring has ever been produced after growing follicles completely in vitro. A triple-stage process was required, involving culture of ovarian explants followed by isolation of granulosa-oocyte complexes and, finally, suitable conditions for completing meiotic maturation. Achievement of this goal for the larger and more slowly developing follicles from human and farm animal ovaries is still a remote possibility.