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Zhou B, Kwan B, Desai MJ, Nalawade V, Henk J, Viravalli N, Murphy JD, Nathan PC, Ruddy KJ, Shliakhtsitsava K, Su HI, Whitcomb BW. Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer. Fertil Steril 2024; 121:1020-1030. [PMID: 38316209 PMCID: PMC11128346 DOI: 10.1016/j.fertnstert.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions. DESIGN Retrospective cohort study. SETTING US administrative database. PATIENTS We identified incident breast, colorectal, and ovarian cancer cases in females aged 15-39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. INTERVENTION Platinum-based chemotherapy. MAIN OUTCOME MEASURES We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries). RESULTS There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42-0.82) and 0.70 (95% CI 0.51-0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97-1.15) and 1.42 (95% CI 1.31-1.53), respectively. CONCLUSIONS Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.
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Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
| | - Milli J Desai
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Vinit Nalawade
- Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Joe Henk
- OptumLabs, Eden Prarie, Minnesota
| | | | - James D Murphy
- Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Paul C Nathan
- Department of Paediatrics, Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ksenya Shliakhtsitsava
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, San Diego, California
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts.
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Hoefgen HR, Benoit J, Chan S, Jayasinghe Y, Lustberg M, Pohl V, Saraf A, Schmidt D, Appiah LC. Female reproductive health in pediatric, adolescent, and young adult cancer survivors. Pediatr Blood Cancer 2023; 70 Suppl 5:e29170. [PMID: 37381166 DOI: 10.1002/pbc.29170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 06/30/2023]
Abstract
An estimated 500,000 cancer survivors of reproductive age in the United States will live to experience the long-term consequences of cancer treatment. Therefore, a focused aspect of cancer care has appropriately shifted to include quality of life in survivorship. Infertility is a late effect of therapy that affects 12% of female survivors of childhood cancer receiving any cancer treatment in large cohort studies and results in a 40% decreased likelihood of pregnancy in young adults of ages 18-39 years. Nonfertility gynecologic late effects such as hypoestrogenism, radiation-induced uterine and vaginal injury, genital graft-versus-host disease after hematopoietic stem cell transplant, and sexual dysfunction also significantly affect quality of life in survivorship but are underdiagnosed and require consideration. Several articles in the special edition "Reproductive Health in Adolescent and Young Adult Cancer Survivorship" address infertility, genital graft-versus-host disease, and psychosexual functioning in survivorship. This review article focuses on other adverse gynecologic outcomes of cancer therapies including hypogonadism and hormone replacement therapy, radiation-induced uterovaginal injury, vaccination and contraception, breast and cervical cancer screening, and pregnancy considerations in survivorship.
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Affiliation(s)
- Holly R Hoefgen
- Division of Pediatric and Adolescent Gynecology, Department of Obstet Gynecol, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janie Benoit
- Gynecology & Reproductive Sciences, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Serena Chan
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology & Reproductive Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yasmin Jayasinghe
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Victoria Pohl
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Amanda Saraf
- Division Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Deb Schmidt
- MACC Fund Center for Cancer and Blood Disorders, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leslie Coker Appiah
- Division of Pediatric and Adolescent Gynecology, Department of Obstet Gynecol, Children's Hospital Colorado, University of Colorado Denver, Denver, Colorado, USA
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Silva SD, Boer R, Cruz LAPD, Gozzo TDO. Fertilidade e contracepção em mulheres com câncer em tratamento quimioterápico. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2019-0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo identificar em mulheres em idade reprodutiva, com câncer e durante o tratamento quimioterápico, as orientações sobre preservação de fertilidade e planejamento reprodutivo e conhecer as informações fornecidas pela equipe de saúde. Métodos estudo descritivo, realizado com mulheres na pré-menopausa, com diagnóstico de câncer e em tratamento quimioterápico. A coleta de dados foi realizada com apoio de um instrumento com informações sociodemográficas, sobre o câncer e seus tratamentos, informações referentes a preservação de fertilidade e uso de métodos contraceptivos antes e após o diagnóstico do câncer. A análise dos dados foi feita por meio de estatística descritiva. Resultados a média de idade das 49 participantes foi de 38,2 anos (DP=6,1) e 79,6% estavam em tratamento devido ao câncer de mama. Quanto as informações recebidas sobre a importância do planejamento reprodutivo, 77,6% das participantes referiram que foram orientadas e 59,2% receberam tais orientações da equipe médica. Entretanto, em relação ao aconselhamento sobre métodos para manter a fertilidade, apenas, 6,1% das participantes foram orientadas. Conclusão e Implicações para a prática Deve-se considerar a relevância do aconselhamento especializado e a da manutenção de tomada de decisões ativas da mulher sobre a preservação de sua fertilidade.
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Lam CM, Shliakhtsitsava K, Stark SS, Medica ACO, Pinson KA, Whitcomb BW, Su HI. Reproductive intentions in childless female adolescent and young adult cancer survivors. Fertil Steril 2020; 113:392-399. [PMID: 32106992 DOI: 10.1016/j.fertnstert.2019.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the association between prior cancer treatments, medical comorbidities, and voluntary childlessness in reproductive-age women who are survivors of cancers diagnosed as adolescents and young adults (AYA survivors). DESIGN Cross-sectional analysis. SETTING Participants were recruited from California and Texas cancer registries, fertility preservation programs, and cancer advocacy groups. PATIENT(S) Women (n = 413) ages 18-40 who were diagnosed with cancer between ages 15 and 35, completed primary cancer treatments, had at least one ovary, and were nulliparous. INTERVENTION(S) Cancer treatment gonadotoxicity and medical comorbidities. MAIN OUTCOME MEASURE(S) Voluntary childlessness. RESULT(S) The mean age of survivors was 31.8 years (SD, 4.9) with a mean of 6.5 years (SD, 4.4) since cancer diagnosis. Breast (26%), thyroid (19%), and Hodgkin lymphoma (18%) were the most common cancers. Twenty-two percent of the cohort was voluntarily childless. Medical comorbidities, cancer diagnosis, prior surgery, prior chemotherapy, and prior gonadotoxic treatments were not significantly associated with voluntary childlessness. In adjusted analysis, survivors of older reproductive age (adjusted odds ratio = 2.97 [1.71-5.18]) and nonheterosexual participants (adjusted odds ratio = 4.71 [2.15-10.32]) were more likely to report voluntary childlessness. CONCLUSION(S) A moderate proportion of AYA cancer survivors are voluntarily childless, but reproductive intentions were not related to cancer type or cancer treatments. AYA survivors of older age and nonheterosexual identification were more likely to be voluntarily childless. These data support assessing reproductive intentions and tailoring reproductive care such as fertility and contraception counseling that is appropriate for a survivor's intentions.
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Affiliation(s)
- Christina M Lam
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, La Jolla, California
| | - Ksenya Shliakhtsitsava
- Department of Pediatric Hematology/Oncology, University of Texas Southwestern, Dallas, Texas
| | - Shaylyn S Stark
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Alexa C O Medica
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, La Jolla, California
| | - Kelsey A Pinson
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, La Jolla, California
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, La Jolla, California; Moores Cancer Center, University of California, San Diego, La Jolla, California.
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Oncofertility: Meeting the Fertility Goals of Adolescents and Young Adults With Cancer. ACTA ACUST UNITED AC 2019; 24:328-335. [PMID: 30480578 DOI: 10.1097/ppo.0000000000000344] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adolescents and young adults aged 15 to 39 years who are diagnosed with cancer (AYA survivors) undergo a range of therapies for cancer cure but subsequently may be at risk of treatment-related infertility, and for female AYA survivors, adverse pregnancy outcomes. Future fertility is important to AYA survivors. Meeting their fertility goals requires awareness of this importance, knowledge of cancer treatment-related fertility risks, appropriate fertility counseling on these risks, and access to fertility care. Epidemiologic and dissemination and implementation research are needed to estimate more precise risks of traditional and novel cancer therapies on fertility and pregnancy outcomes and improve the delivery of fertility care.
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Perceived infertility and contraceptive use in the female, reproductive-age cancer survivor. Fertil Steril 2019; 111:763-771. [PMID: 30929732 DOI: 10.1016/j.fertnstert.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/10/2018] [Accepted: 12/19/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate the association between perceived fertility potential and contraception use and to characterize factors important in contraceptive decision making in reproductive-age, female cancer survivors. DESIGN Cross-sectional study. SETTING Participants were from two state cancer registries, physician referrals, and cancer survivor advocacy groups in the United States. PATIENT(S) A total of 483 female survivors aged 18-40 years. INTERVENTION(S) Online questionnaire. MAIN OUTCOME MEASURE(S) Contraception use. RESULT(S) Eighty-four percent of participants used contraception; 49.7% used highly effective, World Health Organization tiers I and II methods (surgical sterilization, intrauterine devices, contraceptive implant, combined hormonal contraceptives, medroxyprogesterone acetate, progestin-only pills, contraceptive diaphragm). Contraception non-use was more common among survivors who perceived themselves to be infertile, compared with survivors who perceived themselves to be as or more fertile than similarly aged peers (prevalence ratio 4.0, 95% confidence interval 2.5-7.4). In mediation analysis that adjusted for clinical infertility, 59% of the association between prior chemotherapy and contraception non-use was explained by perceived infertility. Contraception efficacy (n = 62, 25.8%) and ease of use (n = 50, 20.8%) were the most cited reasons for using tier I/II methods; compared with lack of hormones (n = 81, 49.7%) as the predominant reason for using less-effective, tier III/IV methods. CONCLUSION(S) Although female, reproductive-age cancer survivors had high uptake of contraception, those who perceived themselves to be infertile were less likely to use contraception. Throughout survivorship, clinicians should counsel survivors on fertility potential in the context of their prior cancer treatments and on factors, including contraceptive efficacy and hormone-free contraception, that inform reproductive decision making in this population.
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Young K, Shliakhtsitsava K, Natarajan L, Myers E, Dietz AC, Gorman JR, Martínez ME, Whitcomb BW, Su HI. Fertility counseling before cancer treatment and subsequent reproductive concerns among female adolescent and young adult cancer survivors. Cancer 2018; 125:980-989. [PMID: 30489638 DOI: 10.1002/cncr.31862] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fertility counseling before cancer treatment has been advocated by clinical guidelines, though little is known about its long-term impact on the unique reproductive concerns of female adolescent and young adult (AYA) cancer survivors. The goal of this study was to measure the association between fertility counseling by fertility specialists before cancer treatment and subsequent reproductive concerns. METHOD A cross-sectional analysis was performed among 747 AYA survivors aged 18-40 years who had been recruited from cancer registries and physician and advocacy group referrals between 2015 and 2017. Participants self-reported information on past fertility counseling at cancer diagnosis, cancer type and treatment, and current reproductive concerns, as measured using the multidimensional Reproductive Concerns After Cancer scale. Multivariable log-binomial regression models tested associations between fertility counseling and reproductive concerns. RESULTS The mean age of the cohort was 33.0 years (standard deviation, 5.1 years), and the mean period since diagnosis was 7.7 years (standard deviation, 5.0 years). Seventy-three percent of participants were white, and 24% were Hispanic. Fertility counseling was reported by 19% of survivors; moderate to high overall reproductive concerns were reported by 44% of participants. In adjusted analysis, fertility counseling was significantly associated with moderate to high reproductive concerns (risk ratio, 1.22; 95% confidence interval, 1.02-1.45) and not modified by exposure to fertility-threatening treatments (Pinteraction = .23). CONCLUSION A large proportion of AYA cancer survivors across cancer types and treatment exposures reported moderate to high reproductive concerns, suggesting that there is a need to address these cancer-specific reproductive health concerns after treatment. Higher concerns, even with counseling, suggests the need to improve the quality of fertility counseling throughout the cancer continuum.
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Affiliation(s)
- Katie Young
- School of Medicine, University of California, San Diego, California
| | - Ksenya Shliakhtsitsava
- Department of Pediatric Hematology & Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Loki Natarajan
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego, California
| | - Emily Myers
- Moores Cancer Center, University of California, San Diego, California
| | - Andrew C Dietz
- Moores Cancer Center, University of California, San Diego, California
| | - Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, Oregon
| | - María Elena Martínez
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego, California
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences and Moores Cancer Center, University of California, San Diego, California
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