Female cancer survivors without gonadotoxic cancer treatments have fewer children than desired

  • Howards P
  • Fothergill A
  • Mertens A
  • et al.
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Abstract

OBJECTIVE: To evaluate whether female cancer survivors not treated with chemotherapy or radiation meet their reproductive goals. DESIGN: The FUCHSIAWomen's Study is a population-based study of cancer survivors (aged 25-45 years) and cancer-free women frequency matched on age and residence. MATERIALS AND METHODS: Cancer survivors diagnosed from ages 20-35 years were identified in the Georgia Cancer Registry. Cancers of the reproductive organs and cancers treated with chemotherapy or radiation were excluded from this analysis. Participants (survivors n=371, cancer-free n=1,051) were interviewed about their reproductive histories. RESULTS: Both cancer survivors and cancer-free women desired a median of 2 children. Cancer-free women were more likely to report that it was important to have a biologic child (80% vs. melanoma 74%, thyroid 69%, other 75%) but were less likely to report that they would be disappointed if they found out they could not get pregnant (34% vs. melanoma 45%, thyroid 38%, other 38%). Thyroid cancer survivors were told that they had a medical condition that could prevent pregnancy more frequently than cancer-free women (20% vs. 16%). Endometriosis was more common among survivors of melanoma (14%) and other cancers (17%) than among cancer-free women (9%), but polycystic ovary syndrome was similar across groups. Survivors were less likely to have been pregnant (melanoma 71%, thyroid 70%, other 79%) than cancer-free women (85%). They were also less likely to have had a live birth (melanoma 64%, thyroid 66%, other 73% vs. cancer-free women 82%). Pregnancy loss was more common among survivors of thyroid (37%) and other cancers (39%) than among cancer-free women (32%). Induced abortion was more common among survivors of other cancers than among cancer-free women (22% vs. 17%). After adjusting for age, race, education, income, and marital status, survivors were more likely to have fewer children than desired compared with cancer-free women (odds ratio, 95% confidence interval: melanoma 1.6, 1.0-2.5; thyroid 1.9, 1.2-2.8; other 1.4, 1.0-2.1). Fertility counseling at cancer diagnosis was uncommon (melanoma 7%, thyroid 37%, other 21%). CONCLUSION: Cancer survivors not treated with gonadotoxic therapies are not meeting their reproductive goals. The reason is unclear, but greater efforts to provide fertility counseling may be warranted.

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Howards, P. P., Fothergill, A., Mertens, A. C., & Spencer, J. B. (2014). Female cancer survivors without gonadotoxic cancer treatments have fewer children than desired. Fertility and Sterility, 102(3), e153. https://doi.org/10.1016/j.fertnstert.2014.07.524

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