Fertility rates, including pregnancy and livebirth rates, for both male and female childhood cancer survivors were recently analyzed in a large study, indicating promising data in this emotionally charged issue among young cancer survivors. The results were recently published in The Lancet Oncology.
The risk of infertility among cancer survivors who are still young enough to become parents in the future is an area of intense emotional distress. Fortunately, ways in which to preserve fertility for these patients is an issue that has come to the forefront of cancer care among young people.
Specialized counseling to educate patients of all options of maintaining their ability to become a biologic parent in the future has become part of the standard of care for young patients. Methods to preserve fertility continue to improve, leading to greater success rates of producing biologic children for cancer survivors. Furthermore, data leading to the identification of specific treatments that might be associated with infertility is continuing to emerge so that therapeutic regimens can be tailored according to a patient’s desires and needs.
Researchers recently evaluated data from a subset of patients in the Childhood Cancer Survivor Study cohort to compare rates of pregnancy and livebirths between childhood cancer survivors and their siblings. The study included data following patients diagnosed with the most common types of childhood cancer and their treatment. Patients were diagnosed before the age of 21 years and were treated at 27 institutions in the USA and Canada between 1970 and 1999. Patients did not receive radiation treatment to the pelvis or brain.
- After a median follow-up of 8 years from study entry, or at the age of 15 years (whichever was later), 38% of survivors had reported a pregnancy (females being pregnant and males siring pregnancy), of which 83% reported a livebirth.
- After a median follow-up of 10 years, 62% of siblings had reported a pregnancy; 90% of whom reported a livebirth.
- Male survivors had a 37% decreased likelihood of both pregnancy and livebirth compared to siblings.
- Female survivors had a 13% decreased likelihood of pregnancy and an 18% decreased likelihood of livebirth compared to siblings.
- In male survivors, the rate of pregnancy was decreased when treatment included higher doses of cyclophosphamide, ifosfmide, procarbazine and cisplatin.
- In female survivors, the rate of pregnancy was decreased when treatment included busulfan and lomustine or high doses of cyclophosphamide.
- Results in terms of treatment were similar for livebirth and pregnancy rates.
These results indicate that among female childhood cancer survivors, fertility rates remain fairly high. The fact that this data includes treatment from 1970-1999 is encouraging, as cancer treatment, fertility awareness, and fertility measures have all improved since that time.
Although male childhood cancer survivors have increased infertility rates compared to women in this study, the identification of the role in fertility of specific therapeutic agents and their doses for each gender can help guide treatment decisions.
Understanding fertility options prior to initiation of treatment remains crucial for young patients diagnosed with cancer. Importantly, several effective methods are now available to maintain a young cancer survivor’s ability to become a biologic parent in their future.
Reference: Chow E, Stratton K, Leisenring W et al. Pregnancy after chemotherapy in male and female survivors of childhood cancer treated between 1970 and 1999: a report from the Childhood Cancer Survivor Study cohort. The Lancet Oncology. Published online March 22, 2016. DOI: http://dx.doi.org/10.1016/S1470-2045(16)00086-3. Available at: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)00086-3/abstract. Accessed March 23, 2016.
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