NEW YORK (Reuters Health) – Adult survivors of childhood cancer tend to have an incorrect perception of their infertility risk and need ongoing fertility care, a large single-site longitudinal study suggests.
“These results highlight the importance of continued appropriate testing and counseling on fertility risk throughout the reproductive lifespan. Physicians should make individual survivors of childhood cancer who are seeking information about their fertility potential aware that their laboratory values may not correlate with their ultimate fertility,” Dr. Melissa M. Hudson of St. Jude Children’s Research Hospital in Memphis, Tennessee, told Reuters Health by phone.
“Providers can correct their patients’ misperceptions, help improve their mental health, and offer fertility preservation to those with impaired gonadal functioning,” said Dr. Hudson, the principal investigator of the long-term St Jude Lifetime Cohort Study (SJLIFE) of childhood cancer survivors.
Her team asked adult participants in the study to complete questionnaires about infertility-risk perceptions and to undergo physical examinations including blood hormone levels, semen and menses.
The 444 female and 623 male eligible survivors who completed the questionnaire before being tested for fertility were, on average, 29.0 years of age and 21.9 years after their diagnosis. The participants had no biological children or history of conceiving a pregnancy.
Nearly two-thirds (61.9%) of the survivors perceived themselves as being at increased risk for infertility, the researchers report in the Journal of Clinical Oncology, online February 27.
This group was significantly older and more likely to be white, married or partnered, more highly educated, to have received gonadotoxic treatments, and to have fertility concerns, previous unsuccessful attempts to conceive, and sexual dysfunction.
Overall, 43.6% of women and 19.7% of men perceived that they were at increased risk for infertility although laboratory values showed them to be fertile. By contrast, 5.3% of women and 16.3% of men perceived no risk for fertility although laboratory values showed increased risk.
In laboratory tests, 24.3% of female and 55.6% of male survivors actually had impaired gonadal function.
“When patients are given cancer treatments that are potentially gonadotoxic, we inform them about potential risks to fertility based on our understanding of populations that have been exposed and on dose relationships, but the interactions are actually much more complicated than that,” Dr. Hudson said.
The outcomes are quite variable, she added. Doctors anticipate that some patients, who’ve had much lower exposure, will be fertile but they are not; and that others, with much higher exposure, will be infertile but they maintain fertility.
“We can do laboratory tests, including semen analysis for men and tests of ovarian reserve for women. But except for a semen analysis that shows no sperm, this information is not 100% accurate,” she explained. “There are variances related to age if you’re a woman, and variances related to genetics that we don’t quite understand. For specific exposures to cancer treatments, we can anticipate potential risk, but we don’t know the actual risk until the survivor ages.”
Dr. Michael Roth, director of the Childhood Cancer Survivorship Program at The University of Texas MD Anderson Cancer Center in Houston, told Reuters Health by email, “This is the first study to assess patients’ perceptions about their ability to have biological children and their fertility status based on laboratory and clinical assessment.”
“The study highlights the importance of reassessing patients’ fertility status as they become young adults and the importance of continuing to provide fertility-risk counseling throughout survivorship,” added Dr. Roth, who was not involved in the study.
Dr. Denise Rokitka, who heads the Young Adult Program and Oncofertility Program at Roswell Park Comprehensive Cancer Center in Buffalo, New York, told Reuters Health by email, “This study is important because it shows clear evidence that survivorship care and patient education are extremely important.”
“Many survivors are very concerned about their fertility and potential offspring and will engage if the conversation is brought up to them, but often they will not bring it up themselves,” added Dr. Rokitka, who also was not involved in the study. “I don’t think we can overstate how important it is for every young person who might benefit from fertility preservation to be informed about the effects of treatment as well as the steps that can limit their impact.”
J Clin Oncol 2019.