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An in-depth look at fertility and cancer survivorship

Pregnant_woman2The physical and emotional after-effects of cancer treatment - things like fatigue, pain and depression - have been well-documented. And because some treatments cause havoc on parts of the body's reproductive system, younger patients often must also contend with fertility issues.

In a paper recently published online in CA: A Cancer Journal for Clinicians, a group of Stanford researchers review the existing literature on fertility and cancer survivorship. The topic, they explain, is an increasingly important one, given that around 9 percent of patients diagnosed with cancer in the United States are younger than 45 years old and that infertility has been shown to negatively impact quality of life among cancer survivors. They write:

The distress resulting from the interruption of fulfilling one's reproductive goals as a result of a cancer diagnosis and treatment  persists several years after the diagnosis, particularly for those who never conceive.

The goal of the review, which was led by Lynn Westphal, MD, associate professor of obstetrics and gynecology, was to aid in pre- and post-treatment fertility counseling for patients. In their lengthy article, Westphal and her colleagues summarize what is known about infertility and survivorship - and what we still need to study further. Among the information shared about patients' reproductive health and the health of their offspring:

  • Since it varies with type of treatment and patient age, among other things, there isn't an accurate estimate of women's risk of infertility or primary ovarian insufficiency after cancer treatment. But, the researchers write, studies have shown the incidence of acute ovarian failure or premature menopause among childhood cancer survivors varies from 6 to 12 percent.
  • In the landmark Childhood Cancer Survivor Study, exposure of the ovaries to radiation was shown to be to be one of the highest risks for acute ovarian failure and premature menopause in women.
  • In several studies comparing pregnancies in cancer survivors with those in the general population, "the vast majority of pregnancies occurring in cancer survivors are routine  and uneventful." But patients who have undergone abdominal or pelvic radiotherapy are known to face a higher risk of preterm birth, low birth-weight offspring, stillbirth and early neonatal death.
  • Testicular and hematologic malignancies are the most common cancers that are associated with impaired sperm production in men.
  • Recent estimates suggest that up to two-thirds of all pediatric cancer survivors will face male germ cell dysfunction.
  • For most cancer survivors, there is no increase in cancer or birth defects in their children. One study comparing more than 2,100 offspring of cancer survivors with more than 4,500 offspring of controls in the United States found no difference in birth defects between the two groups.

The authors discuss specific types of fertility preservation, including egg and embryo freezing, and note that techniques to help survivors have children have improved over the past decade. Yet, they write, only "a subset of oncologists discuss the gonadotoxic effects of cancer treatments with patients of reproductive age, and even fewer refer them for fertility preservation consultations."

In light of research showing that treatment-related infertility is significantly associated with depressive symptoms among survivors, Westphal and her colleagues encourage clinicians to address these issues - and the options - with their patients.

"Discussion of the changes to a patient's reproductive health after cancer treatment is essential to providing comprehensive quality care," they conclude.

Previously: Study highlights fertility-related concerns of young cancer survivorsUnique challenges face young women with breast cancer and A need to provide infertility counseling to cancer patients
Photo by Canwest News Service

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