First live births less common among cancer survivors

Survivors of childhood and adolescent cancer were less likely as adults to have a first live birth than adults who never had cancer, according to results of a population-based study conducted in Sweden and published in Journal of Clinical Oncology.

“To improve the possibilities for building a family in the future, patients with newly diagnosed cancer and/or parents should be informed about the risk for infertility to make informed decisions about future family planning,” Gabriela Armuand, RN, PhD, a postdoctoral researcher in clinical and experimental medicine, obstetrics and gynecology at Linkoping University, and colleagues wrote.

The 5-year survival rate for all childhood cancers is approximately 80%; however, modern cancer treatment can affect fertility. Previous studies have focused on treatment regimens, but not diagnostic groups.

Armuand and colleagues investigated the probability of first live birth among 1,206 survivors diagnosed with cancer during childhood (age younger than 14 years) or adolescence (age 14 to 20 years) compared with an age-matched comparison group of 2,412 participants never diagnosed with cancer.

The majority of survivors were diagnosed before the age of 14 years (65.7%), almost half (47.2%) were diagnosed in 1988 or later, and 17.6% had received more than one cancer diagnosis.

The most common childhood malignancies were leukemia and central nervous system tumors. Among survivors diagnosed during adolescence, the most common malignancies among males were CNS tumors (19%), malignancies in genital organs (15%) and leukemia (12%). The most common among female survivors were CNS tumors (18%), Hodgkin disease (15%) and bone tumors (15%).

Probability of first live birth served as the primary outcome. Age at time of first live birth and the time between diagnosis and first live birth served as secondary outcomes.

Among 654 male survivors, 258 (39%) were linked to at least one live birth after diagnosis. Mean age at first live birth was 30.1 years for cancer survivors and 33 years for men in the control group.

Time to first live birth was 20 years following diagnosis for male survivors and 22.5 years from start of observation for men without cancer. Adjusted models showed the relative probability of men being linked to a first live birth after being diagnosed with any cancer was 35% lower than among the control group.

Men least likely to have a child were those who had been diagnosed with mesothelial and soft tissue tumors (HR = 0.17; 95% CI, 0.07-0.4) and CNS tumors (HR = 0.43; 95% CI, 0.28-0.67), whereas those diagnosed with malignancies in the urinary tract and genitals showed no difference from controls.

Additionally, men diagnosed with cancer in adolescence were at greater risk to not be linked to a first live birth (HR = 0.59; 95% CI, 0.45-0.76) than those diagnosed in childhood (HR = 0.74; 95% CI, 0.62-0.88).

Among 552 female cancer survivors, 278 (50%) had at least one live birth after diagnosis. Mean age at first live birth was 27.6 years for cancer survivors and 32.1 years for women in the control group.

Time to first live birth was 16.2 years from diagnosis for cancer survivors and 21 years from start of observation for women controls.

Female cancer survivors were 21% less likely to give birth after diagnosis compared with women in the control group.

The most common malignancies associated with reduced likelihood of first live births for women were malignancies of the eye (sample too small to calculate HR), CNS tumors (HR = 0.5; 95% CI, 0.35-0.73) and leukemia (HR = 0.69; 95% CI, 0.49-0.96).

Male and female survivors of CNS tumors had similarly low HRs for first live birth, a finding similar to previously reported data.

“Treatment of CNS tumors often combines chemotherapy, radiotherapy and/or surgery, all of which may have a negative impact on fertility,” Armuand and colleagues wrote. “In addition, survivors of CNS tumors are at a higher risk for severe neurocognitive impairment, which is associated with lower educational level, higher unemployment, less independent living, and a higher risk for never getting married — all factors that could negatively impact opportunities to build a family.”

Although women diagnosed during childhood (HR = 0.79; 95% CI, 0.66-0.95) generally were less likely to have a first live birth than women diagnosed during adolescence (HR = 0.9; 95% CI, 0.71-1.13), the opposite was true for survivors of leukemia (childhood, HR = 0.76; 95% CI, 0.53-1.1; adolescence, HR = 0.55; 95% CI, 0.21-1.46). Notably, women diagnosed in 1988 or later were no less likely to give birth than those never diagnosed.

A woman’s desire to have children may increase following the diagnosis of cancer, which might explain the shorter period between diagnosis and first live birth, the researchers noted.

“Building a family has been described as a way to restore normality, as a way to connect with others and as a way to form an identity,” the researchers wrote. “An additional explanation could be that the survivors had been informed about the risk of [treatment-related] premature menopause and, therefore, decided to have children earlier.” – by Chuck Gormley

Disclosure: The researchers report no relevant financial disclosures.