Better fertility information needed for adolescent, young adult cancer survivors

Key takeaways:

• Most female adolescent and young adult cancer survivors had a perceived higher infertility risk vs. other women their age.
• Several factors were tied to odds of infertility over- or underestimation.

Accurate information on fertility likelihood after cancer treatment remains an unmet need among adolescent and young adult cancer survivors, researchers reported in JAMA Network Open.

“Data on fertility perceptions of adolescent and young adult cancer survivors and their alignment with objective infertility risk are scant,” Hena Naz Din, PhD, associate professor at Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, and colleagues wrote. “Prior studies, largely in childhood cancer survivors, report that survivors often overestimate or underestimate their infertility risk.”

Din and colleagues conducted a retrospective cohort study with 785 female adolescent and young adult (mean age, 33.2 years; 74.5% white) cancer survivors who were diagnosed from age 15 to 39 years. Participants were recruited from two state cancer registries, social media and clinician referrals. All participants reported their menstrual pattern and fertility risk perception. Researchers identified objective fertility risk through gonadotoxicity, menstrual pattern and ovarian reserve testing of self-collected blood samples.

Overall, 61.5% of participants had a perceived higher infertility risk compared with other women their age. Researchers observed higher odds of perceived increased risk for infertility among participants with prior exposure to moderate to high gonadotoxicity treatments (adjusted OR = 2.73; 95% CI, 1.87-3.97) compared with those with exposure to low gonadotoxicity treatments (aOR = 15.39; 95% CI, 5.52-42.96).

Women with amenorrhea (aOR = 3.98; 95% CI, 2.13-7.41) and those with irregular menstrual cycles had higher odds of perceived increased risk for infertility compared with women without (aOR = 1.69; 95% CI, 1.19-2.4).

In addition, older age (aOR = 0.94; 95% CI, 0.89-0.98), endocrine comorbidity (aOR = 0.35; 95% CI, 0.18-0.69) and prior infertility (aOR = 0.16; 95% CI, 0.07-0.38) were all associated with lower odds of underestimation while multiparity (aOR = 4.17; 95% CI, 2.61-6.64) was associated with increased odds of underestimation.

The following variables were associated with lower odds of overestimation:

• multiparity (aOR = 0.48; 95% CI, 0.27-0.86);
• breast cancer (aOR = 0.38; 95% CI, 0.2-0.73); and
• skin cancer (aOR = 0.24; 95% CI, 0.11-0.51).

“Past studies with adolescent and young adult cancer survivors show that the use of survivorship care plans can improve infertility concerns and reduce unmet information needs,” the researchers wrote. “Strategies to reduce misalignment between perceptions and actual risk are essential to reducing psychological distress and allow for better informed reproductive decisions for adolescent and young adult cancer survivors.”