Critical appraisal:Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al 2018

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Critical Appraisal

Article being appraised

Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al. The impact of cancer on subsequent chance of pregnancy: a population-based analysis. Hum Reprod 2018 Jul 1;33(7):1281-1290 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29912328.


Applicable clinical question

Key Facts

Study Design

cohort study

Study aims:

To study if women achieved pregnancy after cancer diagnosis on a population level

Number of Patients:

23201

Female patients with a record of a first incident cancer diagnosed below the age of 40 years between 1981 and 2012 in Scotland were identified from the Scottish Cancer Registry and linked to national general and maternity hospital discharge records to ascertain subsequent pregnancies(miscarriage, termination of pregnancy, or delivery of a still or live born infant) up until the end of 2014. Linkage to subsequent death records up to the end of 2014 was also performed. Patients treated with radiotherapy and with chemotherapy in the first 2 years following the cancer incidence date from 1997 onwards were identified from Scottish Cancer Registry records; prior to 1997, acute hospital discharge records were used to identify any radiotherapy or chemotherapy treatments. As these records do not contain all episodes of radiotherapy or chemotherapy treatment, any patients with no matching treatment records were recorded as Not Known


There were 30811 match controls
Reported outcome(s):

Total number of pregnancies in cancer group. Calculated standardized incidence ratio using expected pregnancies based upon rates in the general population. The overall impact of each cancer diagnostic group was calculated from the number of women with each diagnosis and its impact, as a proportion of the total pregnancy deficit.

Results of outcome(s):

Overall the cancer survivors achieved a lower than expected number of pregnancies compared to the general population of women: 6627 observed compared to 10 736 expected pregnancies, SIR 0.62 (95% CI: 0.60, 0.63: Table I). Thus cancer survivors were approximately 38% less likely to achieve pregnancy after diagnosis. SIR was significantly reduced for women with all cancer types with the exception of liver cancer, which was the least prevalent. SIR ranged from 0.34 (0.31–0.37) for women with cervical cancer, to 0.87 (0.84–0.90) for skin cancers.

Comments on results:

There was an overall reduction in likelihood of pregnancy after diagnosis. The reduction was seen in all groups by age at diagnosis and across the diagnostic spectrum, even in cancers which are predominantly managed surgically, although treatment with chemotherapy and radiotherapy were both shown to have importanteffects. There was no marked variation by deprivation index.
No increased risk of miscarriage or still birth among first pregnancies achieved after a cancer diagnosis.
The slightly lower proportion of pregnancies among women with previous cancer that end in a termination of pregnancy may reflect more active planning of pregnancies in the cancer group, increased use of
contraception, or continuation of more unplanned pregnancies.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-3

Risk of bias
High risk of bias Comments:
Result of appraisal

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Completed by

Dr Jessica Harris

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Article
Anderson RA, Brewster DH, Wood R, Nowell S, Fischbacher C, Kelsey TW, et al. The impact of cancer on subsequent chance of pregnancy: a population-based analysis. Hum Reprod 2018 Jul 1;33(7):1281-1290 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29912328.
Assigned to
User:Natalie.bradford
Topic area
Guidelines:COSA:Cancer fertility preservation guidelines/Impact of cancer on fertility
Clinical question
Form
Form:Critical appraisal


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