Critical appraisal:Barton SE, Najita JS, Ginsburg ES, Leisenring WM, Stovall M, Weathers RE, et al 2013
Barton SE, Najita JS, Ginsburg ES, Leisenring WM, Stovall M, Weathers RE, et al. Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol 2013 Aug;14(9):873-81 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23856401.
- Are cancer survivors who received cancer treatment less likely than the general population to conceive or give birth after treatment?
infertility and time to pregnancy among female childhood cancer survivors, and analyzes treatment characteristics associated with infertility and subsequent pregnancy.
-1,366 female sibling control
-Self-reported infertility (‘clinical infertility’ - anyone who responded yes to: “Was there ever a period in your life when you and a partner tried for one year or more to become pregnant, without success?” AND ‘total infertility’ included women with ‘clinical infertility’ as well as those who reported ovarian failure [never having had a menstrual period or menstrual periods stopping five years or more from time of baseline], inclusive of both those women who attempted to become pregnant for one year or more).
-pregnancy (including time to first pregnancy)
-risk of infertility
-still menstruating at the time of the baseline questionnaire (82·0%[2894/3531] of survivors and 86·8% [1186/1366] of siblings).
-Survivors had an increased risk of clinical infertility (>1 year of attempts at conception without success) compared to siblings:
~including ovarian failure group - RR =1.48 95% CI 1·23–1·78 (adj for sociodemographic and behavioral risk factors)
~was most pronounced at early reproductive ages (≤24 years RR=2·92, 95%CI 1·18–7·20; 25–29 years RR=1·61, 95% CI 1·05–2·48; 30–39 years RR=1·37, 95% CI 1·11–1·69).
-In adjusted models, older age (>29 vs. 24–29) at the time of the baseline questionnaire (RR=1·68, 95% CI 1·26–2·24), marital status (RR=7·91, 95% CI 4·58–13·68 if currently married), and BMI >30 kg/m2 (RR=1·71, 95% CI 1·30–2·26) were associated with clinical infertility
-association between age at primary diagnosis and infertility was not observed after adjustment
-In adjusted models, uterine RT doses >5 Gy (RR=2·48, [95% CI 1·54–4·01] for 5·1–10 Gy; RR=2·02, [95% CI 1·27–3·23] for
10·1–20 Gy; RR=1·95, [95% CI 1·19–3·19] for >20 Gy) and the alkylating agent (AA) score of 3 (RR=1·48, 95% CI 1·10–1·99) remained significant.
-704 participants who reported a planned first pregnancy
-survivors had an increased time to pregnancy interval (p=0·032):
~13.0% (55/423) of survivors required more than twelve months of attempts to achieve pregnancy, compared to 8·3% (21/253) of siblings
~When grouped by Tx - abdominal RT significantly longer to become pregnant (than no abom RT), RT to the brain or head had a significantly decreased time to pregnancy compared to other survivors
~64·2% (292/455) with infertility achieved a pregnancy
~In adjusted analyses, infertile survivors who received >10 Gy of uterine RT were less likely to become pregnant (RR=0·33, 95% CI 0·14–0·75 for 10·1–20 Gy and RR=0·21, 95% CI 0·08–0·60 for >20 Gy) than those who were not exposed to uterine RT. Additionally, those with AA scores of 2 (RR=0·59, 95% CI 0·43–0·82) or 3 (RR=0·77, 95% CI 0·62–0·97) were less likely to become pregnant
-median age 27.6 years in survivors and 33.6 years in controls
-also collected medical treatment for infertility (which is listed as exclusion criteria above, but I am assuming this is not what is meant for exclusion of the paper) - Despite being equally likely to seek treatment for infertility, survivors were less likely to be prescribed medication for treatment of infertility (RR=0·57, 95% CI 0·46–0·70).
|Low risk of bias||Comments: Questionnaire based - selection bais, recall bias etc|
- Barton SE, Najita JS, Ginsburg ES, Leisenring WM, Stovall M, Weathers RE, et al. Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol 2013 Aug;14(9):873-81 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23856401.
- Assigned to
- Topic area
- Guidelines:COSA:Cancer fertility preservation guidelines/Impact of cancer on fertility
- Clinical question
Section below only relevant for Cancer Council Project Officer