Critical appraisal:Baxter NN, Sutradhar R, DelGuidice ME, Forbes S, Paszat LF, Wilton AS, et al 2013

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Critical Appraisal

Article being appraised

Baxter NN, Sutradhar R, DelGuidice ME, Forbes S, Paszat LF, Wilton AS, et al. A population-based study of rates of childbirth in recurrence-free female young adult survivors of non-gynecologic malignancies. BMC Cancer 2013 Jan 23;13:30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23343211.


Applicable clinical question

Key Facts

Study Design

cohort study

Study aims:

To evaluate childbirth in a population-based group (registry data) of female young adult survivors of malignancy in Ontario Canada compared with matched control participants without a cancer diagnosis

Number of Patients:

Not applicable

Identified 5,172 women age 20-34 who developed a non-gynecologic invasive malignancy between Jan 1, 1992 and Dec 31, 1999 based on registration in the OCR. Of these, 3,536 survived at least 5 years after diagnosis

with no evidence of recurrence --> 3,285 after all exclusion criteria - breast cancer (18%), thyroid cancer (27%) or melanoma (15%).
Selected 15,176 matched controls from a potential control population of 2,660,134 women.

1,194 survivors and 6,049 controls experienced childbirth to the end of observation (March 2011)
Reported outcome(s):

childbirth

Results of outcome(s):

- 1,194 of survivors delivered 1,910 children between 1 yr after Dx until end of F/U vs. 6,049 controls who delivered 9,516 children.
-Survivors less likely than controls to be admitted for childbirth starting 12 months or more after diagnosis
-the cumulative rate of childbirth at 10-years in the survivor group was 36.3% vs. 39.9% in the control group (p < 0.001)
- time to childbirth was significantly longer for survivors than controls (HR 0.92, 95%CI 0.87–0.98) (adjusted for socioeconomic status and age)
-Childbirth prior to diagnosis influenced time to childbirth after diagnosis
-compared to controls, survivors with prior childbirth were less likely to experience a delivery over time (HR 0.76, 95% CI 0.66–0.86) while survivors without prior childbirth had a similar rate of childbirth (HR 1.00, 95% CI 0.92–1.08)
-BC (HR 0.45, 95% CI 0.29–0.68) or Hodgkin disease (HR 0.57, 95% CI 0.36–0.91) were sig. less likely to experience childbirth than controls (but not in other tumour groups)

Comments on results:

Population based study (Canadian cancer registries) - with a long follow up (>10 years).
Limitations:
- restricted our cohort to an 8 year period and therefore the sample size for some types of malignancies is small.
- information regarding childbirth was only available since 1988 and thus did not have complete prediagnosis information for all women.
- no data on ART

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-3

Risk of bias
Moderate risk of bias Comments: Registry study
Result of appraisal

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Completed by

Dr Michelle Peate

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Article
Baxter NN, Sutradhar R, DelGuidice ME, Forbes S, Paszat LF, Wilton AS, et al. A population-based study of rates of childbirth in recurrence-free female young adult survivors of non-gynecologic malignancies. BMC Cancer 2013 Jan 23;13:30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23343211.
Assigned to
User:Michelle.peate
Topic area
Guidelines:COSA:Cancer fertility preservation guidelines/Impact of cancer on fertility
Clinical question
Form
Form:Critical appraisal


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