Critical appraisal:Wasilewski-Masker K, Seidel KD, Leisenring W, Mertens AC, Shnorhavorian M, Ritenour CW, et al 2014

Critical Appraisal

Article being appraised

Wasilewski-Masker K, Seidel KD, Leisenring W, Mertens AC, Shnorhavorian M, Ritenour CW, et al. Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study. J Cancer Surviv 2014 Sep;8(3):437-47 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24711092.

Applicable clinical question

Are cancer survivors who received cancer treatment less likely than the general population to conceive or give birth after treatment?

Key Facts

Study Design

cohort study

Study aims:

To assess the prevalence of male infertility and treatment-related risk factors in childhood cancer survivors.

Number of Patients:

1622

938 of 1622 survivors reported trying to become pregnant. Analysis restricted to those 938. Matched with 274 siblings

Reported outcome(s):

Relative risks of infertility

Results of outcome(s):

the prevalence of infertility was 46.0 % in survivors versus 17.5 % in siblings (RR=2.64, 95 % CI 1.88–3.70, p<0.001). Of survivors who met the definition for infertility, 37% had reported at least one pregnancy with a female partner that resulted in a live birth. In a multivariable analysis, risk factors for infertility included an alkylating agent dose (AAD) score ≥3 (RR=2.13, 95 % CI 1.69–2.68 for AAD ≥3 versus AAD <3), surgical excision of any organ of the genital tract (RR=1.63, 95 % CI 1.20–2.21), testicular radiation ≥4 Gy (RR=1.99, 95 % CI 1.52–2.61), and exposure to bleomycin (RR=1.55, 95 % CI 1.20–2.01).

Comments on results:

Many survivors who experience infertility father their own children, suggesting episodes of both fertility and
infertility. This and the novel association of infertility with bleomycin warrant further investigation

Includes an economic evaluation

no