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

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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

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

Evidence ratings

Level of evidence

III-3

Risk of bias
Moderate risk of bias Comments: Only 57% of eligible childhood cancer survivors completed questionnaire. Low proportion of matched controls.
Result of appraisal

Jutta's tick icon.png Included



Comments

Check if numbers too low to include as less than 1000 survivors

Completed by

Associate Professor Natalie Bradford PhD MPH Bnur

Jutta's tick icon.png This appraisal has been completed.


Article
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.
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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