Critical appraisal:Winther JF, Boice JD Jr, Svendsen AL, Frederiksen K, Stovall M, Olsen JH 2008

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Critical Appraisal

Article being appraised

Winther JF, Boice JD Jr, Svendsen AL, Frederiksen K, Stovall M, Olsen JH. Spontaneous abortion in a Danish population-based cohort of childhood cancer survivors. J Clin Oncol 2008 Sep 10;26(26):4340-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18779621.


Applicable clinical question

Key Facts

Study Design

cohort study

Study aims:

To assess the risks for spontaneous abortion and stillbirths among cancer survivors who received radiotherapy and subsequently became pregnant.

Number of Patients:

1688

Pregnancy outcomes of 1688 survivors, 2737 sisters of survivors and 16700 comparison women from the general population.
Reported outcome(s):

Proportion of pregnancy live births, stillbirths and types of abortions among cancer survivors and the control populations

Results of outcome(s):

No significant differences were seen between survivors and comparison women in the proportions of livebirths, stillbirths, or all types of abortions combined. Survivors, however, had a 23% excess risk for spontaneous abortion (PR, 1.23; 95% CI, 1.0 to 1.5), related primarily to prior radiation treatments (PR, 1.58; 95% CI, 1.2 to 2.2) and especially high-dose radiotherapy to the ovaries and uterus (PR, 2.8; 95% CI, 1.7 to 4.7).

Comments on results:

The pregnancy outcomes of survivors were similar to those of comparison women. A slight excess risk for spontaneous abortion may have resulted from uterine damage after high-dose pelvic radiotherapy, consistent with previous studies, although radiation-induced germinal mutations or decreased hypothalamic-pituitary-ovarian function could not be ruled out

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-3

Risk of bias
Low risk of bias Comments: Population based study, objective measures
Result of appraisal

Jutta's tick icon.png Included



Comments

The pregnancy outcomes of survivors were similar to those of comparison women. A slight excess risk for spontaneous abortion may have resulted from uterine damage after high-dose pelvic radiotherapy,

Completed by

Dr Jessica Harris

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


Article
Winther JF, Boice JD Jr, Svendsen AL, Frederiksen K, Stovall M, Olsen JH. Spontaneous abortion in a Danish population-based cohort of childhood cancer survivors. J Clin Oncol 2008 Sep 10;26(26):4340-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18779621.
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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