Reproductive Care of Childhood and Adolescent Cancer Survivors: A
Twelve-Year Evaluation
Abstract
Background: Reproductive complications for cancer survivors are
identified as one of the top unmet needs. Current models of care do not
routinely incorporate reproductive follow-up for cancer patients. The
Kids Cancer Centre have had a one stop survivorship clinic which
includes a gynecologist and fertility specialist. Methodology: To inform
the future development of our reproductive survivorship care we audited
this service over a twelve-year period reviewing who used the service
and their gonadotoxic risk, their reproductive needs and concerns. Main
results: 278 patients were seen (397 consultations), including 189
female patients (68.0%). Median age at follow up was 25.0 years
(range=6-50) and they were 19.2 years from their primary diagnosis
(range=3-46). We identified 10 themes of reproductive need. Patients had
on average 2.5 reproductive concerns documented per consultation (range
1-5). The three most commonly documented concerns at initial
consultation related to fertility status (43.9%), endocrine dysfunction
(35.3%), and contraception advice (32.4%). In patients younger than 25
years discussions were predominately about endocrine dysfunction,
fertility status and contraception, while dominant themes for 26-35
years olds were fertility status, reproductive-related health prevention
strategies, contraception and endocrine dysfunction. Survivors aged
36-45 prioritised fertility status, pregnancy, and contraception.
Fertility preservation (p=0.05), preventative health strategies
(p=0.001), and contraception advice (p<0.001) were more
commonly discussed by females than males. Conclusion: Longitudinal
reproductive follow up care is important, as patients have a number of
ongoing reproductive concerns which change over time. Our data can
assist in informing the model of care.