Perceived Infertility Risk and Actual Fertility Status in Adult Survivors of Childhood Cancer
In a report from the St. Jude Lifetime Cohort Study in the Journal of Clinical Oncology, Lehmann et al found that perceptions of risk of infertility were often discordant with laboratory-assessed fertility status in adult survivors of childhood cancer.
Study Details
In the study, 1,067 survivors of childhood cancer without children or history of pregnancy completed questionnaires on infertility risk perceptions. They then underwent physical evaluation and assessments of biomarkers of gonadal functioning (eg, semen analysis, blood hormone levels, and menses).
Perceived Risk
A total of 61.9% of survivors perceived themselves at increased risk for infertility, with the perception of increased risk being significantly associated with older age, white ethnicity, being married/partnered, higher education, gonadotoxic treatments, fertility concerns, previous unsuccessful attempts to conceive, and sexual dysfunction (all P < .05).
Laboratory-evaluated impaired gonadal function was found in 24.3% of female and 55.6% of male survivors. However, concordance of laboratory findings with survivor risk perceptions was low (Cohen’s κ < .19). Overall, 19.7% of male and 43.6% of female survivors with apparently normal fertility status perceived themselves to be at risk of infertility, whereas 16.3% of male survivors and 5.3% of female survivors perceived no risk of infertility but were subsequently found to be impaired/infertile. Factors associated with discordance included sociodemographic factors, gonadotoxic treatments, fertility concerns, and sexual dysfunction (all P < .05).
The investigators concluded, “Although child-free survivors may correctly consider themselves at risk for infertility on the basis of their previous treatments, such risk perceptions were discordant from laboratory-evaluated fertility status among many survivors in adulthood. Thus, repeated fertility-related communication throughout survivorship is essential, because treatment-indicated risk does not equal fertility status after treatment. Offering fertility testing to those who were at risk and/or those with fertility-related concerns is recommended.”
Vicky Lehmann, PhD, of the Department of Psychology, St. Jude Children’s Research Hospital, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported National Cancer Institute grants and the American Lebanese Syrian Associated Charities. The study authors' full disclosures can be found at jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
