Post-cancer reproduction still low for women, men

NEW YORK (Reuters Health) - Strategies introduced in the late 1980s for protecting fertility in patients undergoing cancer treatment may have indeed helped boost reproduction rates modestly among survivors of certain types of cancer, new research from Norway suggests.

However, overall, female cancer survivors remain about half as likely as women who had never been diagnosed with the disease to have a child within the 10 years following their diagnosis, the researchers found. For male cancer survivors, reproduction rates were about 30 percent lower than among their healthy peers.

“There is much left to be done to improve post-diagnosis reproduction, in particular in women,” Dr. Sophie Dorothea Fossa of The Norwegian Radium Hospital in Oslo and her colleagues conclude in a report in the Journal of Clinical Oncology.

Studies to date on reproduction among cancer survivors have been small, and most don’t compare these individuals to controls who were never diagnosed with cancer.

In the current investigation, Fossa and her team matched 6,071 men and women who had been diagnosed with cancer between the ages of 15 and 45 and received treatment between 1971 to 1997 to 30,355 healthy controls. All study participants were born after 1950.

The researchers calculated the 10-year post-diagnosis cumulative reproduction rates, which is the percentage of people who had children within a decade of cancer diagnosis. They measured fertility for the controls for the 10 years beginning at the time of diagnosis of the age-matched patient corresponding to them.

The 10-year post-diagnosis reproduction rates were always lower for cancer patients than for controls, although the difference was not as great for people who had no children before being diagnosed with cancer. “This might reflect the former patient’s desire to have at least one biologic offspring despite possible concerns for the mother’s or infant’s health,” Fossa and her colleagues note.

For example, the 10-year post-diagnosis reproduction rate for women who had no children at diagnosis and who were diagnosed before 1988 was 31 percent, compared to 12 percent for women diagnosed before 1988 who already had children and 47 percent for the healthy controls.

For men diagnosed before 1988 who were childless when diagnosed, the 10-year post-diagnosis reproduction rate was 33 percent, compared to 28 percent for men who already had children when they were diagnosed, also before 1988, and 38 percent for controls.

Overall, there was only “minimal improvement” in fertility among cancer patients diagnosed in 1988 and afterwards compared to those diagnosed earlier, the researchers found. Post-1988 fertility-saving strategies may have improved the reproduction rates for some select genital cancers, they note.

“Although fertility-sparing treatment is allowing more patients to have children after cancer, the gains are minimal compared with the elevated rates of childlessness among cancer survivors,” Dr. Leslie R. Schover of The University of Texas M.D. Anderson Cancer Center in Houston notes in an accompanying editorial. And while men can bank their sperm before treatment, she adds, “many oncologists neglect to discuss the option or make a referral.”

Studies like this one, Schover concludes, “remind us that controlling cancer is necessary but not sufficient to ensure a satisfying quality of life for our patients.”

SOURCE: Journal of Clinical Oncology, online December 15, 2008.

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