Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments

Abstract

It is well established that cancer and its treatment, whether by chemotherapy, radiotherapy, hormone therapy, or surgery, can adversely impact reproductive function in both women and men. The effects of cancer treatment on reproductive function in both sexes may lead to loss of fertility, sexual desire and function, and hormone deficiency, which results in additional long-term morbidity in more than a third of patients. Given the importance of reproductive function to most people, and the often devastating effect of cancer treatment on it, we propose that proactive assessment of the functional and endocrinological impact of treatment be made a vital component of the assessment of modern cancer treatment, and should be a routine part of discussions with patients before and after treatment, both in trials and in routine care. Reproductive counselling should be proactive and encouraged, as implementation of such counselling has been shown to be beneficial to patient mental health, quality of life, and adherence to treatment. Similarly, efforts should be made to provide more adequate and accurate information to patients, as well as to offer appropriate fertility

Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review

“…In particular, reproductive health outcomes should be included in standard toxicity assessments of all clinical trials. 77 …”

“…In particular, reproductive health outcomes should be included in standard toxicity assessments of all clinical trials. 77 It seems that checkpoint inhibitors may cause primary hypogonadism, especially in men. However, the frequency of this side-effect needs to be clarified, as well as its duration after treatment discontinuation, the laboratory perturbations of sex hormones (e.g.…”

Understanding the barriers to, and facilitators of, ovarian toxicity assessment in breast cancer clinical trials

“…Current tools used for trial endpoint decision-making [ 25 , 41 , 42 ] do not address ovarian toxicity assessment. As reported by many participants in this study, development of clinical trial design guidelines which make recommendations regarding which ovarian measures to collect and when, may overcome many of the barriers we identified [ 43 ].…”

Male and Female Fertility: Prevention and Monitoring Hodgkin’ Lymphoma and Diffuse Large B-Cell Lymphoma Adult Survivors. A Systematic Review by the Fondazione Italiana Linfomi

“…Therefore, fertility preservation options should be offered to patients wishing for future offspring, especially those who will receive gonadotoxic treatment that has a subsequent infertility risk greater than 50%. Other fertility preservation candidates are patients undergoing aggressive chemotherapy regimens that are associated with high cumulative doses of alkylating agents and/or hematopoietic stem cell transplantation [10,59]. However, it is reasonable to offer fertility preservation strategies in less gonadotoxic treatments because it is difficult to predict which patients will relapse and, thus, have to undergo treatment with a high risk of infertility, such as ASCT [55].…”