Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium

Dorp, Wendy van; Mulder, Renée L.; Kremer, Leontien C. M.; Hudson, Melissa M.; Heuvel‐Eibrink, Marry M. van den; Berg, Marleen H van den; Levine, Jennifer; Broeder, Eline van Dulmen‐den; Iorgi, Natascia Di; Albanese, Assunta; Armenian, Saro H.; Bhatia, Smita; Constine, Louis S.; Corrias, A; Deans, Rebecca; Dirksen, Uta; Gracia, Clarisa R.; Hjorth, Lars; Kroon, Leah; Lambalk, Cornelis B.; Landier, Wendy; Levitt, Gill; Leiper, Alison; Meacham, Lillian R.; Mussa, A.; Neggers, Sebastian J C M M; Oeffinger, Kevin C.; Revelli, Alberto; Santen, Hanneke M van; Skinner, Roderick; Toogood, Andrew; Wallace, William H.; Haupt, Riccardo

doi:10.1200/jco.2015.64.3288

Cited by 178 publications

(150 citation statements)

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“…Ovarian function is vulnerable to gonadotoxic chemotherapy drugs such as alkylating agents (Table 3) and radiotherapy (80,142,143). Given the age-related natural decline of follicular reserve, older age at treatment exposure has also been described as an additional risk factor (142, 144).…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

“…Patients undergoing cancer treatments frequently experience interruptions in their pubertal development or amenorrhea; assessments of ovarian function are generally initiated if such dysfunctions last for more than 2 years after the completion of therapy (163). The laboratory diagnosis is primarily based on the observation of abnormally elevated FSH levels contrasting with low estradiol concentrations (143). The role of other markers of follicular reserve such as antral follicle count via ultrasound and plasma anti-Mullerian hormone levels is yet to be determined in CCS (143).…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…The laboratory diagnosis is primarily based on the observation of abnormally elevated FSH levels contrasting with low estradiol concentrations (143). The role of other markers of follicular reserve such as antral follicle count via ultrasound and plasma anti-Mullerian hormone levels is yet to be determined in CCS (143). Sex hormone replacement is the mainstay of POI treatment; it aims at inducing pubertal development during childhood and adolescence and promoting skeletal, cardiovascular, psychological and sexual health during adulthood (143).…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…The role of other markers of follicular reserve such as antral follicle count via ultrasound and plasma anti-Mullerian hormone levels is yet to be determined in CCS (143). Sex hormone replacement is the mainstay of POI treatment; it aims at inducing pubertal development during childhood and adolescence and promoting skeletal, cardiovascular, psychological and sexual health during adulthood (143). It follows the same guidelines as in the general population (79,80,143).…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…Sex hormone replacement is the mainstay of POI treatment; it aims at inducing pubertal development during childhood and adolescence and promoting skeletal, cardiovascular, psychological and sexual health during adulthood (143). It follows the same guidelines as in the general population (79,80,143). Information on screening and management is summarized in Decreased BMD…”

Section: Diagnosis and Managementmentioning

confidence: 99%

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DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

Chemaitilly

Cohen

2017

European Journal of Endocrinology

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Endocrine complications are frequently observed in childhood cancer survivors (CCS). One of two CCS will experience at least one endocrine complication during the course of his/her lifespan, most commonly as a late-effect of cancer treatments, especially radiotherapy and alkylating agent chemotherapy. Endocrine late-effects include impairments of the hypothalamus/pituitary, thyroid and gonads, as well as decreased bone mineral density and metabolic derangements leading to obesity and/or diabetes mellitus. A systematic approach where CCS are screened for endocrine late-effects based on their cancer history and treatment exposures may improve health outcomes by allowing the early diagnosis and treatment of these complications.

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Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Section: Diagnosis and Managementmentioning

confidence: 99%

Section: Diagnosis and Managementmentioning

confidence: 99%

Section: Diagnosis and Managementmentioning

confidence: 99%

Section: Diagnosis and Managementmentioning

confidence: 99%

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DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

Chemaitilly

Cohen

2017

European Journal of Endocrinology

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Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Din,

Singh-Carlson,

Corliss

et al. 2023

JAMA Netw Open

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ImportanceFertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population’s fertility perceptions and their alignment with objective infertility risk are scant.ObjectiveTo assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception.Design, Setting, and ParticipantsThis retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022.ExposuresParticipants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review.Main Outcomes and MeasuresParticipants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk.ResultsThis study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation.Conclusions and RelevanceIn this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.

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Generalizing approaches to surveillance for complex social outcomes in broad‐range patient populations—The cost in terms of lost information and subgroup utility

Boman

Lannering

Essén

et al. 2022

Cancer

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Complex social outcomes, including those related to education and employment, depend on compound combinations of background factors that are significantly different for childhood and adult cancers. Medical and psychosocial prerequisites related to the age at cancer diagnosis and treatment require surveillance for complex social outcomes that meets the particularized needs of corresponding patient subgroups.

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Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium

Abstract: The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer.

Cited by 178 publications

References 70 publications

DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Generalizing approaches to surveillance for complex social outcomes in broad‐range patient populations—The cost in terms of lost information and subgroup utility

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