Survival from cancer in young people: An overview of late effects focusing on reproductive health

Abstract

This paper provides a summary of the areas of survival from childhood, teenage and young adult cancers and the significant late effects that can arise from treatment; with particular focus on the area of reproductive health and the impact on both fertility and pregnancy. To complete this review, Web of Science and MEDLINE were used. Search terms included: “"survival AND childhood OR teenage OR young adult cancer", "late effects", "childhood cancer", "teenage AND/OR young adult cancer", AND "fertility after cancer" OR "pregnancy AND cancer" OR "fertility preservation”. Additionally, the clinical expertise of the authors was drawn upon. Childhood cancer is a thankfully rare occurrence; however, the incidence is increasing. Survival rates remain high and this means that a growing population of childhood and young adult cancer survivors are reaching adulthood. For some of these adults, although cured of their cancer, they are now facing a future with lasting effects on their health from their treatments. These effects, commonly referred to as late effects, are defined as health problems related either directly to the underlying cancer or to its treatment and which occur months or years after treatment has finished. Reproductive health is an important consideration for these patients, and although many will be able to conceive naturally, some will exhibit impaired fertility after their treatments. This can include difficulties at all points along the path from conception to delivery of a live, healthy offspring. High‐quality, large‐population evidence is sparse in many areas relating to fertility risk from treatment and the maternal and fetal health of childhood cancer survivors. Yet given the potential for complications, the authors advocate consideration of fertility at the time of diagnosis and before potentially gonadotoxic treatment.

Study protocol for the Fex-Can Childhood project

“…Several studies of childhood cancer survivors demonstrate impairment in sexual and reproductive functions. [ 15 , 65 , 66 ] This include different types of sexual dysfunctions, negative impact on intimate relations, and the emotional consequences of living with threatened or actual infertility. There is, however, a lack of large-scale methodologically rigid studies on the prevalence of these issues, and of the factors associated to them.…”

Oncologists’ Knowledge, Practice and Attitude toward Fertility Preservation: A National Survey

“…Embryo cryopreservation is the most common and cost-effective form of fertility preservation nowadays. The cryopreservation of ovarian cells or oocytes may help female survivors become mothers in the future, even if they have been exposed to chemotherapy or certain infertility-causing agents [ 9 , 10 ]. The conjugating gonadotropin-releasing hormone given during the chemotherapy will reduce the damage to the female reproductive organs and oocytes during the treatment [ 11 ].…”

Inconsistencies in fertility preservation for young people with cancer in the UK

“…2 This is a major concern for many patients and their parents at diagnosis. 3 The impact of specific chemotherapy and radiation treatment regimens on fertility is increasingly understood. [4][5][6][7] Given the risks to fertility from cancer and cancer treatments, strategies to preserve fertility have been developed.…”

“…In a population-based study in Scotland of all women with a cancer diagnosis under the age of 40 between 1981 and 2014, cancer survivors were approximately 38% less likely to achieve pregnancy after diagnosis compared with women in the general population 2. This is a major concern for many patients and their parents at diagnosis 3. The impact of specific chemotherapy and radiation treatment regimens on fertility is increasingly understood 4–7.…”