Use of emergency contraception among female young adult cancer survivors

Medica, A.C.; Stark, Shaylyn S.; Hadnott, Tracy N.; Dietz, Andrew C.; Romero, Sally A. D.; Martinez, Elana; Whitcomb, Brian W.

doi:10.1016/j.fertnstert.2018.02.136

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…For example, survivors who assume that they are at risk despite a fertility status that seems normal may become anxious about their family planning, which could result in unnecessary worry and distress and thus affect their emotional health. Also, such misperceptions could affect survivors' physical health if they have unplanned pregnancies, 11 increased use of emergency contraception, 56 and/or acquire sexually transmitted diseases secondary to engaging in unprotected sexual behaviors. In contrast, survivors with impaired fertility who perceive themselves at no increased risk also raise concern.…”

Section: Discussionmentioning

confidence: 99%

“…15 This again underscores the importance of educating survivors about their reproductive health. 56,57 Addressing survivors' fertility status after treatment will continue to be a salient issue in the future. Although there are many efforts to increase fertility preservation at diagnosis, preservation is not viable for every patient or family, and preservation methods remain experimental for prepubertal patients.…”

Section: Discussionmentioning

confidence: 99%

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Gonadal Functioning and Perceptions of Infertility Risk Among Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study

Lehmann

Chemaitilly

et al. 2019

JCO

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PURPOSE To describe perceptions of infertility risk among adult survivors of childhood cancer, to test the concordance of survivors’ risk perceptions and their adult fertility status, and to identify explanatory factors (sociodemographic factors, gonadotoxic treatments, reproductive history, sexual dysfunction) associated with these outcomes. PATIENTS AND METHODS Adult childhood cancer survivors (N = 1,067; without children or a history of pregnancies) completed questionnaires that asked about infertility risk perceptions and participated in physical evaluations, including biomarkers of gonadal functioning (eg, semen analysis, blood hormone levels, menses). Multivariable regression models tested associations between explanatory factors and risk perceptions as well as concordance of perceptions and fertility status. RESULTS Most childhood cancer survivors (61.9%) perceived themselves at increased risk for infertility, which was significantly associated with sociodemographic factors (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, but concordance with survivors’ risk perceptions was low (Cohen’s κ < .19). Most survivors with discordant perceptions overestimated risk (ie, perceived being at risk, though fertility status seemed normal; 19.7% of male and 43.6% of female survivors), whereas a minority underestimated risk (ie, perceived no risk but were impaired/infertile; 16.3% of male and 5.3% of female survivors). Factors related to discordance included sociodemographics, gonadotoxic treatments, fertility concerns, and sexual dysfunction (all P < .05). CONCLUSION Although childfree 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gonadal Functioning and Perceptions of Infertility Risk Among Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study

Lehmann

Chemaitilly

et al. 2019

JCO

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“…Indeed, in the literature, data suggest that they are less likely to receive adequate contraception counselling, with rates up to 56% of survivors reporting no family planning counselling at all (Castro-Sanchez et al, 2018). Additionally, they are less likely to be satisfied and compliant with the prescribed method (Blouet et al, 2019) and more likely to wrongly assume they are infertile and to face unwanted pregnancies (Medica et al, 2018;Hadnott et al, 2019). Information on contraception during chemotherapy, along with information on fertility preservation, is part of our pre-therapy counselling.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study has reported that cancer survivors are more likely to use emergency contraception than their peers (Medica et al, 2018), opening a debate on the best way to empower them with fertility awareness and enhancing the need for a multidisciplinary approach that includes the fertility specialist also during oncologic follow-up (Nahata and Quinn, 2018). Women who are not (or not yet) wishing for a pregnancy could benefit from a long-term follow-up for managing the gynecological adverse effects of anticancer therapies, counselling on contraception or menopause, or evaluation of their post-treatment ovarian reserve and reproductive potential.…”

Section: Introductionmentioning

confidence: 99%

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

et al. 2019

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STUDY QUESTION Are there reasons that motivate young cancer survivors to ask for follow-up visits at an oncofertility unit? SUMMARY ANSWER Cancer survivors request oncofertility follow-up visits for the management of treatment-related side effects or ovarian reserve evaluation, even if not (or not yet) wishing for a pregnancy. WHAT IS KNOWN ALREADY Personalised oncofertility counselling before gonadotoxic therapies is considered standard of care for young women with newly diagnosed cancer. However, the long-term follow-up of these patients in an oncofertility unit is not described in the literature other than for the use of cryopreserved material. STUDY DESIGN, SIZE, DURATION We retrospectively examined rates and reasons for the first follow-up visits of 154 consecutive young female cancer patients (age range: 18–40 years) who underwent a pre-treatment consultation between January 2012 and June 2017. Demographic and clinical data were collected, as well as information about the chosen fertility preservation method, if any. PARTICIPANTS/MATERIALS, SETTING, METHODS Rates and reasons for follow-up visits were collected and expressed as percentages. Different reasons were examined in the whole cohort and stratified for type of malignancy. Possible predictive factors for return to the follow-up visit (age, nulliparity, presence of a partner, neoplasm, having cryopreserved material) were investigated through logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Out of 154 patients, 74 returned to the oncofertility unit (48.1%) for a follow-up visit. The first visit was requested mostly at the end of anticancer therapies (51.3% versus 40.5% during therapies and 8.1% after cancer relapse). Among these patients, only 10.8% returned for the first time because they were actively desiring a pregnancy. For the others, the most common reasons for consultations were management of gynecological adverse effects of therapies (29.7%) and evaluation of ovarian reserve not linked to an immediate desire for a pregnancy (39.2%). Other patients asked for contraception (4.1%), menopause counselling (5.4%), or new fertility preservation counselling because of cancer relapse (10.8%). None of the examined factors were significantly predictive of return to the oncofertility unit. LIMITATIONS, REASONS FOR CAUTION These findings represent the experience of a single centre. A longer duration of follow-up would be needed to provide more precise information on this regard. WIDER IMPLICATION OF THE FINDINGS The role of an oncofertility unit should not be limited to proposing fertility preservation procedures. In the management of young adult cancer patients, the reproductive medical specialist should be considered a key figure not only before but also during and after anticancer treatments to explore salient aspects of gynecological and reproductive health. STUDY FUNDING/COMPETING INTEREST(S) This research did not receive any specific funding. M.L. served as a consultant for Teva and received honoraria from Theramex outside the submitted work. The other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N.A.

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“…Despite clinical guidelines recommending adequate contraception for survivors of cancers occurring in adolescence and young adulthood, contraception rates are lower and use of emergency contraception is higher in this population than in the general U.S. population of reproductive-age women (16)(17)(18)(19)(20). Moreover, studies have shown that cancer survivors also have lower utilization rates of highly effective contraceptive methods categorized as tier I (surgical sterilization, contraceptive implant, intrauterine device [IUD]) or II (combined hormonal contraceptive, injectable progestin, progestin-only pills, lactation amenorrhea) by the World Health Organization (WHO) (18).…”

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confidence: 99%

Perceived infertility and contraceptive use in the female, reproductive-age cancer survivor

Hadnott

Stark

Medica

et al. 2019

Fertility and Sterility

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Objective: To estimate the association between perceived fertility potential and contraception use and to characterize factors important in contraceptive decision making in reproductive-age, female cancer survivors. Design: Cross-sectional study. Setting: Participants were from two state cancer registries, physician referrals, and cancer survivor advocacy groups in the United States. Patient(s): A total of 483 female survivors aged 18-40 years. Intervention(s): Online questionnaire. Main Outcome Measure(s): Contraception use. Result(s): Eighty-four percent of participants used contraception; 49.7% used highly effective, World Health Organization tiers I and II methods (surgical sterilization, intrauterine devices, contraceptive implant, combined hormonal contraceptives, medroxyprogesterone acetate, progestin-only pills, contraceptive diaphragm). Contraception non-use was more common among survivors who perceived themselves to be infertile, compared with survivors who perceived themselves to be as or more fertile than similarly aged peers (prevalence ratio 4.0, 95% confidence interval 2.5-7.4). In mediation analysis that adjusted for clinical infertility, 59% of the association between prior chemotherapy and contraception non-use was explained by perceived infertility. Contraception efficacy (n ¼ 62, 25.8%) and ease of use (n ¼ 50, 20.8%) were the most cited reasons for using tier I/II methods; compared with lack of hormones (n ¼ 81, 49.7%) as the predominant reason for using less-effective, tier III/IV methods. Conclusion(s): Although female, reproductive-age cancer survivors had high uptake of contraception, those who perceived themselves to be infertile were less likely to use contraception. Throughout survivorship, clinicians should counsel survivors on fertility potential in the context of their prior cancer treatments and on factors, including contraceptive efficacy and hormone-free contraception, that inform reproductive decision making in this population. (Fertil Steril Ò 2019;111:763-71. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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Use of emergency contraception among female young adult cancer survivors

Cited by 17 publications

References 22 publications

Gonadal Functioning and Perceptions of Infertility Risk Among Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study

Gonadal Functioning and Perceptions of Infertility Risk Among Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study

Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

Perceived infertility and contraceptive use in the female, reproductive-age cancer survivor

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