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Supportive Care
Effects of Chemotherapy on Fertility May Be Underestimated Significantly By John Schieszer
M
any cancer survivors who thought they were fertile now may be finding that is not the case. New research is suggesting that current estimates of the impact of chemotherapy on women’s reproductive health are too low. Researchers at the University of California San Francisco (UCSF) say their analysis of the age-specific, longterm effects of chemotherapy provides new insights that will help patients and clinicians make more informed decisions about future reproductive options, such as egg harvesting (Cancer. September 1, 2011. Epub ahead of print). The investigators adopted a more tailored investigation into chemotherapy-related infertility and found estimates may have been far too low. They say these findings will now change how oncology nurses counsel their patients. “The nurses play a pivotal role here,” said study investigator Mitchell Rosen, MD, assistant professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. “Nurses are the most important. Most of the time, referrals are generated and initiated by the nurse.” He said that oncology nurses need to be aware of the new study findings and consider them when educating patients. Rosen said even though an oncologist mentions that fertility may be affected, many patients simply don’t comprehend fully what that means because they are focused more on their current treatment options to enhance survival. “They forget
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The researchers used the California Cancer Registry (a statewide population-based cancer surveillance system) “We found chemotherapy essentially narrows a to ask women about their reproductive woman’s reproductive window by causing a range of history before and after cancer treatment. Survey questions addressed acute damage to the ovaries, even if her menses resume ovarian failure (cessation of menses after chemotherapy.” —Mitchell Rosen, MD after treatment), early menopause (menopause before 45 years of age), and infertility (failed conception). A total of 1041 women diagnosed about the one sentence from the oncolo- mary reproductive side effect of with 1 of 5 targeted cancers (leukemia, gist,” said Rosen in an interview with The chemotherapy. Analyzing retrospective Hodgkin disease, non-Hodgkin lymOncology Pharmacist. “I think everyone survey responses from women who phoma, breast cancer, and gastroinwho is taking care of patients diagnosed were diagnosed between 18 and 40 testinal cancers) between the ages of 18 with cancer needs to be educated about years, the researchers focused on and 40 years responded, and 620 it. There are still not enough referrals longer-term, age-specific outcomes as- reported having been treated with only going to the fertility specialists. The more sociated with chemotherapy, including chemotherapy. awareness we can do, and the more peo- infertility and early menopause. Their The researchers found the percentage ple that are involved, the better.” analysis suggests that the younger a of women reporting acute ovarian failure He said many men and women woman is when diagnosed with cancer, was 8% (Hodgkin disease), 10% (nonundergoing chemotherapy are not get- the more likely she will experience Hodgkin lymphoma), 9% (breast canting enough information about how early menopause. “We found chemo - cer), and 5% (gastrointestinal cancers). their future fertility may be affected by therapy essentially narrows a woman’s In women without acute ovarian failure, the various treatments they may be reproductive window by causing a the incidence of infertility increased sigreceiving. “At every center there is a range of damage to the ovaries, even if nificantly with age at diagnosis. difference in who is involved when a her menses resume after chemotheraIn addition, the estimated probabilipatient is getting treated, so the more py,” said Rosen. ty of early menopause increased signifi[nurses] are involved the better. It Many of the women who responded cantly with younger age at diagnosis. needs to be standard of care for both to the survey had been told that as long When counseling patients, focusing men and women. Only 10% to 30% of as their periods returned, they would solely on short-term outcomes like loss men bank sperm, and that is easy. It is have no negative impact from treat- of menses may give women unrealistimuch more complicated with women. ment, he said. Making recommenda- cally low assessments of their risks, Yet 10% to 30% do it, and the main tions on preserving fertility currently is because they could experience infertilireason for [the low numbers] is a lack of based on rather limited data. These ty or early menopause years to decades education and awareness,” said Rosen. new findings, which also take into after treatment. Rosen noted that more Previous studies largely have focused account cancer type and age, hopefully research is needed because this study on amenorrhea, the lack of menstrua- will enable clinicians to offer more did not include genetics or variations tion shortly after treatment, as the pri- strategic and personalized counseling. in individual cancer treatments. ●
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