Reproductive Health in Female Members of Cook Children's Life After Cancer Program

Reproductive Health in Female Members of Cook Children’s Life After Cancer Program Purpose: Late effects from cancer treatment have been a topic of growing interest in pediatric oncology. In this study, we assessed the relationship between cancer treatment modalities (radiation therapy and chemotherapeutic drugs) on spontaneous primary ovarian insufficiency (POI) and hormone replacement therapy (HRT) among female pediatric cancer survivors enrolled in the Life After Cancer Program (LACP) at Cook Children’s Medical Center. Reproductive ability is an important quality of life issue in pediatric cancer survivors. Oncologists can utilize this information to minimize risks during treatment and recommend fertility-preserving steps such as removal and cryopreservation of oocytes and ovarian tissues prior to treatment. Female pediatric patients benefit from being more informed of reproductive late effects as fertility-preserving measures can be pursued prior to initiation of cancer treatment. Methods: Chart review (n = 194) was conducted of LACP cancer survivors from 1/1/2011 to 6/30/2013. POI was defined clinically as females <40 years old with metrorrhagia or amenorrhea in association with elevated serum FSH levels as determined by individual lab assay method. Bivariate and stepwise logistic regression models assessed associations between treatment-related factors and both POI and HRT. Two-sided statistical tests (significance = 0.10) were performed in the model. Inclusion criteria as follows: Females who are currently ≥12 years of age, Females who completed last cancer treatment ≥2 years ago, Females who were seen at least once in LACP clinic between 1/1/2011 to 6/30/2013. Results: Mean age of diagnosis = 6.69 years. 25 subjects required HRT. Age at diagnosis, busulfan, ifosfamide, carboplatin, radiation therapy affecting ovaries/uterus, and total body irradiation (TBI) were found to be significantly associated (p < .05) with HRT in stepwise model. Twenty-three patients developed POI. Age at diagnosis, busulfan, carboplatin, radiation therapy affecting ovaries/uterus, and total body irradiation (TBI) were found to be significantly associated (p < .05) with POI in stepwise model Conclusions: Findings show certain alkylating agents (busulfan, ifosfamide), heavy metals (carboplatin), and radiation therapy increased odds of HRT and POI among LACP pediatric and young adult cancer survivors. Future analyses are ongoing with an expanded cohort (n = 449).