TY - JOUR
T1 - Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer
AU - Zhou, Beth
AU - Kwan, Brian
AU - Desai, Milli J.
AU - Nalawade, Vinit
AU - Henk, Joe
AU - Viravalli, Nina
AU - Murphy, James D.
AU - Nathan, Paul C.
AU - Ruddy, Kathryn J.
AU - Shliakhtsitsava, Ksenya
AU - Su, H. Irene
AU - Whitcomb, Brian W.
N1 - Publisher Copyright:
© 2024 American Society for Reproductive Medicine
PY - 2024
Y1 - 2024
N2 - Objective: To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions. Design: Retrospective cohort study. Setting: US administrative database. Patients: We identified incident breast, colorectal, and ovarian cancer cases in females aged 15–39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. Intervention: Platinum-based chemotherapy. Main Outcome Measures: We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries). Results: There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42–0.82) and 0.70 (95% CI 0.51–0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97–1.15) and 1.42 (95% CI 1.31–1.53), respectively. Conclusions: Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.
AB - Objective: To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions. Design: Retrospective cohort study. Setting: US administrative database. Patients: We identified incident breast, colorectal, and ovarian cancer cases in females aged 15–39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. Intervention: Platinum-based chemotherapy. Main Outcome Measures: We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries). Results: There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42–0.82) and 0.70 (95% CI 0.51–0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97–1.15) and 1.42 (95% CI 1.31–1.53), respectively. Conclusions: Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.
KW - cancer
KW - infertility
KW - live birth
KW - Platinum chemotherapy
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U2 - 10.1016/j.fertnstert.2024.01.039
DO - 10.1016/j.fertnstert.2024.01.039
M3 - Article
C2 - 38316209
AN - SCOPUS:85186640699
SN - 0015-0282
JO - Fertility and sterility
JF - Fertility and sterility
ER -