A crosscut survey on reproductive health in Lithuanian childhood cancer survivors

Abstract

Objectives: Sexual dysfunction was reported to compromise the quality of life in childhood cancer survivors. The aim of our study was to evaluate the reproductive health in long-term pediatric cancer survivors by conducting a crosscut survey. Material and methods: Childhood cancer survivors over 18 years of age, who were in remission for more than 5 years, were invited to complete a gender-specific questionnaire surveying on their reproductive health. Demographic and treatment data were retrieved from their medical records. Treatment modalities were reviewed for its potential gonadotoxicity. Results: 34 (17 males and 17 females, respectively) from 346 addressed survivors (9.8%) completed the questionnaire. Median age and follow-up after diagnosis was 27 (18-35) and 14 (3-25) years, respectively. Some respondents reported sexual concerns: 11.8% males experienced problems with penetration, two males (11.8%) who underwent semen analysis were found to be azoospermic. Similarly, 11.8% females reported delayed puberty, the average age of menarche was 14 (12-17) years, 29.4% females reported irregular menstrual cycles. Cyclophosphamide equivalent dose (CED) differed significantly between the patients treated for leukemia, lymphoma and solid tumors (3000 vs 4352 vs 6660 mg/m 2 , respectively, p = 0.014). Conclusions: Low prevalence of sexual dysfunction, fertility related disorders or delayed puberty in childhood cancer survivors was found. However, the results should be interpreted with caution taking into account a low response rate.

Fertility preservation in children and young adults with cancer

“…Within both the male and female population, referrals for fertility preservation at larger centers seem to be increasing, alongside use of preservation [53]. Follow-up surveys after treatment during childhood may yield low rates of response, suggesting a need for better databases or strategic long-term follow-up [54]. This work highlights the need for enrollment of patients in a cohesive referral and tracking system to better understand outcomes after treatment.…”

Evaluation of oncofertility care in childhood cancer patients: the EU-Horizon 2020 twinning project TREL initiative

“…Thus, gonadal toxicity must be discussed before the initiation of any therapy ( 29 – 32 ). In our previous cross-sectional study, a majority of adult CCS who were in a long-term remission (age 18+ years as of December 2016) treated at VULSK had limited knowledge about reproductive health and did not receive sufficient information regarding fertility ( 16 ). At the time of this previous study patients did not get any information on fertility damage mostly because survival rate was quite low and long-term treatment effects were not a primary concern.…”

“…Besides, fertility preservation at that time was not possible. From the previous study, we learned that potential azoospermia after high alkylating agents dosages should imply semen preservation before treatment ( 16 ). The results prompted the initiation of counseling on fertility damage (6 boys were counseled in this study) and building up the fertility preservation services (performed for 4 boys in this study) ( Figure 1 ).…”

“…The aforementioned oncofertility care plan served as an example to implement IGHG guidelines and improve oncofertility care at the Center for Pediatric Oncology and Hematology of Vilnius University Hospital Santaros Klinikos (VULSK, Lithuania) through a twinning exercise with the Princess Máxima Center within an EU-Horizon 2020-funded project “Twinning in Research and Education to Improve Survival in Childhood Solid Tumors in Lithuania (TREL).” The project aims to foster research on different aspects of pediatric cancer including survivorship ( https://siope.eu/TREL-project ). A previous cross-sectional study revealed that a majority of adult CCS treated at VULSK had limited knowledge about reproductive health and had not received sufficient information regarding fertility ( 16 ). These findings mirror the results of other research groups, suggesting that patients with childhood cancer are not always properly counseled about the effects of cancer treatment on reproductive health ( 17 , 18 ) or even do not know their fertility status ( 19 ).…”

Development of a questionnaire to evaluate female fertility care in pediatric oncology, a TREL initiative

“…They are at risk for infertility, which affects quality of life. As reported in a previous study on reproductive health of Lithuanian CCSs [ 42 ], many of them point out that they receive insufficient information about the impact of cancer treatment on fertility and possible preservation options. Discussing the risk for infertility with pediatric cancer patients and their parents/guardians before the gonadotoxic treatment is crucial.…”