Contraceptive Practices Among Female Cancer Survivors of Reproductive Age

Abstract

Objective To compare rates of contraception between reproductive-aged cancer survivors and women in the general U.S. population. Among survivors, the study examined factors associated with use of contraception and emergency contraception. Methods This study analyzed enrollment data from an ongoing national prospective cohort study on reproductive health after cancer entitled the Fertility Information Research Study. We compared current contraceptive use in survivors with that of the general population ascertained by the 2006–2010 National Survey for Family Growth. Log-binomial regression models estimated relative risks for characteristics associated with use of contraception, World Health Organization tiers I–II (sterilization and hormonal) contraceptive methods, and emergency contraception in survivors. Results Data from 295 survivors (mean age 31.6 ± 5.7 years, range 20–44 years) enrolled in this prospective study (85% response rate) were examined. Age-adjusted rates of using tiers I–II contraceptive methods were lower in survivors than the general population (34% [28.8–40.0] compared with 53% [51.5–54.5], P<.01). Only 56% of survivors reported receiving family planning services (counseling, prescription or procedure related to birth control) since cancer diagnosis. In adjusted analysis, receipt of family planning services was associated with both increased use of tiers I–II contraceptive methods (relative risk 1.3, 95% confidence interval [CI] 1.1–1.5) and accessing emergency contraception (relative risk 5.0, 95% CI 1.6–16.3) in survivors. Conclusion Lower rates of using Tiers I–II contraceptive methods were found in reproductive-aged cancer survivors compared to the general population of U.S. women. Exposure to family planning services across the cancer care continuum may improve contraception utilization among these women. Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT01843140.

Impact of tamoxifen therapy on fertility in breast cancer survivors

“…Cox proportional hazard models were used to estimate the hazard ratios (HR) for factors associated with time to having a child after cancer diagnosis among those who were capable of childbearing. Despite treatment guidelines dictating that physicians counsel breast cancer survivors taking tamoxifen on the need for concurrent contraception use (21), studies have shown that reproductive-aged cancer survivors are less likely to use contraception than the general population (22), and sexually active cancer survivors are at considerable risk of unintended pregnancy (23). To account for this, the date of breast cancer diagnosis was chosen as the start of the risk period.…”

Unintended Pregnancy: A Systematic Review of Contraception Use and Counseling in Women With Cancer

“…Five studies documented the occurrence of unintended pregnancies throughout the cancer care continuum: in the time period between cancer diagnosis and end of treatment (Güth, Huang, Bitzer, Tirri, & Moffat, 2015; Patel et al, 2015), in the years following diagnosis with cancer (Connell, Patterson, & Newman, 2006; Dominick et al, 2015), and five years after diagnosis (Zebrack, Casillas, Nohr, Adams, & Zeltzer, 2015).…”

“…In a sample of Turkish women diagnosed with breast cancer in the past year, the majority said they would have an abortion if they became pregnant, but a minority said their religious views precluded termination (Karaöz, Aksu, & Küçük, 2010). Eight of 20 American women indicated they would terminate if pregnant during treatment (Patel et al, 2009), and 3 of 5 women with unintended pregnancies in another study did choose to have an abortion (Dominick et al, 2015). One Australian woman with an unintended pregnancy was considering an abortion but did not disclose her final decision to the authors (Connell, Patterson, & Newman, 2006).…”

“…Maslow et al (2014) found that 65% of their sample received contraception counseling, and women who had contraception counseling had almost seven times greater odds of using highly effective methods than women who had no contraception counseling. Dominick et al (2015) found that 56% of their sample reported receipt of contraception counseling since diagnosis, and users of highly effective contraception methods were more likely to have received family planning counseling than users of less effective methods.…”

“…In another study among survivors of non-gynecological cancers, 58 of 275 women (21%) did not use contraception, despite not desiring pregnancy and having resumed menstruation, which was used as a proxy for fertility (Quinn et al, 2014). When Dominick et al (2015) compared a cancer survivor sample to the general population as described by the 2006–2010 National Survey for Family Growth, cancer survivors were significantly less likely to use highly effective contraception than women in the general population. Additionally, 10% of survivors were not using contraception while sexually active despite not seeking pregnancy, which was not significantly different but trending higher than the 8% of women in the general population (Dominick et al, 2015).…”