Contraceptive use and contraceptive counselling interventions for women of reproductive age with cancer: a systematic review and meta-analysis

Abstract

Background A lack of clarity exists regarding contraceptive uptake and counselling among women with cancer, despite these women having unique family planning needs. This study aimed to systematically review the available literature and produce an overall summary estimate of contraceptive use and counselling among women with cancer across the cancer care continuum. Methods A systematic search of articles reporting on contraceptive counselling and/or contraceptive use among women of reproductive age (15–49 years) with cancer across the cancer care continuum (e.g. diagnosis, treatment, survivorship) was conducted in MEDLINE, Embase, CINAHL, Maternity and Infant Care and Cochrane Library. Two independent reviewers conducted the data screening, data extraction and risk of bias assessment. Qualitative synthesis and meta-analyses were conducted to summarise the key findings. Results We included 21 articles involving 3835 participants in this review. Studies varied according to the cancer population and time along the cancer care continuum it was assessed. Of the studies that reported the overall contraceptive prevalence among women diagnosed with cancer (n = 8), contraceptive use ranged from 25 to 92%. Of the four studies that focused on cancer survivors, the contraceptive prevalence ranged from 47 to 84%. When the prevalence of these studies was pooled, a crude summary prevalence of 64% (62% among women with cancer versus 68% among cancer survivors) was found. The rate of contraceptive counselling was assessed in ten studies. A pooled prevalence of 50% (44% among women with cancer versus 58% among cancer survivors) was found, with the prevalence ranging from 12 to 78% among individual studies depending on the point in the cancer care continuum that it was provided. When contraceptive counselling was provided, it was found to significantly increase contraceptive use although biases were identified in its application. Conclusions Contraceptive counselling interventions as part of standard cancer care have the potential to not only empower women with cancer and cancer survivors to make informed choices regarding their reproductive health but also provide the ability to plan future pregnancies for times of better health.

A minority of women of childbearing potential are tested for pregnancy before chemoimmunotherapy: an Australian cancer centre experience

“…Research has found effective modes of contraception are rarely used by WoCBP diagnosed with cancer. 9 Reasons for not using contraception include unconfirmed beliefs regarding infertility and compatibility with imaging or difficulty finding a suitable option. 19 This further highlights the need to ensure adequate pregnancy screening prior to CIT.…”

“…7 Patients may want to discuss contraception options with their oncologists or haemotologists as hormones are known to promote the growth of some cancers. 9 Counselling improves contraception uptake if physicians tailor discussions to their patients' diagnosis and treatment path. 20 Contraception should be emphasised as a priority for discussion among oncologists and haematologists.…”

“…Our study showed that only 18.8% of women had documentation of past or present contraception details, and none had contraception counselling documented. Research has found effective modes of contraception are rarely used by WoCBP diagnosed with cancer 9 . Reasons for not using contraception include unconfirmed beliefs regarding infertility and compatibility with imaging or difficulty finding a suitable option 19 .…”

“…The effects of chemotherapy make ovulation unpredictable, with this population consequently resorting to emergency contraception at much higher rates than the general population. 9 Pregnancy screening should especially be a priority in WoCBP who, for personal choice or clinical reasons, are not on any effective forms of contraception. For those on hormone-based contraception, it is important to acknowledge the lack of data on the impact of CIT on the efficacy of these methods or vice versa.…”

“…Furthermore, breaks between chemotherapy cycles are typically short, and in this time it becomes increasingly difficult for women to distinguish between chemotherapy effects and premenstrual and pregnancy symptoms. The effects of chemotherapy make ovulation unpredictable, with this population consequently resorting to emergency contraception at much higher rates than the general population 9 …”