Management of Primary Ovarian Insufficiency Symptoms in Survivors of Childhood and Adolescent Cancer

Abstract

Cancer treatments can damage the ovaries, causing primary ovarian insufficiency (POI), a condition associated with numerous sequelae that impact long-term quality of life. This article systematically reviews the literature on the prevalence, surveillance, and treatment of POI in survivors of pediatric and adolescent and young adult (AYA) cancers. A systematic review of the literature was conducted in January 2018 through a search of Medline, Embase, Web of Science, and SCOPUS, alongside the screening of relevant reference lists. An initial search identified 746 potentially relevant studies. A total of 36 studies were included in the final review. Studies were categorized into one of the following categories: incidence/prevalence of POI, measurement of ovarian reserve, and other. Depending on patient characteristics, cancer diagnosis, and treatment, the prevalence of POI ranged from 2.1% to 82.2%. Risk factors for POI included exposure to alkylating agents and abdominal/pelvic radiation. POI may be associated with a number of complications, including low bone mineral density and poor cardiovascular health. Radiotherapy and chemotherapy are known to cause gonadal damage in female survivors of pediatric and AYA cancers. Acute or chronic effects depend on the dose of treatment, age of the individual, radiotherapy field, and ovarian reserve of the individual. Some women experience short-term loss of reproductive function and then may resume menstrual cycles, months or even years later. Although protecting fertility through banking of mature eggs, embryos, and tissue samples has become standard of care, additional steps need to be taken to ensure that patients have adequate hormone levels to maintain whole-body health, including life expectancy, bone health, cardiovascular health, quality of life, sexual and genitourinary function, and neurologic function. Surveillance and management of each of these comorbidities is critically important to survivor health.

Study protocol for the Fex-Can Childhood project

“…Several studies of childhood cancer survivors demonstrate impairment in sexual and reproductive functions. [ 15 , 65 , 66 ] This include different types of sexual dysfunctions, negative impact on intimate relations, and the emotional consequences of living with threatened or actual infertility. There is, however, a lack of large-scale methodologically rigid studies on the prevalence of these issues, and of the factors associated to them.…”

Knowledge of Iatrogenic Premature Ovarian Insufficiency Among Chinese Obstetricians and Gynecologists: A National Questionnaire Survey

“…This process makes PGCs extremely sensitive to the effects of CT and RT. Evidence suggests that the incidence of POI in female survivors of childhood and adolescent cancer is 2.1-82.2% [21]. RT can be more damaging to ovarian tissue than CT because apart from being particularly irreversibly toxic to oocytes [22,23], its off-target effects can also affect the surrounding tissue [24].…”

“…Of the few identi ed causes, iatrogenic conditions account for a large proportion (~ 65%) of cases [12], including radiotherapy (RT), chemotherapy (CT), and drugs for various autoimmune diseases [13,14]. The incidence of iatrogenic POI has been reported to be growing owing to increasing survival rates following diverse cancer treatments [15][16][17]. In addition, accumulating evidence has revealed that women with endometriosis or a history of pelvic surgery are more likely to have severely compromised ovarian function, including POI [18,19].…”

From bench to bedside: Current developments and future possibilities of artificial human ovary to restore fertility

“…Although experimental, artificial human ovary technology may be the only option to preserve and restore fertility in some patients when other fertility preservation and restoration options are contraindicated, infeasible, unavailable, rejected or unsuccessful . Contraindications of the major options for female fertility preservation and restoration are listed in Table .…”

“…Although experimental, artificial human ovary technology may be the only option to preserve and restore fertility in some patients when other fertility preservation and restoration options are contraindicated, infeasible, unavailable, rejected or unsuccessful. [17][18][19][20][21][22][23] Contraindications of the major options for female fertility preservation and restoration are listed in Table 1. Although experimental, three major categories of patients (age <40 years) may benefit from artificial ovary technology to preserve and restore fertility:…”