Marriage and parenthood among childhood cancer survivors: a report from the Italian AIEOP Off-Therapy Registry

Abstract

BackgroundThe aim of this study was to describe the patterns of marriage and parenthood in a cohort of childhood cancer survivors included in the Off-Therapy Registry maintained by the Italian Association of Pediatric Hematology and Oncology. Design and MethodsWe analyzed a cohort of 6,044 patients diagnosed with cancer between 1960 and 1998, while aged 0 to 14 years and who were 18 years old or older by December 2003. They were followed up through the regional vital statistics registers until death or the end of follow up (October 30, 2006), whichever occurred first, and their marital status and date of birth of their children were recorded. The cumulative probabilities of being married and having a first child were computed by gender and compared by tumor type within the cohort. Marriage and fertility rates (the latter defined as the number of live births per woman-year) were compared with those of the Italian population of the same age, gender, area of residence and calendar period by means of the observed to expected (O/E) ratios. ResultsDuring the follow-up period, 4,633 (77%) subjects had not married. The marriage O/E ratios were 0.56 (95% CI: 0.51-0.61) and 0.70 (95% CI: 0.65-0.76) among men and women, respectively. Overall, 263 men had 367 liveborn children, and 473 women had 697 liveborn children. The female fertility O/E ratio was 0.57 (95% CI: 0.53-0.62) overall, and 1.08 (95% CI: 0.99-1.17) when analyses were restricted to married/cohabiting women ConclusionsChildhood cancer survivors are less likely to marry and to have children than the general population, confirming the life-long impact of their previous disease on their social behavior and choices. The inclusion of counseling in the strategies of management and long-term surveillance of childhood cancer patients could be beneficial to survivors as they approach adulthood.Key words: childhood cancer, marriage, fertility, long-term survivors, quality of life.Citation: Pivetta E, Maule MM, Pisani P, Zugna D, Haupt R, Jankovic M, Aricò M, Casale F, Clerico A, Cordero di Montezemolo L, Kiren V, Locatelli F, Palumbo G, Pession A, Pillon M, Santoro N, Terenziani M, Valsecchi MG, Dama E, Magnani C, Merletti F and Pastore G,

Life beyond the disease: relationships, parenting, and quality of life among survivors of childhood cancer

“…3 The authors confirm findings of fewer marriages among survivors with 81% of males and 70% of females never marrying or having started a live-in relationship. Fertility among the women also appeared lower but statistical significance was lost after adjusting for marriage or cohabitation, suggesting that when a partner was found, these women produced offspring similar to their peers.…”

Age at Birth of First Child and Fecundity of Women Survivors of Childhood Acute Lymphoblastic Leukemia (1987−2007): A Study of the Childhood Cancer Registry of the Rhône-Alpes Region in France (ARCERRA)

“…But it may be assumed that another 10 or 20 years of follow-up would result in additional live births, thus rising the mean age at childbirth in this cohort. Few studies mention the age of survivors at birth of their first child [5,13]. The age at birth of first child in the Norwegian cohort was 23 years likely as in the general female population [5].…”

“…The age at birth of first child in the Norwegian cohort was 23 years likely as in the general female population [5]. Among women survivors of childhood leukemia or other cancer between 1960 and 1998 recorded in the Italian registry, the mean age at first newborn was 26.2 years [13].…”

“…Although physicians generally advise their female patients with cancer or leukemia "not to wait too long before having their first child," few studies mention the age of survivors at the birth of their first child [5,13].…”

A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors

“…Furthermore, their concerns extend beyond biological fertility potential to include concerns about recurrence, living long enough to raise children, and the health of their (potential) children [8][9][10][11][19][20][21][22]. Biological parenthood is less likely among cancer survivors than in the general population [23][24][25][26][27]; the 10-year postdiagnosis pregnancy rate for females diagnosed between 15 and 44 has been observed to be half of that expected [26]. This may be indicative of lower fertility rates as well as psychological, social/cultural, medical, and economic barriers to parenthood occurring later in the course of survivorship [14,20,25,28].…”