Desire for future children and interest in consultation with a fertility specialist among adolescent and young adult (AYA) cancer patients.
In a questionnaire and cancer-registry analysis of 4,847 patients aged 18–39 years, desire for future children and interest in fertility consultation varied by age, sex, parental status, cancer type, and treatment characteristics.
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In a questionnaire and cancer-registry analysis of 4,847 patients aged 18–39 years, desire for future children and interest in fertility consultation varied by age, sex, parental status, cancer type, and treatment characteristics.
Research significance
The study provides observational evidence that identifiable AYA subgroups differ in fertility goals and consultation interest; it supports the inference that systematic pre-treatment fertility counseling and referral could reduce unmet fertility needs, but it does not test whether such an intervention preserves fertility or improves quality of life.
Source abstract
PURPOSE: Adolescent and young adult (AYA) patients (18-39) with cancer experience psychosocial challenges upon being diagnosed with cancer. AYAs are also at risk of potential infertility due to certain cancer treatments. We examined factors associated with desire for future children among AYAs. Among those interested in having future children or were unsure if they wanted children, we examined factors associated with interest in fertility consultations. METHODS: Patients completed an electronic patient questionnaire (EPQ) which included items assessing physical/mental health, desire for future children, and interest in fertility consultations. Cancer registry data comprised cancer characteristics (e.g., cancer and treatment type). Multinomial regression analysis examined factors associated with desire for future children. Binary regression examined factors associated with interest in fertility consultations. RESULTS: AYAs (n = 4847) were majority female (62%) and on average, 32 years old. In multinomial analysis, females (vs. males) (OR [95% CI] = 0.56 [0.48-0.71]), older AYAs (OR [95% CI] = 0.81 [0.80-0.83]), and those with children (OR [95% CI] = 0.34 [0.26-0.45]) were less likely to report wanting future children. Among AYAs wanting children, older patients (OR [95% CI] = 1.04 [1.01-1.06]), females (OR [95% CI] = 1.39 [1.00-1.94]), breast cancer (OR [95% CI = 2.65 [1.38-5.10]) or lymphoma patients (OR [95% CI] = 1.99 [1.12-3.56]), and receiving hormone therapy (OR [95% CI] = 1.73 [1.06-2.81]) or transfusions (OR [95% CI] = 3.23 [0.86-12.21]) were more likely to desire consultations. CONCLUSIONS: There is a need to systematically address and offer fertility consultation for all AYA patients prior to treatment initiation. Sociodemographic, clinical, and psychosocial factors warrant additional study and future intervention development to ensure fertility needs are met.