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Evidence to incorporate inclusive reproductive health measures in guidelines for childhood and adolescent cancer survivors.

Abstract：

OBJECTIVE:Female childhood cancer survivors are at an increased risk of reproductive health impairment. We compared reproductive health outcomes with the recommended standard in a cohort of childhood cancer survivors. STUDY DESIGN AND PARTICIPANTS:A retrospective chart review of 222 female childhood cancer survivors aged 21 years or younger that presented to a tertiary referral center between 1997-2008 was initiated. The main outcome measures were the compliance with the American Society of Clinical Oncology guidelines for childhood cancer survivor management of reproductive health. In particular, we evaluated menstrual cycle regularity, fertility preservation counseling, and endocrine profile, as defined by follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) levels as surrogate markers for ovarian reserve. Secondary outcomes were to study the contribution of survivor clinics in enforcing these guidelines. RESULTS:Of 136 patients older than 13 years at their last visit, 58 patients (43%) had FSH data available and none had AMH data. Patients were stratified into 3 groups according to FSH levels. Forty of 58 patients (69%) have normal ovarian reserve (FSH level < 10), 10 of 58 patients (17%) have decreased ovarian reserve (FSH levels 10-40), and 8 of 58 patients (14%) have premature menopause, defined as FSH > 40. Most patients with amenorrhea have elevated FSH levels indicating primary ovarian insufficiency, while 3 patients (2.2%) have low FSH levels consistent with hypothalamic amenorrhea. None of the patients were counseled on fertility preservation. CONCLUSIONS:Reproductive health follow-up in children with cancer, including FSH and AMH measurement when indicated, should be established and strictly adhered.

journal_name

J Pediatr Adolesc Gynecol

journal_title

Journal of pediatric and adolescent gynecology

authors

Salih SM,Elsarrag SZ,Prange E,Contreras K,Osman RG,Eikoff JC,Puccetti D

doi

10.1016/j.jpag.2014.05.012

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

95-101

issue

eissn

1083-3188

issn

1873-4332

pii

S1083-3188(14)00220-4

journal_volume

pub_type

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Evidence to incorporate inclusive reproductive health measures in guidelines for childhood and adolescent cancer survivors.