Reproductive Expectations in Female Young Adult Cancer Survivors Open Access

Ramer, Stephanie (Spring 2021)

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More women are surviving cancer, and this has led to an increased focus on the long-term effects of cancer and its treatments, such as the effects on fertility. The objective of this study was to investigate feelings around reproduction of female survivors of young adult cancers and understand how these feelings differ from women who are not cancer survivors using data from the Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women’s study. Our cohort included 979 cancer survivors and 992 comparison women who were asked questions about their feelings around reproduction, their reproductive histories, demographic characteristics, and lifestyle. We fit models to estimate whether cancer survivors were more or less likely to agree with the questions about reproductive feelings compared with the cancer-free women. Our results suggest that cancer survivors with children were more likely to report they wanted more children (Odds Ratio 1.33, 95% Confidence Interval 1.05, 1.67) and would be disappointed if they could not get pregnant again (OR 1.15 95% CI 0.90, 1.53). Nulliparous cancer survivors rated having biologic children more important than the comparison group (OR 1.17, 95% CI 0.82, 1.67) and were less comfortable with adoption (OR 0.59 95% CI 0.38, 0.92) and using assisted reproductive technology (OR 0.80, 95% CI 0.55, 1.16). Generally, predictors of reproductive feelings were similar for cancer survivors and comparison women. Younger women and women who had fewer children than desired were more likely to want a/another child and be disappointed if they could not get pregnant. Parous women were more likely to value the importance of having biologic children and less likely to agree that they would be comfortable with adoption. Our results suggest that many cancer survivors still want children after treatment, even if they already have children yet parous women are less likely to receive fertility counseling. Therefore, adequate fertility counseling services for cancer survivors are needed regardless of whether women already have children as they may not have reached their desired family size at the time of diagnosis. 

Table of Contents

Table of Contents


Chapter I: Background/Literature Review. 1

Epidemiology of Cancer in Reproductive Aged Women. 2

The effect of cancer on pregnancy. 2

Fertility Preservation. 4

Fertility Concern and Reproductive Expectations. 5

Critical gaps. 7

Chapter II: Reproductive Expectations in Female Young Adult Cancer Survivors 9

Introduction. 9

Methods. 10

Study Population. 10

Statistical Analysis. 11

Results. 12

Discussion. 15

Tables. 18

Table 1: FUCHSIA Questions about Reproductive Feelings. 18

Table 2. Demographics Table. 19

Table 3. Association of Survivorship with Reproductive Feelings. 21

Table 4. Association of Reproductive Feelings with Reproductive Characteristics Stratified by Survivorship 22


Appendix Table 1. Reproductive Feelings in Cancer Survivors. 25

Appendix Table 2. Reproductive Feelings of women who have raised non-biologic children. 26

Appendix Table 3. Reproductive Feelings in Women who have had a hysterectomy. 27

References. 28

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