The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, 700 Children's Drive, Columbus, OH 43205, USA.
The Ohio State University, Department of Pediatrics, 700 Children's Drive, Columbus, OH 43205, USA.
Hum Reprod. 2017 Nov 1;32(11):2250-2253. doi: 10.1093/humrep/dex297.
Do young adult survivors of childhood cancer know their fertility status, in the context of their parenthood goals and screening for gonadal functioning?
While 80% of survivors (who were without children) wanted children in the future, most did not know their fertility status, and screening for gonadal functioning was underutilized.
Survivors of childhood cancer are at risk for infertility, but fertility counseling and assessment are underutilized. Separate studies indicated that survivors' fertility-related knowledge is poor and that they often wanted to have children. Yet, studies have not investigated the intersection of both issues, as well as potential distress if parenthood goals are not met.
STUDY DESIGN, SIZE, DURATION: Young adult male and female survivors of childhood cancer (N = 149) completed cross-sectional surveys, and data for those without children (n = 105, 70.5%) are presented here.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were 20-40 years old (M = 26.5), diagnosed 5-33 years prior to study participation, and completed questionnaires online. Knowledge of fertility status, parenthood goals, and potential distress if survivors were unable to have children were assessed. Medical records were reviewed for hormone levels as indicators of screening for gonadal functioning.
Most survivors (n = 81; 77.1%) did not know their fertility status, while over 80% (n = 89) wanted children (neither aspect varied by socio-demographic/cancer-specific factors). Two-thirds of survivors indicated they would be distressed if parenthood goals remained unfulfilled; especially female (versus male, t = 2.64; P = 0.01) or partnered (versus single, t = -3.45; P < 0.001) survivors. Forty survivors (38.1%) had documented assessments of gonadal functioning, of which 33 (82.5%) reported not knowing their fertility status.
LIMITATIONS, REASONS FOR CAUTION: Relevant risk factors may have not been identified owing to limited sample size and missing treatment information. The underutilization of screening for gonadal functioning needs further exploration in other pediatric centers.
Most adult childhood cancer survivors want to become parents, but do not know their fertility status, which could cause significant psychological distress. Healthcare providers should continuously address fertility among survivors, but more research is needed on how to implement routine fertility counseling and/or testing.
STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Research Institute at Nationwide Children's Hospital (V.L.) and Dutch Cancer Society (RUG2009-4442, M.A.T.). All authors have no conflict of interest to declare.
在考虑到父母目标和性腺功能筛查的情况下，年轻的成年儿童癌症幸存者是否了解自己的生育能力状况？
尽管 80%（无子女）的幸存者未来希望生育孩子，但大多数人不知道自己的生育能力状况，且对性腺功能的筛查利用不足。
儿童癌症幸存者存在不孕风险，但生育咨询和评估利用不足。单独的研究表明，幸存者的生育相关知识匮乏，且他们往往希望生育孩子。然而，研究并未调查这两个问题的交叉点，以及如果父母目标无法实现可能带来的困扰。
研究设计、规模和持续时间：本研究纳入了 149 名年轻的成年男性和女性儿童癌症幸存者（N=149），他们完成了横断面调查，目前仅呈现无子女的参与者数据（n=105，70.5%）。
参与者/材料、地点和方法：参与者年龄为 20-40 岁（M=26.5），在研究参与前 5-33 年前被诊断为癌症，并在线完成了问卷调查。评估了对生育能力状况、父母目标的了解情况，以及如果幸存者无法生育可能带来的潜在困扰。回顾了医疗记录，以激素水平作为筛查性腺功能的指标。
大多数幸存者（n=81；77.1%）不知道自己的生育能力状况，而超过 80%（n=89）希望生育孩子（这两个方面都没有因社会人口统计学/癌症特异性因素而有所不同）。三分之二的幸存者表示，如果父母目标无法实现，他们会感到困扰；特别是女性（与男性相比，t=2.64；P=0.01）或有伴侣的（与单身相比，t=-3.45；P<0.001）幸存者。40 名幸存者（38.1%）有记录的性腺功能评估，其中 33 名（82.5%）报告不知道自己的生育能力状况。
由于样本量有限且缺乏治疗信息，可能未发现相关的风险因素。在其他儿科中心，需要进一步探索对性腺功能筛查的利用不足问题。
大多数成年儿童癌症幸存者希望成为父母，但不知道自己的生育能力状况，这可能会导致严重的心理困扰。医疗保健提供者应持续关注幸存者的生育能力，但需要进一步研究如何实施常规生育咨询和/或检测。
研究资金/利益冲突：本研究由全国儿童医院研究所以及荷兰癌症协会（RUG2009-4442，M.A.T.）共同资助。所有作者均无利益冲突。
