Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.
J Pediatr Adolesc Gynecol. 2024 Jun;37(3):360-364. doi: 10.1016/j.jpag.2024.01.004. Epub 2024 Jan 20.
Recommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes.
Follow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion.
We included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P = .03), to be diagnosed with POI (29.8% vs 0%, P = .01), and to have sexual activity recorded (77.2% vs 51.7%, P = .03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing.
This study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors.
儿童肿瘤学组长期随访（COG-LTFU）指南为儿童、青少年和青年期癌症幸存者提供了生殖健康护理建议，强调了其重要性，但对于这些建议的遵守情况以及非生育相关的性和生殖健康（SRH）结果知之甚少。
对在单家机构接受性腺毒性治疗前进行生育力保留咨询且治疗结束至少 6 个月的女性患者进行了 COG-LTFU 指南基础上的结局随访。
共纳入 140 例患者，从治疗结束到随访的平均时间为 2.7 年。86 例患者年龄为 12 岁或以上，其中 59 例（68.7%）记录了性行为，31 例（38.7%）有性行为的患者中有 12 例接受了性功能评估。诊断时具有较高发生早发性卵巢功能不全（POI）风险的 57 例（66.3%）患者，与低风险患者（29 例，33.7%）相比，更可能出现异常子宫出血（42.1% vs. 17.2%，P =.03）、诊断为 POI（29.8% vs. 0%，P =.01）以及记录性行为（77.2% vs. 51.7%，P =.03）。17 例 POI 患者中，82.4%正在接受激素替代治疗，58.8%进行了骨密度检查。
本研究增加了关于性腺毒性治疗后非生育相关 SRH 结局的有限文献，并说明了提高对 COG-LTFU 指南的遵守率的机会。增加对 SRH 指南的关注可能会增加 SRH 疾病的检出和治疗，从而提高女性癌症幸存者的健康和生活质量。
