Contraception after cancer treatment: describing methods, counseling, and unintended pregnancy risk

Abstract

ObjectiveThe objective was to describe contraceptive methods utilized by young female cancer survivors and determine whether pretreatment fertility counseling decreases unintended pregnancy risk. MethodsOne thousand and forty-one nongynecologic cancer survivors between18 and 40 years of age responded to a survey of reproductive health, contraceptive methods utilized and history of fertility counseling before cancer treatment. Subjects who had resumed menstrual bleeding following treatment and had not undergone surgical sterilization were defined at risk of unintended pregnancy if they reported unprotected vaginal intercourse in the prior month but did not desire conception. Statistical methods utilized were Student’s t test and χ2. ResultsOverall, 918 women (88%) received treatment with potential to affect fertility (chemotherapy, radiation or sterilizing surgery). Of 476 women younger than 40 years old who still had menses, 58% did not want to conceive; of these 275 women, 21% reported unprotected intercourse in the prior month and were defined at risk of unintended pregnancy. This compares to the 7.3% risk of unintended pregnancy reported by the National Center for Health Statistics. Increasing age was associated with greater risk of unintended pregnancy (odds ratio 1.07, p=.006). The following contraceptive methods were reported: barrier (25.5%), hormonal (24.5%), tubal ligation (21.3%) vasectomy (17.5%), intrauterine device (7.2%) and other (4.0%). Sixty-seven percent of women received pretreatment fertility counseling. Counseling prior to treatment did not decrease risk of unintended pregnancy (p=.93). ConclusionsSexually active cancer survivors are at threefold increased risk of unintended pregnancy compared to the US population. Contraceptive counseling in this high-risk population is recommended posttreatment. ImplicationsSexually active cancer survivors are at considerable risk of unintended pregnancy. Patient report of pretreatment counseling regarding fertility was not associated with a decline in risk of unintended pregnancy, highlighting the importance of clear recommendations regarding content and timing of counseling.