Abstract
In 2006, the American Society of Clinical Oncology established guidelines on fertility preservation in cancer patients, but recent data suggest that the guidelines are not widely followed. To identify the frequency of fertility discussions and the characteristics that influence the rate of discussion, we performed a retrospective chart review for patients less than 40 years of age with newly diagnosed colorectal cancer (CRC). Charts of patients aged 18-40 years with newly diagnosed crc presenting to the Juravinski Cancer Centre from 2000 to 2009 were reviewed for documentation of discussions regarding fertility risks with treatment and reproductive options available. The influences of sex, age, year of diagnosis, stage of cancer, and type of treatment on the frequency of discussions were explored. The review located 59 patients (mean age: 35 years) who met the criteria for inclusion. A fertility discussion was documented in 20 of those patients [33.9%; 95% confidence interval (CI): 22.1% to 47.4%]. In the multivariate analysis, the odds of fertility being addressed was higher for patients receiving radiation [odds ratio (OR): 9.31; 95% ci: 2.49 to 34.77, p < 0.001) and lower by age (OR: 0.86; 95% ci: 0.74 to 0.99; p = 0.040). Of patients less than 35 years of age undergoing radiation treatment, 85% had a documented fertility discussion. We observed no significant difference in the frequency of discussions after 2006, when the American Society of Clinical Oncology guidelines were published (31.4% for 2000-2006 vs. 37.5% for 2007-2009, p = 0.63). Discussions about fertility risks associated with CRC treatment occur infrequently among young adults with newly diagnosed CRC. However, discussions occur more frequently in younger patients and in those undergoing radiation. Further investigations assessing barriers and physician attitudes to fertility risk discussion and reproductive options are planned.
Highlights
Colorectal cancer is the third most common cancer among men and women, with approximately 150,000 new cases diagnosed each year in the United States 1
We observed no significant difference in the frequency of discussions after 2006, when the American Society of Clinical Oncology guidelines were published (31.4% for 2000–2006 vs. 37.5% for 2007–2009, p = 0.63)
Discussions about fertility risks associated with crc treatment occur infrequently among young adults with newly diagnosed crc
Summary
Colorectal cancer (crc) is the third most common cancer among men and women, with approximately 150,000 new cases diagnosed each year in the United States 1. About 6% of cases occur in the first four decades of life, with 3% occurring in people between the ages of 20 and 40 years 1. Issues of fertility and family planning can arise because of the effects of surgery, radiation, and chemotherapy on a patient’s reproductive health. Adjuvant chemotherapy with 5-fluorouracil alone may have little influence on fertility, it is unknown whether agents such as oxaliplatin and irinotecan cause gonadal failure 1. The use of radiation can have negative fertility consequences, leading to premature ovarian failure in women and sterility in men 4
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