Study: Chemo for Childhood Cancer Affects Male Survivors’ Fertility More Than Females’

A study by researchers from leading cancer centers across the US has found that modern chemotherapy treatments have only a small impact on the ability of female childhood and adolescent cancer survivors to have children when they grow up. However, male survivors are more likely to have fertility problems.

An estimated 400,000 survivors of childhood and adolescent cancer are living in the US today. However, therapies to treat their cancer can affect their reproductive health when they become adults, making it harder for them to have their own children. One way the medical community has responded to this problem is to lower the intensity of radiation treatments, and rely more on chemotherapy instead.

Researchers from the Fred Hutchinson Cancer Research Center in Seattle and colleagues set out to study how much newer chemotherapy drugs affects childhood cancer survivors’ ability to have children. They looked at data from the Childhood Cancer Survivor Study, which tracks survivors of childhood cancer who were treated in the US and Canada between 1970 and 1999.

The study looked at 10,938 childhood cancer survivors who were treated with 14 different commonly prescribed chemotherapy drugs and compared the number of pregnancies and children they eventually had with 3,949 of their brothers and sisters. The study focused on survivors who were treated with chemotherapy and did not receive radiation to the pelvis or brain.

In the study, about 70% of female cancer survivors became pregnant by age 45, compared to more than 80% of survivors’ sisters. However, only about 50% of male cancer survivors fathered children by age 45, compared to 80% of survivors’ brothers. In men, higher doses of several alkylating chemotherapy drugs (cyclophosphamide, ifosfamide, and procarbazine) and cisplatin were linked to less likelihood of fathering a child. For women, only busulfan and high doses of lomustine were directly linked with lower likelihood of becoming pregnant. Women were also more likely to become pregnant if they did so before age 30.

The study was published online March 22, 2016 in The Lancet Oncology.

Preserving fertility for childhood cancer survivors

Parents of children diagnosed with cancer are obviously focused mainly on their child’s treatment and survival, and may find it hard to think beyond the present. But about 80% of children treated for cancer will go on to live for a long time. And when they become adults, fertility issues may become important to them.

For this reason, parents should talk about the future risk of infertility with their child’s doctor and with children who are old enough. In some cases, medical options are available to help preserve fertility in girls and boys.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Pregnancy after chemotherapy in male and female survivors of childhood cancer treated between 1970 and 1999: a report from the Childhood Cancer Survivor Study cohort. Published online March 22, 2016 in The Lancet Oncology. First author Eric J. Chow, MD, Fred Hutchinson Cancer Research Center, Seattle.

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