Female survivors of childhood cancer, who underwent treatment with a modern form of chemotherapy, could have a 70 per cent chance of still being able to conceive and have a family, according to new international evidence.
Research from the US, published in The Lancet Oncology this week, shows that many children who live with cancer may grow into healthy, fertile adults despite having received aggressive treatment for a paediatric cancer at a young age.
The study found that around 70 per cent of female cancer survivors became pregnant by age 45, compared to over 80 per cent of their siblings without cancer.
However, the study, one of the largest of its kind, also highlighted that male survivors don’t fare as well as their female counterparts. Male survivors of childhood cancer are significantly less likely to have children naturally.
70 per cent of female cancer survivors became pregnant by age 45, compared to over 80 per cent of their siblings without cancer.
The likelihood of fathering a child generally decreased as cumulative exposure to alkylating drugs (contained in chemotherapy regimens) increased, with only 50 per cent of male survivors being fertile enough to enable conception compared to 80 per cent of their siblings.
Study co-author, Dr Eric Chow from the Fred Hutchinson Cancer Research Center, Seattle (USA) says the results are encouraging for most women but not as hopeful for males who were treated with specific chemotherapy regimens in childhood.
“I think, we, as paediatric oncologists, still need to do a better job discussing fertility and fertility preservation options with patients and families upfront before starting cancer treatment,” says Dr Chow.
“In particular, all boys diagnosed post-puberty should be encouraged to bank their sperm to maximise their reproductive options in the future.”
According to the research paper, alkylating drugs directly damage DNA (the genetic material in each cell) to keep the cell from reproducing.
These drugs are widely used to treat a variety of common paediatric cancers, including leukaemia, lymphoma, Hodgkin disease, kidney tumour, and neuroblastoma.
The Leukaemia Foundation’s head of research and advocacy, Dr Anna Williamson, believe the issue of whether a childhood cancer survivor can have children as an adult is a major concern for many.
“Having the option to have children is very important to many people, and in the past, many survivors have had to deal with the loss of this option,” says Dr Williamson.
“It is also often the parents that fret most over the child’s potential loss of fertility. They feel a great pressure to choose, with the specialist, the best treatment for the child for long-term benefit of the child in all aspects of their life.
“It is very good news to see that improved treatments have not only improved survival, but also improved quality of life measures, including fertility.
The study’s authors examined the impact of various doses of 14 commonly used chemotherapy drugs on pregnancy and live births in almost 11,000 male and female survivors, compared with around 4,000 siblings.
Data from the Childhood Cancer Survivor Study (CCSS) was used to track people aged under 21 who were diagnosed with a common type of childhood cancer, treated between 1970 and 1999, and had survived at least five years after diagnosis.
It is very good news to see that improved treatments have not only improved survival, but also improved quality of life measures, including fertility.
“However, our findings should provide reassurance to most female survivors treated with chemotherapy without radiotherapy to the pelvis or brain, given that chemotherapy-specific effects on pregnancy were generally few.
“Nevertheless, consideration of fertility preservation before cancer treatment remains important to maximise the reproductive potential of all adolescents newly diagnosed with cancer.”
Dr Williamson says the study’s findings will help many childhood survivors of cancer to grow into adults with quality lives with a greater chance of knowing the same experiences that non-cancer patients may enjoy.
“Many children believe that when they grow up, they will have children of their own.
“Studies like this one are helping to give children some peace of mind that once they get through treatment and recovery, many aspects of life will return to normal.”
More research is also needed to estimate the exact risk of some less commonly used drugs.
The Leukaemia Foundation runs the Young Bloods program to support children with blood cancer. If you are in need of support or information, visit their website.