scholarly journals Acute Ovarian Failure in the Childhood Cancer Survivor Study

2006 ◽  
Vol 91 (5) ◽  
pp. 1723-1728 ◽  
Author(s):  
Wassim Chemaitilly ◽  
Ann C. Mertens ◽  
Pauline Mitby ◽  
John Whitton ◽  
Marilyn Stovall ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Ovarian Failure ◽  
Childhood Cancer Survivor ◽  
Patient Treatment ◽  
Small Subset ◽  
Bilateral Oophorectomy ◽  
Ovarian Irradiation ◽  
Childhood Cancer Survivor Study

Context: Defined as the loss of ovarian function within 5 yr of diagnosis, acute ovarian failure (AOF) is known to develop in a subset of survivors of pediatric and adolescent cancers. Its precise incidence is unknown, and data concerning its risk factors are limited. Objective: Our objective was to determine the incidence of and patient/treatment factors associated with AOF in a large cohort of pediatric cancer survivors. Design and Setting: We conducted a retrospective cohort, multicenter study. Patients: Female participants from the Childhood Cancer Survivor Study who were greater than 18 yr of age were considered for inclusion. We excluded survivors who received cranial irradiation at doses of more than 3000 cGy, those with hypothalamic/pituitary tumors, and survivors who underwent bilateral oophorectomy. Survivors who reported never menstruating or who had ceased having menses within 5 yr after their cancer diagnosis were considered to have AOF. Main Outcome: We assessed incidence and risk factors for AOF. Results: Of a total of 3390 eligible survivors, 215 cases (6.3%) developed AOF. Survivors with AOF were older at diagnosis and more likely to have been diagnosed with Hodgkin’s lymphoma or to have received abdominal or pelvic radiotherapy than survivors without AOF. Among survivors with AOF, 116 (54%) had received at least 1000-cGy ovarian irradiation. In a multivariable logistic regression model, increasing doses of ovarian irradiation, exposure to procarbazine, and exposure to cyclophosphamide at ages 13–20 yr were independent risk factors for AOF. Conclusions: AOF develops in a small subset of survivors, especially those treated with at least 1000-cGy ovarian radiation. These results will facilitate patient counseling and selection of candidates for newer fertility preservation techniques.

scholarly journals Fertility of Male Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2010 ◽  
Vol 28 (2) ◽  
pp. 332-339 ◽  
Author(s):  
Daniel M. Green ◽  
Toana Kawashima ◽  
Marilyn Stovall ◽  
Wendy Leisenring ◽  
Charles A. Sklar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Radiation Dose ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Proportional Hazards ◽  
Chemotherapeutic Agents ◽  
Cox Proportional Hazards ◽  
Childhood Cancer Survivor ◽  
Childhood Cancer Survivor Study

Purpose This study was undertaken to determine the effect of treatment for childhood cancer on male fertility. Patients and Methods We reviewed the fertility of male Childhood Cancer Survivor Study survivor and sibling cohorts who completed a questionnaire. We abstracted the chemotherapeutic agents administered, the cumulative dose of drug administered for selected drugs, and the doses and volumes of all radiation therapy from medical records. Risk factors for siring a pregnancy were evaluated using Cox proportional hazards models. Results The 6,224 survivors age 15 to 44 years who were not surgically sterile were less likely to sire a pregnancy than siblings (hazard ratio [HR], 0.56; 95% CI, −0.49 to 0.63). Among survivors, the HR of siring a pregnancy was decreased by radiation therapy of more than 7.5 Gy to the testes (HR, 0.12; 95% CI, −0.02 to 0.64), higher cumulative alkylating agent dose (AAD) score or treatment with cyclophosphamide (third tertile HR, 0.42; 95% CI, −0.31 to 0.57) or procarbazine (second tertile HR, 0.48; 95% CI, −0.26 to 0.87; third tertile HR, 0.17; 95% CI, −0.07 to 0.41). Compared with siblings, the HR for ever siring a pregnancy for survivors who had an AAD score = 0, a hypothalamic/pituitary radiation dose = 0 Gy, and a testes radiation dose = 0 Gy was 0.91 (95% CI, 0.73 to 1.14; P = .41). Conclusion This large study identified risk factors for decreased fertility that may be used for counseling male cancer patients.

scholarly journals Ovarian Failure and Reproductive Outcomes After Childhood Cancer Treatment: Results From the Childhood Cancer Survivor Study

2009 ◽  
Vol 27 (14) ◽  
pp. 2374-2381 ◽  
Author(s):  
Daniel M. Green ◽  
Charles A. Sklar ◽  
John D. Boice ◽  
John J. Mulvihill ◽  
John A. Whitton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Alkylating Agent ◽  
Ovarian Failure ◽  
Premature Menopause ◽  
Reproductive Outcomes ◽  
Childhood Cancer Survivor Study

These studies were undertaken to determine the effect, if any, of treatment for cancer diagnosed during childhood or adolescence on ovarian function and reproductive outcomes. We reviewed the frequency of acute ovarian failure, premature menopause, live birth, stillbirth, spontaneous and therapeutic abortion and birth defects in the participants in the Childhood Cancer Survivor Study (CCSS). Acute ovarian failure (AOF) occurred in 6.3% of eligible survivors. Exposure of the ovaries to high-dose radiation (especially over 10 Gy), alkylating agents and procarbazine, at older ages, were significant risk factors for AOF. Premature nonsurgical menopause (PM) occurred in 8% of participants versus 0.8% of siblings (rate ratio = 13.21; 95% CI, 3.26 to 53.51; P < .001). Risk factors for PM included attained age, exposure to increasing doses of radiation to the ovaries, increasing alkylating agent score, and a diagnosis of Hodgkin's lymphoma. One thousand two hundred twenty-seven male survivors reported they sired 2,323 pregnancies, and 1,915 female survivors reported 4,029 pregnancies. Offspring of women who received uterine radiation doses of more than 5 Gy were more likely to be small for gestational age (birthweight < 10 percentile for gestational age; 18.2% v 7.8%; odds ratio = 4.0; 95% CI, 1.6 to 9.8; P = .003). There were no differences in the proportion of offspring with simple malformations, cytogenetic syndromes, or single-gene defects. These studies demonstrated that women treated with pelvic irradiation and/or increasing alkylating agent doses were at risk for acute ovarian failure, premature menopause, and small-for-gestational-age offspring. There was no evidence for an increased risk of congenital malformations. Survivors should be generally reassured although some women have to consider their potentially shortened fertile life span in making educational and career choices.

scholarly journals Risk Factors for Obesity in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2012 ◽  
Vol 30 (3) ◽  
pp. 246-255 ◽  
Author(s):  
Daniel M. Green ◽  
Cheryl L. Cox ◽  
Liang Zhu ◽  
Kevin R. Krull ◽  
Deo Kumar Srivastava ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Cancer ◽  
Root Mean Square ◽  
Cancer Survivor ◽  
Childhood Cancer Survivor ◽  
Equation Modeling ◽  
Mean Square ◽  
Intrapersonal Factors ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study

Purpose Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. Patients and Methods We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). Results Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form–36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. Conclusion Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.

scholarly journals Risk factors for smoking among adolescent survivors of childhood cancer: A report from the childhood cancer survivor study

2011 ◽  
Vol 58 (3) ◽  
pp. 428-434 ◽  
Author(s):  
Lisa S. Kahalley ◽  
Leslie A. Robinson ◽  
Vida L. Tyc ◽  
Melissa M. Hudson ◽  
Wendy Leisenring ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Childhood Cancer Survivor ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer
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