Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer.

OBJECTIVE: Lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer limits counseling on fertility preservation decisions. The objective was to estimate the effect of platinum-based chemotherapy on live birth and infertility after cancer.

DESIGN: Retrospective cohort study using U.S. administrative data PARTICIPANTS: We identified incident breast, colorectal and ovarian cancer cases in females ages 15-39 who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer.

EXPOSURE: Platinum-based chemotherapy OUTCOMES: We estimated the effect of chemotherapy on incidence of live birth and infertility after cancer, overall and after accounting for competing events (recurrence, death, sterilizing surgeries).

RESULTS: There were 1,287 survivors in the chemotherapy group, 3,192 survivors in the no chemotherapy group, and 34,147 women without cancer, mean age 33. Accounting for competing events, overall five-year live birth incidence was lower in the chemotherapy group (3.9%) versus the no chemotherapy (6.4%) group. Adjusted relative risks versus no chemotherapy and no cancer were 0.61 (95%CI 0.42-0.82) and 0.70 (95%CI 0.51-0.93), respectively. Overall five-year infertility incidence was similar in the chemotherapy group (21.8%) compared to no chemotherapy group (20.7%). The adjusted relative risks versus no chemotherapy and no cancer were 1.05 (95%CI 0.97-1.15) and 1.42 (95%CI 1.31-1.53), respectively.

CONCLUSIONS AND RELEVANCE: Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. Estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.