A Population-Based Study of Fertility in Female Survivors of Young Adult Cancer

青年癌症女性幸存者生育能力的人群研究

• 批准号: 8142877
• 负责人: Penelope P. Howards
• 金额: $ 73.76万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-29 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8142877
• 关键词: Acute; Address; Affect; Aftercare; Age; Antral; Area; Award; Awareness; Biological Markers; Biology; Cancer Survivor; Child; Child health care; Clinical Markers; Communities; Complex; Computer Assisted; Data; Diagnosis; Epidemiologic Studies; Epidemiology; Exposure to; Failure; Female; Fertility; Fertility Study; Goals; Hormones; Housing; Human Development; Incidence; Infertility; Institutes; Knowledge; Life; Literature; Longevity; Malignant Neoplasms; Measurement; Measures; Medical; Medical Records; Medical Surveillance; Menstrual cycle; National Cancer Institute; Nature; Operative Surgical Procedures; Outcome; Outcome Measure; Ovarian; Participant; Patients; Physicians; Population; Pregnancy; Pregnancy Histories; Premature Menopause; Prevalence; Probability; Radiation therapy; Recording of previous events; Recruitment Activity; Registries; Reproductive Health; Reproductive History; Research; Risk; SEER Program; Secondary to; Source; Sterility; Survival Rate; Survivors; Telephone Interviews; Universities; Woman; abstracting; base; cancer diagnosis; cancer statistics; cancer therapy; cancer type; chemotherapy; childhood cancer survivor; comparison group; epidemiology study; improved; innovation; meetings; metropolitan; mullerian-inhibiting hormone; neoplasm registry; population based; pregnant; prevent; public health relevance; reproductive; treatment effect; young adult

DESCRIPTION (provided by applicant): A 2007 expert panel convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development highlighted the need for more research in the area of fertility among cancer survivors. As survival rates have improved, it has become increasingly apparent that many life-saving cancer therapies impair fertility among childhood cancer survivors. Survivors of young adult cancers are affected as well, but the incidence and prevalence of infertility in this population is unknown. We propose to perform a population-based epidemiology study to characterize the risks of gonadal damage secondary to exposure to chemotherapy and radiation therapy in female survivors of young adult cancers (cancers diagnosed between the ages of 20-39). Eligible cancer survivors will be identified through the award-winning Georgia Center for Cancer Statistics, which operates both the statewide Georgia Comprehensive Cancer Registry and the Metropolitan Atlanta Surveillance Epidemiology and End Results (SEER) Registry of the National Cancer Institute's SEER Program. Reproductive age female survivors of young adult cancers living in Metropolitan Atlanta will be eligible, and their exposure to different cancer treatments will be determined based on abstraction of medical records. We will also recruit a community-based comparison group of women who were not exposed to cancer therapies. Evaluating the incidence and prevalence of infertility is challenging because no single outcome measure truly captures compromised fertility, and subfertility is usually unrecognized until pregnancy is attempted. Therefore, we will evaluate fertility from several angles summarized by two aims. First, we will assess the fertility history of cancer survivors (n=2,000) compared to unexposed women (n=1,000). We will use an in-depth computer assisted telephone interview (CATI) to collect data on a wide range of factors contributing to reproductive potential including, menstrual history, pregnancy history, infertility history, and desire for children. Second, we will assess current fertility of cancer survivors (n=750) compared to unexposed women (n=250) based on a number of clinical markers including anti-M|llerian hormone levels, antral follicle count, ovarian volume, and uterine volume. Our proposal is innovative in several areas. It improves upon existing studies first by being population based in young adult cancer survivors and second by fully capturing the complex nature of fertility by assessing a wide range of indicators of fertility across each woman's reproductive life span and combining this information with measurement of biomarkers of current fertility in a large subset of the population. For young women diagnosed with cancer, the potential effect of different therapies on their ability to have children is often a significant concern, but at present, clinicians have limited information with which to advise them. Our proposal will directly address this critical gap in knowledge. PUBLIC HEALTH RELEVANCE: It has become increasingly apparent that many life-saving cancer therapies are detrimental to the fertility of childhood cancer survivors, but the potential gonadotoxic effects of treatments for young adult cancers (cancers diagnosed between the ages of 20-39) have been less well studied despite the fact that survivors of young adult cancers make up a larger proportion of cancer survivors. We propose to perform a population-based, epidemiologic study of the effects of different cancer treatments on fertility- related outcomes in reproductive age female survivors of young adult cancers compared to women unexposed to cancer treatments. We will assess fertility history through a detailed computer assisted telephone interview on menstrual cycle, infertility, and reproductive history (n=3,000) and will assess current fertility by measuring anti-M|llerian hormone, antral follicle count, and ovarian volume in a subset of the population (n=1,000).

描述（由申请人提供）：由Eunice Kennedy Shriver国家儿童健康与人类发展研究所召集的2007年专家小组，强调了癌症幸存者在生育领域进行更多研究的必要性。随着生存率的提高，越来越明显的是，许多挽救生命的癌症疗法会损害儿童癌症幸存者的生育能力。年轻成人癌症的幸存者也受到影响，但是该人群中不孕症的发生率和患病率尚不清楚。我们建议进行一项基于人群的流行病学研究，以表征年轻成人癌症女性幸存者继发于接触化疗和放射治疗的性腺损害的风险（被诊断为20-39岁的癌症）。符合条件的癌症幸存者将通过屡获殊荣的佐治亚州癌症统计中心确定，该中心既运营佐治亚州综合癌症注册表，又运营着国家癌症研究所的SEER计划。居住在亚特兰大大都会的年轻成年癌的生殖年龄女性幸存者将符合条件，并且根据医疗记录的抽象，将确定其对不同癌症治疗的暴露。我们还将招募一个不接受癌症疗法的妇女的社区比较组。评估不育的发病率和患病率是具有挑战性的，因为没有一个单一的结果措施真正捕获了受损的生育能力，并且通常无法识别出生育能力，直到尝试怀孕为止。因此，我们将从两个目标总结的几个角度评估生育能力。首先，我们将评估癌症幸存者的生育历史（n = 2,000）与未暴露的妇女相比（n = 1,000）。我们将使用深入的计算机辅助电话访谈（CATI）来收集有关促成生殖潜力的广泛因素的数据，包括月经历史，怀孕历史，不育历史和对儿童的渴望。其次，我们将根据许多临床标记（包括抗M | llerlerian激素水平，肛门卵泡计数，卵巢量和子宫量），评估癌症幸存者的当前生育能力（n = 750）（n = 250）（n = 250）。我们的建议在几个领域具有创新性。它首先是基于年轻成人癌症幸存者的人群，其次是通过评估每个妇女生殖寿命中的广泛生育指标，并将这些信息与大量人群中当前生育能力的生物标志物相结合，从而改善了现有研究。对于被诊断出患有癌症的年轻妇女来说，不同疗法对生育孩子的能力的潜在影响通常是一个重大问题，但是目前，临床医生对他们的建议有限。我们的建议将直接解决知识的关键差距。 公共卫生相关性：越来越明显的是，许多挽救生命的癌症疗法对儿童期癌症幸存者的生育有害，但是，尽管诊断出20-39岁的癌症的癌症对年轻人的癌症的潜在性促性腺毒性影响却较少，尽管事实却不太妥善地研究了年轻的成人癌症的幸存者，使成人癌症的幸存者构成了更大的癌症。我们建议与受到癌症治疗的女性相比，对不同癌症治疗对生殖年龄的女性幸存者的生育与生育年龄相关的女性幸存者的影响的影响进行基于人群的流行病学研究。我们将通过对月经周期，不育症和生殖历史进行详细的计算机辅助电话访谈评估生育历史（n = 3,000），并通过测量抗M | llerlal激素，牛油卵泡数量和卵巢量来评估当前的生育能力（n = 1,000）。