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）：2007 年由尤尼斯·肯尼迪·施赖弗国家儿童健康和人类发展研究所召集的专家小组强调需要在癌症幸存者的生育能力领域进行更多研究。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会受到影响，但该人群不孕症的发生率和患病率尚不清楚。我们建议开展一项基于人群的流行病学研究，以描述年轻成人癌症（20-39 岁之间诊断出的癌症）女性幸存者因接受化疗和放疗而继发性腺损伤的风险。合格的癌症幸存者将通过屡获殊荣的佐治亚州癌症统计中心进行识别，该中心负责管理全州范围的佐治亚州综合癌症登记处和国家癌症研究所 SEER 计划的亚特兰大大都会流行病学和最终结果 (SEER) 登记处。居住在亚特兰大都会区的年轻成人癌症的育龄女性幸存者将符合资格，他们接受不同癌症治疗的情况将根据医疗记录的摘要确定。我们还将招募一个以社区为基础的对照组，由未接受过癌症治疗的女性组成。评估不孕不育的发生率和患病率具有挑战性，因为没有单一的结果指标能够真正捕捉到生育能力受损的情况，而且在尝试怀孕之前，生育力低下通常无法被识别。因此，我们将从几个角度来评价生育能力，概括为两个目标。首先，我们将评估癌症幸存者 (n=2,000) 与未接触癌症的女性 (n=1,000) 的生育史。我们将使用深入的计算机辅助电话访谈 (CATI) 来收集有关影响生殖潜力的各种因素的数据，包括月经史、怀孕史、不孕史和对孩子的渴望。其次，我们将根据抗苗勒氏管激素水平、窦卵泡计数、卵巢体积和子宫体积等多种临床标志物，评估癌症幸存者 (n=750) 与未暴露女性 (n=250) 的当前生育能力。我们的建议在多个领域具有创新性。它首先以年轻的成年癌症幸存者为基础，对现有研究进行了改进，其次通过评估每个女性生殖寿命的各种生育指标并将这些信息与当前的生物标志物测量相结合，充分掌握了生育的复杂性。很大一部分人口的生育率。对于被诊断患有癌症的年轻女性来说，不同疗法对其生育能力的潜在影响往往是一个重大问题，但目前临床医生提供给她们建议的信息有限。我们的提案将直接解决这一关键的知识差距。 公共健康相关性：越来越明显的是，许多挽救生命的癌症疗法不利于儿童癌症幸存者的生育能力，但治疗年轻成人癌症（20-39 岁之间诊断的癌症）的潜在性腺毒性作用已被证实。尽管年轻成人癌症幸存者在癌症幸存者中所占比例较大，但对这一问题的研究还较少。我们建议对年轻成人癌症的育龄女性幸存者与未接受癌症治疗的女性进行比较，进行一项基于人群的流行病学研究，了解不同癌症治疗对生育相关结果的影响。我们将通过详细的计算机辅助电话访谈评估生育史，了解月经周期、不孕症和生殖史 (n=3,000)，并通过测量子集中的抗苗勒氏管激素、窦卵泡计数和卵巢体积来评估当前的生育能力人口 (n=1,000)。