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Reproductive and Sexual Function in Long-term Ovarian Cancer Survivors after Platinum-based Chemotherapy
Abstract & Commentary
By Robert L. Coleman, MD, is Associate Professor, University of Texas; M.D. Anderson Cancer Center, Houston, is Associate Editor for OB/GYN Clinical Alert.
Dr. Coleman reports no financial relationship to this field of study.
Synopsis: Long-term results of reproductive and sexual function of ovarian germ cell tumor survivors after platinum-based chemotherapy.
Source: Gershenson DM, et al. J Clin Oncol. 2007;19:2792-2797.
Reproductive and sexual functioning following treatment for malignant ovarian germ cell tumors (GCTs) has been sparsely studied since the introduction conservative surgery and chemotherapy. While successful pregnancy has been reported in small series, the impact on quality of life in these young survivors is largely unknown. The current cohort study of GCT cancer survivors and control unaffected women, evaluated fertility and quality of life (QoL) concepts of sexual functioning and social networks. Cases were identified by their participation in one of several Gynecologic Oncology Group or University of Texas, M. D. Anderson Cancer Center chemotherapy protocols. Both were extensively interviewed and case patients were to be disease-free a minimum of 2 years prior to participation. Each case was age, race and education-matched for analysis. Just over half of the case women underwent fertility sparing procedures. Of this group, over 85% reported return of normal menstrual functioning which was similar to the control cohort. Approximately one-third of the women, who were able to become pregnant, had done so and delivered 37 children after cancer treatment. There was no difference in medical problems or miscarriage between the groups. Relative to controls, GCT survivors reported significantly more concerns with reproductive functioning, less sexual pleasure and lower scores on the Sexual Activity Scale. However, they had better dyadic consensus, dyadic satisfaction and dyadic cohesion. The authors concluded that return of menstrual function and potential fertility was common following GCT cancer therapy. While survivors reported more reproductive concerns and lower sexual satisfaction they were more likely to have stronger and more positive relationships with their significant others.
Women diagnosed with malignant germ cell tumor are typically younger and have a better survivorship potential than their epithelial cell counterparts. This is in part due to the response to treatment of these tumors and the stage at which the diagnosis is made, which is typically limited. Nonetheless, years ago, these otherwise rapidly growing and lethal malignancies were addressed with radical surgery and radiation rendering the survivors infertile. Documentation of chemosensitivity has opened the opportunity for parturition through less radical (fertility-sparing) surgery and adjuvant treatment. Early evaluation of the safety of this option demonstrated that return of menstrual function and normal pregnancy outcome in those who desired fertility was feasible but little was known about their quality of life. The current report substantially extends our understanding through careful evaluation of a number of measures including reproductive outcomes, sexual functioning, and dyadic adjustments (relationships). Clearly demonstrated is the expected return to normal menstrual function in the majority of women treated with platinum-based chemotherapy and the ability to have normal pregnancy(ies), if desired. Relative to non-cancer controls these women also demonstrated better and stronger relationships with their significant others but, as expected, were more likely to have reproductive concerns and less sexual satisfaction. The information is vitally important to clinicians caring for these young women as the "cancer" diagnosis is usually associated with images of attenuated lifespan, infertility, castration, and premature menopause. While many of these concerns can be allayed, the latter in non-castrates is not well known and will require longer follow-up to evaluate fully. Equally important will be further insight into the full spectrum of physical and psychological health of these women. Nonetheless, despite the incomplete profile, a very positive message can be introduced to these survivors, hoping to regain pre-cancer functionality.