Reproductive Outcomes in Male Childhood Osteosarcoma Survivors: Cisplatin’s impact
Margarett Shnorhavorian, MD, MPH1, John K. Amory, MD, MPH2, Saro Armenian, DO, MPH3, Eric Chow, MD, MPH4, Holcombe Grier, MD5, Smita Bhatia, MD6, Debra Spoljaric, RN, MSN, CPNP, FNP-C7, Amanda Adler, MS8, Jonathan Gill, MD9, Wendy Leisenring, Sc.D4, Michael K. Skinner, Ph.D10, Stephen M. Schwartz, Ph.D, MPH4.
1University of Washington, Seattle Children's Hospital, SEATTLE, WA, USA, 2University of Washington, SEATTLE, WA, USA, 3City of Hope, Duarte, CA, USA, 4Fred Hutchinson Cancer Research Center, SEATTLE, WA, USA, 5Dana-Farber Cancer Center, Boston, MA, USA, 6University of Alabama, Burmingham, AL, USA, 7Washington University, St. Louis, MO, USA, 8Seattle Children's Hospital, SEATTLE, WA, USA, 9University of Texas MD Anderson Cancer Research Center, Houston, TX, USA, 10Washington State University, Pullman, WA, USA.
Background:Reproductive toxicity in male childhood cancer survivors is a significant concern. Cisplatin, a common chemotherapy agent for childhood cancers, has unclear effects on the reproductive outcomes of male adolescent and young adult (AYA) survivors. This study aims to determine the differences in reproductive outcomes between male osteosarcoma survivors treated with cisplatin and male controls without a history of cancer.
Methods:We identified male osteosarcoma survivors treated with cisplatin from Children's Oncology Group (COG) protocols (AOST0331, INT0133, APEC14B1) (n=177) and compared them to age- and current residence-matched controls from the general population (n=175). Participants completed a male health questionnaire reporting their childbearing and infertility examination history. COG staff recorded details of survivors' chemotherapies on medical record abstract forms. We measured associations between subject type (survivor vs. control) and reproductive outcomes as age-adjusted prevalence ratios (aPRs) and corresponding 95% confidence intervals (CI) using Poisson regression with robust error variance estimation.
Results:177 Survivors and 175 Controls were enrolled. Median time since treatment for survivors was was 9.9 years (IQR: 2.9, 26.2). Largest age group of survivors was 20-24 years (n=67, 37.9%). Majority of survivors were White (n=147, 84%) and non-Hispanic (n=144, 83.2%) .Among those attempting to conceive, survivors reported being more likely to try to become pregnant, with an aPR=1.5 (95% CI=1.1, 1.9). They were also more likely to report not having all desired offspring (aPR=1.7, 95% CI=1.1, 2.6). However, survivors were only slightly more likely than controls to report that their female partners had had difficulty becoming pregnant (aPR=1.3, 95% CI=0.7, 2.5) or received fertility examinations (aPR=1.4, 95% CI=0.8, 2.2).
Conclusions:This study demonstrates important challenges to reproductive outcomes for male childhood osteosarcoma survivors. By documenting these differences, we can better inform cancer survivors about potential fertility challenges and develop strategies for preserving fertility, ultimately improving their quality of life after treatment. This knowledge will also guide healthcare professionals in providing comprehensive care and support for male childhood cancer survivors as they navigate their reproductive journeys.
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