(62) Gynecologic Management Practices of Adolescent and Young Adult Cancer Survivors after Pelvic and/or Total Body Irradiation

Background: Primary ovarian insufficiency (POI) and radiation-induced uterine injury (RIUI) affect 12-82% and 30% of cancer survivors receiving at-risk therapies for cancer and non-malignant conditions, respectively. Significant research has focused on methods to mitigate ovarian and uterine injury prior to therapy, but less attention has been directed towards standardizing the evaluation and treatment of primary ovarian insufficiency (POI) and uterine injury in survivorship. The objective of this study is assess if current practice patterns are consistent with recommended guidelines of care for adolescent cancer survivors and to identify gaps in the management and treatment of radiation-induced uterine injury.

Methods: This retrospective study included data of female cancer survivors ages 20-51 years at the time of study recruitment who were treated with pelvic radiation or total body irradiation (TBI) from September 2009 – September 2019. We received approval from the Institutional Review Board (IRB) to abstract data from the Electronic Medical Record (EMR) at the Children’s Hospital Colorado (CHCO) and University of Colorado. The cohort of patients who received pelvic or total body irradiation were identified and we calculated rates of referral to an oncofertility provider, rates of assessment of uterine volume and subsequent birth outcomes.

Results: 41 patients met criteria for inclusion in the cohort with a median age of 35 years. Of these, 23 (56%) were referred to an oncofertility specialist, 5 (12%) received a pelvic ultrasound which documented uterine volume after radiation therapy, and 5 (12%) were found to have documented POI or infertility after treatment. 2 (4.8%) of the patients in this cohort had term deliveries after their radiation treatment.

Conclusions: In this study, only half of female cancer patients were referred to oncofertility consultation for fertility preservation and many patients had inadequate work-up for fertility preservation. Identifying gaps in timely referrals offers opportunities to improve access to fertility preservation options and reproductive outcomes among cancer survivors.