Fertility-Related Concerns in Long-Term Survivors of Childhood Cancer: A Canadian Cohort Study

Survivors of childhood cancer face reduced fertility, which can be a significant cause for concern. Our study aimed to assess the prevalence of fertility-related concerns and identify associated factors. Self-report data were collected with the Long-Term Survivor Questionnaire at the Alberta Children's Hospital's Long-Term Survivor Clinic (LTSC) between January 2021 and September 2023. Eligible participants were diagnosed before the age of 21 years, ≥2 years off therapy, and ≥13 years old. We analyzed fertility-related concerns cross-sectionally for the whole sample and longitudinally for a subsample of participants that completed three questionnaires. We included N = 311 survivors (49.2% female; mean age = 22.7 years, range = 13.9-42.1; mean time since diagnosis = 14.5 years, range = 2.7-38.4), of whom 21.2% reported fertility-related concerns. Those with additional health concerns and those who were sexually active were more likely to report fertility-related concerns, whereas lymphoma survivors were least likely to report concerns. In the subsample who completed three questionnaires (n = 80), 30% reported having concerns at least once, whereas 9% expressed persistent concerns. Fertility-related concerns are highly prevalent among young survivors of childhood cancer and warrant attention from healthcare professionals. Services that systematically address fertility-related concerns throughout long-term follow-up are urgently needed. These services should provide a space to discuss concerns, provide education, and initiate fertility consultations if desired.