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Reproductive Care of Childhood and Adolescent Cancer Survivors: A Twelve-Year Evaluation
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  • Antoinette Anazodo,
  • Sumin Choi ,
  • Christina Signorelli,
  • Sarah Ellis,
  • Karen Johnston,
  • Claire Wakefield,
  • Rebecca Deans ,
  • Kristen Neville,
  • R. J. Cohn
Antoinette Anazodo
Sydney Children's Hospital Randwick
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Sumin Choi
University of New South Wales
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Christina Signorelli
Sydney Children's Hospital
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Sarah Ellis
Sydney Children's Hospital
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Karen Johnston
Sydney Children's Hospital Randwick
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Claire Wakefield
University of NSW
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Rebecca Deans
Sydney Children's Hospital Randwick
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Kristen Neville
University of New South Wales Faculty of Medicine
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R. J. Cohn
Sydney Children's Hospital Randwick
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Abstract

Background: Reproductive complications for cancer survivors are identified as one of the top unmet needs. Current models of care do not routinely incorporate reproductive follow-up for cancer patients. The Kids Cancer Centre have had a one stop survivorship clinic which includes a gynecologist and fertility specialist. Methodology: To inform the future development of our reproductive survivorship care we audited this service over a twelve-year period reviewing who used the service and their gonadotoxic risk, their reproductive needs and concerns. Main results: 278 patients were seen (397 consultations), including 189 female patients (68.0%). Median age at follow up was 25.0 years (range=6-50) and they were 19.2 years from their primary diagnosis (range=3-46). We identified 10 themes of reproductive need. Patients had on average 2.5 reproductive concerns documented per consultation (range 1-5). The three most commonly documented concerns at initial consultation related to fertility status (43.9%), endocrine dysfunction (35.3%), and contraception advice (32.4%). In patients younger than 25 years discussions were predominately about endocrine dysfunction, fertility status and contraception, while dominant themes for 26-35 years olds were fertility status, reproductive-related health prevention strategies, contraception and endocrine dysfunction. Survivors aged 36-45 prioritised fertility status, pregnancy, and contraception. Fertility preservation (p=0.05), preventative health strategies (p=0.001), and contraception advice (p<0.001) were more commonly discussed by females than males. Conclusion: Longitudinal reproductive follow up care is important, as patients have a number of ongoing reproductive concerns which change over time. Our data can assist in informing the model of care.