Reproductive function in teenage and young adult cancer patients in the UK

The possible loss of fertility is one of the most important concerns of young people facing a new cancer diagnosis. However there remain big gaps in our ability to predict accurately who needs to preserve their fertility. While the field of 'fertility preservation' has developed over recent years, with improvements in egg and sperm storage and freezing of ovarian and testicular tissue now also possible, these treatments are often complex, may delay the start of cancer treatment, may need surgical procedures especially for younger patients, and not all patients either need or can have them. Data on success rates are also limited. These factors all greatly impact on the challenges of providing appropriate care and referral for clinicians, and decision making for patients.
Cancer treatments are changing and improving, and we know very little about new treatments or factors that determine individual's susceptibility to loss of fertility. In this study we will measure the effects of current and new cancer treatments on the reproductive function of teenage and young adult (TYA) males and females who are facing a new cancer diagnosis, recruited from TYA cancer centres across the UK. We will include all cancer types, allowing us to gather information on the less common as well as more common conditions and their treatments. To keep up with developments in cancer treatment, through this study we will collect information on new and emerging treatments, giving the most up to date analysis possible. We will collect clinical information (including details of treatment received), and blood samples to measure hormones that reflect the function of the ovaries and testes. Importantly, we will start collecting these samples before treatment starts, then after the end of treatment and at intervals thereafter. This will allow us to determine which treatments do and do not affect reproductive function in both males and females and what factors are important before treatment starts, in determining this. Over the longer term (subject to ongoing funding) we will link the information gathered in this study to ongoing NHS records to see how it relates to key fertility events-pregnancy and paternity, and in females, time to (potentially early) menopause.

The care of cancer patients increasingly recognises the multimorbidity that may result from treatment. Loss of fertility is a prominent concern among patients, and while most do not lose their fertility, prediction at an individual level is difficult except at extremes of risk, and information on new treatments is very scarce. We will undertake a prospective analysis in teenage and young adult (TYA) male and female patients using the National Cancer Research Institute (NCRI)-linked network of treatment centres to address our hypothesis that cancer treatment and age affect fertility-related biomarkers and long-term reproductive health. This will generate an assessment of post-recovery reproductive function following contemporaneous and emerging treatment regimens, and prediction of that risk in individuals and patient groups. The primary endpoint is the prevalence of gonadal failure or dysfunction by diagnosis and treatment regimen at 2 years after diagnosis, with secondary longer-term outcomes. To determine this, we will recruit patients before starting treatment, and collect blood samples for endocrine analysis of gonadal function at that time, with detailed treatment data. Additional samples will be collected at 1, 2 and 3 years after diagnosis. We will recruit patients at presentation with a new cancer diagnosis, and also recruit patients previously treated who now present with a relapse. This will increase the proportion of likely high-risk therapies and treatments with novel targeted therapies, on which there are currently minimal data relating to reproductive effects. The prospective design of the study allows for detection and adjustment for previous gonadal toxicity.