Participants in a national prospective cohort study of cancer survivors of reproductive age were less likely to report current use of a highly effective contraceptive method—sterilization, the IUD or a hormonal method—than are women in the general U.S. population (34% vs. 53%).¹ Among cancer survivors at risk of unintended pregnancy who used any method, receipt of family planning services in the past year was the only characteristic associated with use of highly effective methods rather than less effective ones (risk ratio, 1.3).

Although some cancer treatments can lead to infertility, most survivors retain ovarian function and hence have a need for family planning services; moreover, rates of contraceptive use among survivors are low. To examine this issue, the present assessment used data from the Fertility Information Research Study on 289 cancer survivors from 44 states; respondents were aged 20–44 and were recruited in 2011–2013 from a variety of sources (mainly cancer advocacy groups and university-based fertility preservation programs). The contraceptive practices of these women were compared with those of women in the general population, as reported in the 2006–2010 National Survey of Family Growth. Log-binomial regression analyses were conducted to generate relative risk ratios identifying characteristics associated with contraceptive use among cancer survivors.

The mean age of survivors was 32, eight in 10 were white and had a college education, and six in 10 were in a relationship. One-third of respondents had ever been pregnant, more than three-fourths wanted to have a child in the future and nearly all had health insurance. The median time since cancer diagnosis was two years; while 56% of survivors had received family planning services since their diagnosis (and 50% had done so in the last year), 2% reported an unintended pregnancy following diagnosis. Ten percent of respondents had used an emergency contraceptive since learning they had cancer. A wide variety of cancers had been diagnosed; two-thirds of respondents had received a diagnosis of breast or gynecologic cancer or lymphoma. Survivors reported a range of cancer treatments: Eight in 10 had had chemotherapy, six in 10 had undergone surgery and nearly half had received radiation treatment.

Fifty-seven percent of respondents were currently using any contraceptive method: 34% a highly effective method and 23% a less effective one. By contrast, among women in the general population, 69% were using any method—53% a highly effective and 16% a less effective one. When the survivor sample was limited to women who were at risk of unintended pregnancy (i.e., were fertile, sexually active, not pregnant or postpartum, and not seeking pregnancy), 84% reported current use of any contraceptive method, and 51% reported use of a more effective one; these proportions were significantly lower than those in the general population (90% and 69%, respectively).

In a multivariate analysis of the 154 survivors who were at risk of unintended pregnancy and had used any method, those who had received family planning services in the past year were more likely than those who had not to report use of a more effective method instead of a less effective one (risk ratio, 1.3); no other demographic or cancer-related characteristic included in the analysis was significant. Finally, in a fully adjusted analysis of emergency contraceptive use among 263 survivors (excluding those who were surgically sterile from noncontraceptive indications), the sole significant finding was that women who had received family planning services since their diagnosis were more likely than others to have used this method (risk ratio, 5.0).

According to the authors, strengths of this study include the use of a sample of women with a diversity of cancers and the sample's demographic similarity to the general U.S. population. Although this study used a sample that was among the largest to evaluate contraceptive use following a cancer diagnosis, the researchers note that the cohort size and limited variability for some measures constrained their ability to control for a wide range of characteristics. Nonetheless, they believe that their analysis "provides novel evidence of lower rates of [use of] effective contraceptive methods" among cancer survivors than among women in the general U.S. population. They suggest that "increased access to family planning services may … ­prevent unintended pregnancy in this vulnerable population."

—J. Thomas

REFERENCE

1. Dominick SA et al., Contraceptive practices among female cancer survivors of reproductive age, Obstetrics & Gynecology, 2015, 126(3):498­–507.