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Abstract
Background Survival following treatment for childhood cancer has increased from less than 10% in 1970 to 75% in 2007. This is largely due to clinical trials and laboratory research conducted by members of the Children's Cancer and Leukaemia Group and through International collaboration.
According to The National Cancer Survivorship Initiative (NCSI 2010) approximately 40 000 of the UK population had cancer as a child or young adult. Infertility is a well-documented late effect of cancer treatment. Chemotherapy and radiotherapy hasten oocyte depletion by damaging ovaries, leading to premature ovarian failure (POF) and premature menopause. Early detection and treatment are essential to ensure timely oestrogen replacement for pubertal induction and cyclical hormone replacement for relieving menopausal symptoms.
Method A review and comparison of departmental practice against national guidelines. To improve practice in identifying at risk patients prior to commencing treatment. Two patient groups were identified.
Group A: 12 patients were receiving hormone replacement therapy; 6 had undergone bone marrow transplant (BMT) with total body irradiation (TBI) conditioning and 6 were post high dose chemotherapy for treatment of their solid tumour.
Group B: 6 at risk patients, on follow-up.
Outcomes Group A (figure 1): BMT patients had late detection of their POF compared to timely detection among the solid tumour patients. POF was diagnosed following annual endocrine bloods in the transplant patients which led to delayed detection. Solid tumour patients were closely monitored with endocrine bloods undertaken following early clinical suspicion.
Group A: BMT premature ovarian failure (POF) detection.
Group B (figure 2): Pubertal growth and development was not monitored among post-transplant patients.
Solid tumours premature ovarian failure (POF) detection.
Conclusion Patients who received TBI and high dose chemotherapy were at an increased risk of POF. It is important to identify at risk children, record their pubertal status pre-treatment and monitor their growth and puberty post treatment. Early detection and commencement of treatment prevents morbidity from premature menopause. Individualised end of treatment summaries identify at risk patients and regular pubertal assessments combined with review of endocrine blood results in the Late effects MDT improve the quality of care.