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  • Title: Oncology patients pose challenge in choosing birth control method.
    Author: Neinstein LS, Katz B.
    Journal: Contracept Technol Update; 1985 Apr; 6(4):66-8. PubMed ID: 12313869.
    Abstract:
    Available information on the impact of radiation and chemotherapy on the fertility and pregnancy outcomes of oncology patients was briefly reviewed, and some suggestions for the contraceptive counseling of oncology patients were provided. Pregnancy generally has no adverse effect on nonhormonal dependent tumors, but the therapy used to treat the tumors may have an adverse effect on the patient's fertility and on the fetus. Studies indicate that radiation therapy can interfere with ovarian function. For example, in a study of 208 patients, under 18 years of age and with various types of cancers, 52% received radiation therapy and 47% received chemotherapy. None of the chemotherapy patients developed ovarian failure. Among radiated patients, ovarian failure developed in 68% of the women when the ovaries were in the treatment field, in 14% of those whose ovaries were at the border of the treatment field, and in none of the women whose ovaries were outside the treatment field. Other studies indicate that chemotherapy can destroy ovarian primordial follicles. The damage seems to be caused by the alkylating agents. Combination chemotherapy is especially damaging to the ovaries. 1 investigator found that among 35 leukemia patients who received chemotherapy, 1 of the 17 prepubertal women and 6 of the 18 pubertal or post pubertal women experienced either ovarian failure or hypothalamic pituitary dysfunction. Radiation therapy during the 1st trimester and radiation therapy which exposes the fetus to 10 or more rad increases the risk of fetal wastage and fetal malformation. The risk of these adverse effects for the fetus can be reduced by using a pelvis shield and by moving the ovaries to midline at staging laparotomy. There is considerable evidence that chemotherapy during the 1st trimester can produce abortion and fetal malformation. Most experts recommend avoiding chemotherapy during the 1st trimester, whenever possible, and many recommend therapuetic abortion for women who are treated with either chemotherapy or radiation during the 1st trimester. Cancer patients should be provided with appropriate contraceptive counseling. Some patients are instructed by their physicians to avoid pregnancy for 1 year following chemotherapy. Pregnancies may also need to be timed so as not to interfere with the disease's management schedule. Counselors should help patients select an effective method, avoid oral contraceptives if the disease is hormonal dependent, and chose a method appropriate to the severity and prognosis of the disease. Consideration should be given to the risk of IUD failure if the patient is being treated with steroids. In addition, counselors should advise patients who received chemotherapy or radiation therapy during the 1st trimester to consider abortion.
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