Defining the whole of reproductive health in adolescent and young adult cancer populations: fertility is only one piece of the puzzle

Gwendolyn P Quinn , Devin Murphy, Ivana Sehovic, Kelly Sawczyn

Quality of life is an important but distinct issue for adolescent and young

adults (AYA) compared with older adults. Reproductive health is a key aspect of health-related

quality of life and spans across physiological and psychological domains. While fertility issues

have had more attention in the past 5 years, there are other aspects of reproductive health

requiring recognition by healthcare practitioners in AYA oncology. These include attention

to human papillomavirus and sexually transmitted infection risk, contraception and sexual

health in relation to late effects of cancer and treatment. Alkylating agents in chemotherapy,

total-body radiation or external-beam radiation in a field that includes the ovaries, testes or

endocrine system may cause long-term impairment to reproductive health functioning. We

examine reproductive health in relation to National Comprehensive Cancer Network and

American Academy of Pediatrics guidelines for AYA cancer survivors in the USA. While fertility

preservation and issues related to fertility are present in the guidelines, contraception, human

papillomavirus vaccine or other sexual health issues are incomplete.

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