New ACOG opinions address gynecologic concerns in young cancer patients

Cancer in young female patients is rare, and the literature to guide the management of gynecologic issues related to treatment is limited. Thus, these two new ACOG committee opinions provide a useful resource for gynecologists who encounter young cancer patients and cancer survivors in their practice or who are consulted on the management of a bleeding emergency in a young cancer patient, Dr. Frances Ginsburg said in an interview.

Importantly, the opinions stress the need for collaboration and involvement of gynecologic care early in the course of treatment or prior to treatment initiation, she said.

"My feeling about a young woman or child who is facing this kind of situation is that the younger they are the more likely that everybody is focusing on a million other things. ... A lot of times I will get a call after the fact about a patient who had chemotherapy at 18 and at 20 is not getting her period. It’s a little late at that point," she said.

However, the committee opinion on gynecologic concerns is not forceful enough in its statement on the use of gonadotropin-releasing agonists to induce ovarian quiescence in an effort to preserve ovarian function and fertility after cytotoxic treatment in those who have reached sexual development, she said, explaining that the opinion states that results have been mixed, that a meta-analysis showed only a slight increase in ovarian function, and that evidence is currently not strong enough to recommend their use for this purpose.

In fact, compelling randomized trial data showing a benefit with these agents were presented at a recent conference.

"The results were really very dramatic. I think the results were dramatic enough that probably all women undergoing chemotherapy who desire future fertility ought to be offered it as one of their options," she said.

Dr. Ginsburg is director of reproductive endocrinology and infertility in the department of obstetrics and gynecology at Stamford (Conn.) Hospital and assistant professor of clinical obstetrics and gynecology at Columbia University, New York. She had no relevant financial disclosures and is not a member of the ACOG committee.