Supplemental Table supporting: "Beyond premature ovarian insufficiency: Staging reproductive aging in adolescent and young adult cancer survivors"
2020-06-24T21:51:16Z (GMT) by
Table: Window Study participants by eligibility for the current analysis on staging reproductive aging
Table supports manuscript titled: Beyond premature ovarian insufficiency: Staging reproductive aging in adolescent and young adult cancer survivors"
Context: While stages of reproductive aging for women in the general population are well described by STRAW+10 criteria, this is largely unknown for female survivors of adolescent and young adult cancers (AYA survivors).
Objective: To evaluate application of STRAW+10 criteria in AYA survivors using bleeding patterns with and without endocrine biomarkers, and assess how cancer treatment gonadotoxicity is related to reproductive aging stage.
Design: The analytic sample (n=338) included AYA survivors from the Window Study cohort. Menstrual bleeding data and dried blood spots for AMH and FSH measurements (Ansh DBS ELISAs) were utilized for reproductive aging stage assessment. Cancer treatment data were abstracted from medical records.
Results: Among participants, mean age 34.0±4.5 and at a mean of 6.9±4.6 years since cancer treatment, the most common cancers were lymphomas (31%), breast (23%), and thyroid (17%). Twenty-nine percent was unclassifiable by STRAW+10 criteria. Most unclassifiable survivors exhibited bleeding patterns consistent with the menopausal transition, but had reproductive stage AMH and/or FSH levels. For classifiable survivors (48% peak reproductive, 30% late reproductive, 12% early transition, 3% late transition, 7% post-menopause), endocrine biomarkers distinguished among peak, early and late stages. Gonadotoxic treatments were associated with more advanced stages in a dose-dependent manner.
Conclusions: We demonstrate a novel association between gonadotoxic treatments and advanced stages. Without endocrine biomarkers, bleeding pattern alone can “upstage” AYA survivors. Moreover, a large proportion of AYA survivors exhibited combinations of endocrine biomarkers and bleeding patterns that do not fit STRAW+10 criteria, suggesting the need for modified staging for this population.