Reproductive and fertility-related challenges in female patients diagnosed with early-onset colorectal cancer.
Authors: Seifert Rachel M. , Ose Jennifer , George Manju , Lockhart Meagan , Letourneau Joseph , Peoples Anita Roselyn , Trabert Britton , Thota Ramya 
Published: January 2024

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Background: Incidence of early-onset colorectal cancer (EOCRC, defined as onset <50 years) is on the rise, with rates increasing by 51% from 2000-2015. Knowledge of fertility concerns in patients with EOCRC is important to provide the resources needed for this group. The aim of this study is to examine reproductive concerns after cancer diagnosis in female COLONTOWN patients with EOCRC using a validated and standardized questionnaire “Reproductive Concerns After Cancer” (RCAC). Methods: Female survivors (N=89, age at diagnosis 20 to 47 years) with EOCRC diagnosis were recruited from COLONTOWN. In order to capture the impact of EOCRC diagnosis on sexual health and fertility, a 51-question survey was created that included the RCAC scale as well as questions about pregnancy history, whether fertility preservation counselling occurred, self-reported demographics, and tumor and treatment. RCAC includes 6 subdomains on fertility preservation, partner disclosure of fertility status, child’s health, personal health, acceptance of possible infertility, and becoming pregnant, with total score being the sum of these domains. Data collected was analyzed using means, ranges, and standard deviations for continuous variables and frequencies and chi squared tests for categorical variables. Results: The mean age at diagnosis was 35 ± 5 years. 72% had discussions with a medical professional about fertility preservation after receiving their cancer diagnosis. Patients with rectal cancer were more likely to have this discussion compared to patients with colon cancer (p=0.04); tumor stage did not affect likelihood of having a fertility discussion (p>0.05). Seventeen (19%) underwent subsequent fertility preservation. Patients with stage IV cancer were less likely to undergo fertility preservation compared to those with stage I-III cancer (p=0.02); the decision to undergo fertility preservation was not affected by tumor site (p>0.05). 13% of all patients had insurance that would cover fertility preservation. Notably, 33 (37%) of patients said they would have considered fertility preservation if it were covered by insurance, and this was not impacted by tumor site or stage (p>0.05). RCAC subcategory scores were 3.47 for fertility preservation, 2.50 for partner disclosure of fertility status, 4.09 for child’s health, 3.88 for personal health, 2.27 for acceptance of possible infertility, and 3.49 for becoming pregnant. Conclusions: This study provides evidence that some patients with EOCRC experience concerns about fertility. Patients endorsed concern for child's health and personal health, followed by concerns about becoming pregnant and fertility potential. Interestingly, 37% would have considered fertility preservation had it been covered by insurance. This study provides characterization of the fertility-related concerns of EOCRC survivors and supports the future development of resources and policies to support these patients.