Contraceptive Practices Among Female Cancer Survivors of Reproductive Age

Abstract

Objective: To compare rates of contraception between reproductive-aged cancer survivors and women in the general U.S.

Population: Among survivors, the study examined factors associated with use of contraception and emergency contraception.

Methods: This study analyzed enrollment data from an ongoing national prospective cohort study on reproductive health after cancer entitled the Fertility Information Research Study. We compared current contraceptive use in survivors with that of the general population ascertained by the 2006-2010 National Survey for Family Growth. Log-binomial regression models estimated relative risks for characteristics associated with use of contraception, World Health Organization tiers I-II (sterilization and hormonal) contraceptive methods, and emergency contraception in survivors.

Results: Data from 295 survivors (mean age 31.6±5.7 years, range 20-44 years) enrolled in this prospective study (85% response rate) were examined. Age-adjusted rates of using tiers I-II contraceptive methods were lower in survivors than the general population (34% [28.8-40.0] compared with 53% [51.5-54.5], P<.01). Only 56% of survivors reported receiving family planning services (counseling, prescription or procedure related to birth control) since cancer diagnosis. In adjusted analysis, receipt of family planning services was associated with both increased use of tiers I-II contraceptive methods (relative risk 1.3, 95% confidence interval [CI] 1.1-1.5) and accessing emergency contraception (relative risk 5.0, 95% CI 1.6-16.3) in survivors.

Conclusion: Lower rates of using tiers I-II contraceptive methods were found in reproductive-aged cancer survivors compared with the general population of U.S. women. Exposure to family planning services across the cancer-care continuum may improve contraception use among these women.

Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01843140.

Level of evidence: II.

Conflict of interest statement

Financial Disclosure: The authors did not report any potential conflicts of interest.

Figures

Fig 1

Contraceptive methods used by reproductive-aged cancer survivors (n=154), categorized by the most effective method.

Fig 2

Comparison of contraceptive practices between reproductive-aged cancer survivors (shown in blue) and women in the general U.S. population, as assessed by the National Survey of Family Growth (shown in white): use of contraception (A), use of World Health Organization (WHO) tiers I-II methods (B), use of WHO tiers III-IV methods (C), surgically sterile (D), pregnant or postpartum (E), seeking pregnancy (F), not sexually active (G), sexually active (H). The total number of survivors by age group is as follows: aged 20–24 years (n=38), aged 25– 29 years (n=81), aged 30– 34 years (n=83), aged 35– 39 years (n=69), and aged 40–44 years (n=18). *Nonoverlapping 95% confidence intervals of the proportions in the survivor and general populations.

Fig 2

Comparison of contraceptive practices between reproductive-aged cancer survivors (shown in blue) and women in the general U.S. population, as assessed by the National Survey of Family Growth (shown in white): use of contraception (A), use of World Health Organization (WHO) tiers I-II methods (B), use of WHO tiers III-IV methods (C), surgically sterile (D), pregnant or postpartum (E), seeking pregnancy (F), not sexually active (G), sexually active (H). The total number of survivors by age group is as follows: aged 20–24 years (n=38), aged 25– 29 years (n=81), aged 30– 34 years (n=83), aged 35– 39 years (n=69), and aged 40–44 years (n=18). *Nonoverlapping 95% confidence intervals of the proportions in the survivor and general populations.