Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Rates of contraceptive uptake and documentation of discussion with anticancer therapy: women deserve gender specific care (#395)

Verity Chadwick 1 , Michaela Kim 2 , Georgia Mills 3 , Catherine Tang 4 , Antoinette Anazodo 2 5 6 , Rachel Dear 2 7 , Rachael Rodgers 8 9 , Orly Lavee 2 3 , Samuel Milliken 2 3 , Georgia McCaughan 3 , John Moore 2 3 , Nada Hamad 3 10 11 , Joshua Hurwitz 12
  1. Royal North Shore Hospital, St Leonards, NSW, Australia
  2. School of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Department of Haematology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
  4. Department of Haematology and Flow Cytometry, Laverty Pathology, Macquarie Park, NSW, Australia
  5. Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
  6. Nelune Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
  7. Department of Oncology, St Vincent’s Hospital, Sydney, NSW, Australia
  8. Department of Reproductive Medicine, Royal Hospital for Women, Sydney, NSW, Australia
  9. School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW, Australia
  10. St Vincent's Clinical School, University of New South Wales , Randwick, NSW, Australia
  11. School of Medicine, University of Notre Dame, Daringhurst, NSW, Australia
  12. Medical Oncology, The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia

Introduction: For women of reproductive age with cancer, unplanned pregnancies and the use of contraception are often unaddressed. Evidence suggests many women with cancer avoid contraception due to fearing worsening prognosis.

Aim: To investigate the documented rates of contraception counselling and uptake in women of childbearing age at a major Sydney tertiary hospital.

Methods: Our group conducted a retrospective chart review at a major Australian cancer centre of premenopausal females aged 18-49 years diagnosed with cancer between 2017 and 2020. Data collected included primary diagnosis, stage of cancer, treatment(s) received, complications, reproductive history, documentation of contraceptive use, and involvement of gynaecologists.

Results: A total of 143 patients met inclusion criteria. At the time of diagnosis, 8.4% of patients were taking the combined oral contraceptive pill (COCP), 4.9% had an intrauterine device, 0.7% were taking the progesterone only pill, and 0.7% had a contraceptive implant. Of those using an oral contraceptive agent, 15.4% had a thromboembolic complication post cancer diagnosis. Only 23.1% received advice on contraception from a physician or a pharmacist, with advice including avoiding pregnancy during treatment (33.3%), use of barrier contraception (24.2%), ceasing the COCP (15.2%), IUD removal (12.1%), and IUD insertion (3%).

Discussion: All women with a cancer diagnosis should be counselled on contraception. Considerations should include tumour type, thrombotic factors, patient immunosuppression, haematological disorders, bone density, drug interactions, and metabolic or cardiovascular effects. Abstinence should not be assumed or recommended. To better facilitate contraception discussions, cancer specialists should receive education sessions on contraception, have centre-facilitated gynaecology referrals, and provide patients written information.