Fertility and sexual function in long-term survivors of haematological malignancy: using patient-reported outcome measures to assess a neglected area of need in the late effects clinic

Problems of sexual function and fertility in long-term survivors (5years) of haematological malignancy are often neglected in clinic. Our centre carried out a questionnaire study in this population addressing patient-perceived fertility and sexual function. 718 patients responded (56% of those invited; 39% Hodgkin, 45% non-Hodgkin lymphoma, 16% acute leukaemia). Respondent women were more likely to remain childless than a normal control population. Self-reported infertility was more likely in men than women [odds ratio (OR) 1<bold>77</bold>, P=0<bold>001</bold>]. Myeloablative therapy increased the likelihood of childlessness (OR 2<bold>48</bold>, P=0<bold>004</bold>). Few attended fertility support services (12%). 24% of men banked sperm and 29% of these used the sample, of which 46% resulted in successful pregnancy. Fertility clinic attendance and sperm storage was more likely post-1990 (OR 4<bold>05</bold>, P<0<bold>001</bold>; OR 5<bold>05</bold>, P<0<bold>001</bold> respectively). Reporting a negative impact of cancer on sexual function was more common in women than men (OR 2<bold>20</bold>, P<0<bold>001</bold>), and increased with current age and age at diagnosis (by 3-4% per year, P0<bold>001</bold>) but decreased with longer follow-up (by 2%/year, P=0<bold>005</bold>). Patients on anti-depressants and those reporting cancer-related body change/appearance concerns more frequently reported a negative impact (P<0<bold>04</bold> and P<0<bold>03</bold> respectively). These self-reported outcomes confirm literature findings, suggest improvement over time, but highlight a need for involvement of support services.