Marriage and parenthood among childhood cancer survivors: a report from the Italian AIEOP Off-Therapy Registry

Abstract

Background: The aim of this study was to describe the patterns of marriage and parenthood in a cohort of childhood cancer survivors included in the Off-Therapy Registry maintained by the Italian Association of Pediatric Hematology and Oncology.

Design and methods: We analyzed a cohort of 6,044 patients diagnosed with cancer between 1960 and 1998, while aged 0 to 14 years and who were 18 years old or older by December 2003. They were followed up through the regional vital statistics registers until death or the end of follow up (October 30, 2006), whichever occurred first, and their marital status and date of birth of their children were recorded. The cumulative probabilities of being married and having a first child were computed by gender and compared by tumor type within the cohort. Marriage and fertility rates (the latter defined as the number of live births per woman-year) were compared with those of the Italian population of the same age, gender, area of residence and calendar period by means of the observed to expected (O/E) ratios.

Results: During the follow-up period, 4,633 (77%) subjects had not married. The marriage O/E ratios were 0.56 (95% CI: 0.51-0.61) and 0.70 (95% CI: 0.65-0.76) among men and women, respectively. Overall, 263 men had 367 liveborn children, and 473 women had 697 liveborn children. The female fertility O/E ratio was 0.57 (95% CI: 0.53-0.62) overall, and 1.08 (95% CI: 0.99-1.17) when analyses were restricted to married/cohabiting women

Conclusions: Childhood cancer survivors are less likely to marry and to have children than the general population, confirming the life-long impact of their previous disease on their social behavior and choices. The inclusion of counseling in the strategies of management and long-term surveillance of childhood cancer patients could be beneficial to survivors as they approach adulthood.

Figure 1.

Off-Therapy Registry 1960–1998. Cumulative probability of marriage for childhood cancer survivors, by gender and tumor type. Time-to-first marriage was calculated from the date of 18^th birthday to the start of the relationship. Gray’s test: men P=0.001, women P<0.001.

Figure 2.

Off-Therapy Registry 1960–1998. Cumulative probability of having a first liveborn child for childhood cancer survivors (married or cohabitants) by gender and tumor type. Time-to-first birth was calculated from the date of 18^th birthday to the date of birth of the first child. Gray’s test: spouses of men P=0.026, women P=0.175.

Figure 3.

Off-Therapy Registry 1960–1998. Cumulative incidence (CI) of marriage in childhood cancer survivors (observed) and in the general population (expected) by gender in 1980–2004, with 95% confidence limits.