EC Gynaecology

Introduction: One of the long-term effects of chemotherapy in young adults who have had cancer is impaired fertility. Due to the infertility and fear of having cancer again may develop depression and anxiety.

Objective: To determine the psychological and reproductive status of women with non-gynecological cancer patients who underwent chemotherapy.

Materials and Methods: An observational, descriptive, cross-sectional study was conducted in patients who finished chemotherapy from 2017 to 2021 at Mongolian National Cancer center. Patients were asked for general demographic, reproductive history, menstrual cycle questionnaire, chemotherapy related questionnaire as well as WHO-QOL, HADS questionnaire. To assess the psychological issues healthy, normal menstrual cycled women were asked to give WHOQOL-BREF questionnaire, HADS questionnaire, as well. Women were asked to re-visit the hospital for the purpose of investigating ovarian function, and were subjected to physical examination, AMH measurement and ultrasound examination. Statistical analysis was done using SPSS26.

Results: The average chemotherapy cycle of the non-gynecological cancer patients were 9.91 ± 6.8 times. Gonadotoxic agents were used in 63.64%, low risk chemo-agents were used in 36.36%. The post chemotherapy ovarian median volume was 3.2 ± 3.1 cm on the right and 2.52 ± 1.9 cm on the left, which is relatively close to healthy women, but with a high standard deviation. The number of antral follicles were 1.23 ± 1.3, indicating a marked decrease in ovarian reserve. The average value of anti-Mullerian hormone in the studied women was 0.49 ± 0.59 ng/ml, and the level of anti-Mullerian hormone gradually decreased with increasing frequency of chemotherapy. There was no statistically significant difference between the frequency of chemotherapy and AMH, but there was an inverse relationship between the frequency of chemotherapy and AMH (r = -0.1 p = 0.63). The physical health and psychological health related QOL were significantly reduced in cancer survivors in comparison to healthy women, while no difference was found in social and environmental QOL. Moreover, the prevalence and severity of anxiety and depression is higher among cancer survivors compared to healthy women.

Conclusion: The decrease of ovarian function is related to type and frequency of chemotherapy cycles. Cancer survivors have severe anxiety and depression, suggesting the necessity of appropriate psychological support.

Keywords: Non-Gynecological Cancer Survivors; AMH; Infertility; HADS; WHO-QOL

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