Quality of Life Research

, Volume 23, Issue 2, pp 585–592 | Cite as

Quality of life in female cancer survivors: is it related to ovarian reserve?

  • Laxmi A. Kondapalli
  • Katherine E. Dillon
  • Mary D. Sammel
  • Anushree Ray
  • Maureen Prewitt
  • Jill P. Ginsberg
  • Clarisa R. Gracia



The purpose of the study is to assess the quality-of-life scores and possible association with measures of ovarian reserve in female cancer survivors compared to healthy controls of similar age.


In this prospective cohort study, fifty-nine cancer survivors aged 16–39 years and 66 healthy, similarly aged unexposed women were recruited at the University of Pennsylvania. The primary outcome measures are the generic and cancer-specific domain scores on the Quality of Life in Adult Cancer Survivors (QLACS) instrument, early follicular phase serum hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), inhibin B (INH), anti-Mullerian hormone (AMH), and ovarian ultrasound measurements [ovarian volume and antral follicle count (AFC)].


Cancer survivors had significantly higher total and cancer-specific domain scores compared to unexposed participants. Serum AMH, INH, ovarian volume, and AFC were lower while serum FSH was higher in cancer survivors. Although survivors exhibited diminished ovarian reserve, these markers were not independently associated with total QLACS score. Cancer survivors with irregular menstrual function were found to have lower quality-of-life (QOL) scores than those with regular cycles.


We found that QOL appears to be significantly impaired in cancer survivors compared to controls, even when remote from initial cancer diagnosis. In addition, our study suggests that reproductive aging contributes to QOL in the setting of irregular menses and likely profound impairment of ovarian function.


Quality of life Oncology Ovarian reserve Cancer Oncofertility 



Supported by NIH T32 HD007440 and NIH 5K12HD001271-12 (LAK); Doris Duke Clinical Research Fellowship (KED); NIH K01 L1-CA-133839-03 and 1R01HD062797 (CRG, MDS).

Conflict of interest



  1. 1.
    Zeltzer, L. K., Recklitis, C., Buchbinder, D., Zebrack, B., Casillas, J., Tsao, J. C., et al. (2009). Psychological status in childhood cancer survivors: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 27, 2396–2404.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Schover, L. R. (2000). Psychosocial issues associated with cancer in pregnancy. Seminars in Oncology, 27, 699–703.PubMedGoogle Scholar
  3. 3.
    Howard-Anderson, J., Ganz, P. A., Bower, J. E., & Stanton, A. L. (2012). Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: A systematic review. Journal of the National Cancer Institute, 104, 386–405.PubMedCrossRefGoogle Scholar
  4. 4.
    Janson, C., Leisenring, W., Cox, C., Termuhlen, A. M., Mertens, A. C., Whitton, J. A., et al. (2009). Predictors of marriage and divorce in adult survivors of childhood cancers: A report from the Childhood Cancer Survivor Study. Cancer Epidemiology Biomarkers Prevent, 18, 2626–2635.CrossRefGoogle Scholar
  5. 5.
    Frobisher, C., Lancashire, E. R., Winter, D. L., Jenkinson, H. C., & Hawkins, M. M. (2007). British Childhood Cancer Survivor Study. Long-term population-based marriage rates among adult survivors of childhood cancer in Britain. International Journal of Cancer, 121, 846–855.CrossRefGoogle Scholar
  6. 6.
    Gracia, C. R., Sammel, M. D., Freeman, E., Prewitt, M., Carlson, C., Ray, A., Vance, A., & Ginsberg, J. P. (2012). Impact of cancer therapies on ovarian reserve. Fertility and sterility, 97, 134,40.e1.Google Scholar
  7. 7.
    Mann, E., Singer, D., Pitkin, J., Panay, N., & Hunter, M. S. (2012). Psychosocial adjustment in women with premature menopause: A cross-sectional survey. Climacteric, 15(5), 481–489.PubMedCrossRefGoogle Scholar
  8. 8.
    Green, D. M., Kawashima, T., Stovall, M., Leisenring, W., Sklar, C. A., Mertens, A. C., et al. (2009). Fertility of female survivors of childhood cancer: A report from the childhood cancer survivor study. Journal of Clinical Oncology, 27, 2677–2685.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Avis, N. E., Ip, E., & Foley, K. L. (2006). Evaluation of the Quality of Life in Adult Cancer Survivors (QLACS) scale for long-term cancer survivors in a sample of breast cancer survivors. Health Qual Life Outcomes, 4, 92.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Avis, N. E., Smith, K. W., McGraw, S., Smith, R. G., Petronis, V. M., & Carver, C. S. (2005). Assessing quality of life in adult cancer survivors (QLACS). Quality of Life Research, 14, 1007–1023.PubMedCrossRefGoogle Scholar
  11. 11.
    Pearce, N. J., Sanson-Fisher, R., & Campbell, H. S. (2008). Measuring quality of life in cancer survivors: A methodological review of existing scales. Psychooncology, 17, 629–640.PubMedCrossRefGoogle Scholar
  12. 12.
    Schover, L. R. (2009). Patient attitudes toward fertility preservation. Pediatric Blood & Cancer, 53, 281–284.CrossRefGoogle Scholar
  13. 13.
    Schover, L. R., Brey, K., Lichtin, A., Lipshultz, L. I., & Jeha, S. (2002). Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. Journal of Clinical Oncology, 20, 1880–1889.PubMedCrossRefGoogle Scholar
  14. 14.
    Schover, L. R., Rybicki, L. A., Martin, B. A., & Bringelsen, K. A. (1999). Having children after cancer. A pilot survey of survivors’ attitudes and experiences. Cancer, 86, 697–709.PubMedCrossRefGoogle Scholar
  15. 15.
    Letourneau, J. M., Ebbel, E. E., Katz, P. P., Katz, A., Ai, W. Z., Chien, A. J., et al. (2012). Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer, 118, 1710–1717.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Partridge, A. H., Gelber, S., Peppercorn, J., Sampson, E., Knudsen, K., Laufer, M., et al. (2004). Web-based survey of fertility issues in young women with breast cancer. Journal of Clinical Oncology, 22, 4174–4183.PubMedCrossRefGoogle Scholar
  17. 17.
    Ferrell, B. R., Grant, M. M., Funk, B. M., Otis-Green, S. A., & Garcia, N. J. (1998). Quality of life in breast cancer survivors: Implications for developing support services. Oncology Nursing Forum, 25, 887–895.PubMedGoogle Scholar
  18. 18.
    Carver, C. S., Smith, R. G., Petronis, V. M., & Antoni, M. H. (2006). Quality of life among long-term survivors of breast cancer: Different types of antecedents predict different classes of outcomes. Psychooncology, 15, 749–758.PubMedCrossRefGoogle Scholar
  19. 19.
    Freeman, E. W., Sammel, M. D., Lin, H., Liu, Z., & Gracia, C. R. (2011). Duration of menopausal hot flushes and associated risk factors. Obstetrics and Gynecology, 117, 1095–1104.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Carpenter, J. S., Andrykowski, M. A., Cordova, M., Cunningham, L., Studts, J., McGrath, P., et al. (1998). Hot flashes in postmenopausal women treated for breast carcinoma: Prevalence, severity, correlates, management, and relation to quality of life. Cancer, 82, 1682–1691.PubMedCrossRefGoogle Scholar
  21. 21.
    Zebrack, B. J., Foley, S., Wittmann, D., & Leonard, M. (2010). Sexual functioning in young adult survivors of childhood cancer. Psychooncology, 19, 814–822.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    van Dijk, E. M., van Dulmen-den Broeder, E., Kaspers, G. J., van Dam, E. W., Braam, K. I., & Huisman, J. (2008). Psychosexual functioning of childhood cancer survivors. Psychooncology, 17, 506–511.PubMedCrossRefGoogle Scholar
  23. 23.
    Grant, M. D., Piotrowski, Z. H., & Chappell, R. (1995). Self-reported health and survival in the Longitudinal Study of Aging, 1984–1986. Journal of Clinical Epidemiology, 48, 375–387.PubMedCrossRefGoogle Scholar
  24. 24.
    Ferrell, B. R., Dow, K. H., & Grant, M. (1995). Measurement of the quality of life in cancer survivors. Quality of Life Research, 4, 523–531.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Laxmi A. Kondapalli
    • 1
    • 2
  • Katherine E. Dillon
    • 2
  • Mary D. Sammel
    • 3
  • Anushree Ray
    • 4
  • Maureen Prewitt
    • 4
  • Jill P. Ginsberg
    • 5
  • Clarisa R. Gracia
    • 2
  1. 1.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and GynecologyUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and GynecologyUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Center for Research in Reproduction and Women’s HealthUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  5. 5.Division of Oncology, Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA

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