Barriers to parenthood project among fertile cancer survivors 2 years after diagnosis: a cross-sectional French national survey Short title: Parenthood project among fertile cancer survivors

Barriers to procreational intentions among cancer survivors 2 years after diagnosis: a French national cross-sectional survey. Abstract Objectives – To determine the rates of parenthood projects among two-year cancer survivors with a preserved fertility, and to identify factors associated with parenthood project, opposing cancer-related factors to socio-demographic factors usually associated with parenting in healthy individuals. Methods – Among 6,957 adult cancer patients randomly selected in the Long Duration Disease File of the French National Health Insurance Fund between September and October 2002, still alive and not hospitalised two years after diagnosis, 4,270 responded to this cross-sectional questionnaire study of whom 969 reported having preserved fertility. Results – Among women aged 20-44 (n=175) and men aged 20-70 (n=784), 26.3% and 6.1% respectively planned to have a child or another child. Such plans were more frequently reported by in younger patients but were also reported by the oldest ones (until 70 years old for men). 33.5% of the 257 male and female survivors, aged 20-45, had parenthood project. After adjustment for age, previous children, and gender, only high education level (adjusted odds ratio: 3.1, 95% confidence interval 1.3 to 7.8) and stability or increase of financial resources (2.4, 1.0 to 5.7) were independently associated with parenthood project. Cancer stage at diagnosis and evolution did not modify this project. Conclusions –Two years after cancer diagnosis when fertility has been preserved, motives against parenthood project tend to be similar among cancer survivors and in the general population. Survivors who reported a reduction in financial resources were less likely to have a parenthood project. Targeted support is needed to help them to face financial consequences of the disease.