By Anne Katz, PhD, RN
This Monthly Survivorship Series, written by CKN Survivorship Editor, Anne Katz, is provided by CKN with permission from ONS. We hope this series will become a useful resource that will help to facilitate dialogue between cancer patients, their loved ones and their physicians with a view towards improving the quality of life for cancer survivors.
Some of the most difficult work I do is talking to patients about loss of fertility after cancer treatment. Sometimes the discussion is with the parents of a teenager who is newly diagnosed. I can see the pain and desperation in their eyes: how could this happen to their child? How can they make the right decision when the fear of losing this precious person overwhelms them? It is no easier when I talk to a young adult, married just a few months, who now faces a delay in starting treatment if he wants to freeze sperm. And more often than these examples are the couples who so desperately want a baby — but treatment years ago makes this impossible. Why did no one tell them at the time about fertility preservation, they ask. Why?
If any of you have had these kinds of conversations with patients, you know how heartbreaking it is — for the nurse, the physician, but mostly for the patients. I’m not sure that we do a great job with this for different reasons. For the patient there is panic and fear, for the health care provider there may be a reluctance to delay treatment. But ultimately it is the patient who is left to deal with the fall out — months of trying to conceive at some point in the future, the disappointment of not knowing what the consequences of treatment on fertility might be, the loneliness of not being able to have a biological child.
Yes, couples can adopt. Yes, in certain circumstances a man has the time to freeze sperm. Yes, if the woman has a partner and has the time before treatment she can produce eggs that are mixed with her partner’s sperm and the embryos are frozen. But other than that, the options for fertility preservation are limited and experimental. Freezing ova or ovarian tissue is still an experimental procedure with very low levels of successful pregnancies. And not everyone has access to specialty centers that even offer these techniques. Or the cost is prohibitive. Or there is no time.
Infertility after cancer is a silent and tragic challenge that many patients face. How can we best help them?
Read Anne’s Last Post here.