The most significant difficulty is that of fertility,” said a founding member of a cancer advocacy organisation that dealt with young adult cancer, during an interview. “When you are diagnosed with cancer in your 20s, 30s… your right to be a parent is at peril. This would not be the case when you are diagnosed in your 60s and 70s.” This was the first time I had heard of cancer survivors talking about fertility issues, and the whole world of young adult cancer and their very often neglected problems came to the fore.
“If you are diagnosed with cancer, say for example when you are getting out of college, the problems are many,” continued my good friend and advocate for young adult cancer. “Coming out of the world of cancer and reentering a normal life, workforce and parenthood is not easy.”
Young adults are defined as people in the age group of 15 to 40, and cancer is the number one killer disease in this group. In the US, there are more young adults being diagnosed with cancer than any other age group. While cancer is a complex disease at any point in life, being diagnosed in one's 20s and 30s can disrupt major milestones—career, financial independence and fertility.
Where fertility becomes a concern
Whether the cancer treatment will affect fertility often depends on the type of cancer and the proposed treatment. The big offender is chemotherapy, which can render a man or woman temporarily or even permanently infertile.
Chemotherapy works because it targets rapidly growing cells. Unfortunately, this also takes out sperms and eggs. It can also speed up the biological clock for women, which could lead to temporary or even permanent menopause. Patients undergoing radiation therapy may also have to face potential infertility depending on the target organ and their overall treatment plan.
Cancer treatments like surgery, too, have an impact on fertility, especially if they involve removal or compromise of certain reproductive organs.
So, what cancers can render a patient infertile? Fertility specialist Dr Andrea Reh says: “We see problems of fertility in patients with breast cancer, non-Hodgkin’s and Hodgkin’s lymphoma, melanoma and sarcomas. There can be gynaecological cancers of the female system, like cervical cancer or ovarian cancer, testicular cancer in men, colorectal cancer, and other types of leukaemia as well as brain and spinal cord tumours.”
Very often, fertility preservation is not introduced to young adult cancer patients until it is too late. “Unfortunately, fertility was not something that was discussed with me at all by my medical team,” says Sajna, a leukaemia survivor. “I found out a few days after my diagnosis, when I started to Google the side effects to the chemotherapy treatment I was scheduled to undergo in less than a week. I had a shot at being cured, but infertility is so permanent and at age 22, I hadn’t even begun to think about starting a family one day. That wasn’t something on my radar, and it felt like a major breach of trust with my doctors earlier on in the conversation. I couldn’t help but wonder what else they weren’t telling me.”
By far, oncologists serve as the frontline for fertility preservation dialogue. Oncologists should address issues of infertility before patients start treatment and, if possible, refer these patients to reproductive specialists. But, oncologists have to consider various facets of a patient’s treatment and may not have the time or resources to discuss fertility to an extent that is necessary.
“For many who are diagnosed in their 20s like me, being told that they may be infertile is sometimes worse than the cancer itself,” says Sajna, who had her eggs frozen prior to starting her leukaemia treatment.
For men, sperm banking is the cornerstone of treatment options available. Women have several options such as egg banking, egg freezing and embryo banking.
Says Reh: “We are starting to see more use of what’s called medical suppression, with medications like Lupron. This is an injection that a woman can take before she undergoes chemotherapy. It basically puts her into a hormonal menopause and it’s been debated back and forth whether this is beneficial. But, a recent article in the New England Journal Of Medicine shows that breast cancer patients who had Lupron had a lower incidence of ovarian failure, more of them got pregnant.”
So, if you have not taken steps to preserve fertility before cancer diagnosis, is there a chance of conception?
Patients who did not have an opportunity to pursue fertility preservation before cancer treatment can think of taking a drug holiday. This decision would largely depend on type of cancer, age and overall prognosis of their treatment in conjunction with their oncologist.
With cancer treatments getting better and cutting-edge research improving survival outcomes, it becomes imperative that fertility be considered as a quality-of-life issue in young adult cancer survivors. And, if fertility is not an issue that comes up in your discussion with the doctor, be your own advocate. Further, patient and family can meet up with a fertility specialist who can help them understand their options better and maybe even help in making the right choice.
Fertility is definitely a concern when young adults are diagnosed with cancer. However, it would be worthwhile to keep in mind that the primary goal, of course, is to get rid of the cancer.
Priya V. Menon is scientific media editor at TrialX/Applied Informatics Inc. She manages and hosts CureTalks, an international online radio talk show on cancer research and health care.