Discussing Fertility Preservation with Young Patients Diagnosed with Cancer
Kristin N. Smith, a patient navigator at Robert H. Lurie Comprehensive Cancer Center, blogs about some fertility options healthcare providers could discuss with young patients diagnosed with breast cancer. Ms. Smith is the speaker for our webinar, Fertility and Breast Cancer: Educational Opportunities and Preservation Options. Register now for this program and discover more about how you can help young women learn about fertility after breast cancer.
Providing care to young cancer patients who wish to pursue fertility preservation prior to initiating cancer treatment requires the collaborative efforts of oncologists, reproductive endocrinologists, nurses and many more within a short time frame.
Being able to effectively communicate and educate patients about the potential gonadotoxicity of cancer therapy, or damage to reproductive organs caused by treatment, and the available options for fertility preservation is essential to improve patient care. Many of the treatments we use to treat cancer for adolescent and young adult (AYA) women can decrease the likelihood of having biological children. High dose alkylating agents and pelvic radiation can destroy the ovarian reserve; radiation to the brain can harm the way the brain communicates to the gonads and surgical resection of reproductive organs can all make family building more difficult for patients.
For recently diagnosed young women, learning that their cancer treatment could lead to infertility can be devastating. Before beginning cancer treatment, multiple decisions need to be made in a short amount of time which can lead to additional stressors. If the proposed treatment is gonadotoxic and the patient is interested in biological parenthood in the future, options for fertility preservation should be presented and a referral to a reproductive specialist should be made quickly. Guidelines presented by the American Society of Clinical Oncology (ASCO), American Society of Reproductive Medicine (ASRM), National Comprehensive Cancer Network (NCCN) and many others all state a similar idea – AYAs should be provided with information on proposed treatment and fertility as well as with options and opportunity for a fertility referral in a timely fashion.
Standard fertility preservation options like embryo and egg freezing before beginning therapy can offer an opportunity to save gametes for patients who have the time and resources to undergo ovarian stimulation and retrieval. Ovarian tissue freezing is an experimental option to save ovarian tissue prior to treatment but requires an invasive surgery and using that tissue in the future for family building is still experimental. This option, however, is the only option available to pre-pubertal patients or others that do not have the time to undergo ovarian stimulation. Studies that have looked at using gonadotripin-releasing hormone (GnRH) analogues like Lupron, have shown mixed results. One recent study, though showed in women 35 and older who were diagnosed with ER/PR-negative breast cancer, GnRH agonist may help improve spontaneous menstrual activity post treatment.
As healthcare providers, we constantly strive to make sure we are accurately discussing medical data with our patients. Furthermore, our goal is to help patients come to a decision that they are comfortable with based on sound scientific evidence and their unique perspectives. This process is even more important when approaching a subject such as fertility preservation. This type of interdisciplinary care is at the forefront of AYA needs and having a fertility preservation champion within the cancer center certainly can aid patients and providers in this type of cancer care.
Kristin N. Smith is a fertility preservation patient navigator at Robert H. Lurie Comprehensive Cancer Center of Northwestern University, in Chicago. Ms. Smith consults with young people who have recently been diagnosed with cancer to help them understand their individual fertility risks associated with impending treatment, as well as their options for fertility preservation. Visit the Oncofertility Consortium website to learn more about Ms. Smith’s work.
Providers: register for our March 18 program to learn the roles you can take to educate your young patients about fertility options.