Principles of Cancer Treatment: Impact on Reproduction

Abstract

According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database [1] 1 million 445,000 new cases of invasive cancer (766,860 in men and 678,060 in women) were diagnosed in the US in 2007 [1]. Approximately 1,530,000 new cancer cases were expected to be diagnosed in 2010 (789,620 in men and 739,940 in women). Men have an overall 45% risk of developing cancer at some time during their lives, which is higher than in women who present with 37% lifetime cancer risk. Age is the most significant risk factor for cancer in both sexes. However, even younger adults and children may develop cancer and in people younger than 39 years, the risk is of about 1/72 for men and 1/51 for women. For adults between 40 and 59 years, 1/12 men and 1/11 women will develop cancer.

A lot of advances have been made in science, technology and reproduction but still we can’t say for sure who will or will not be temporarily or permanently sterile from cancer or the treatment. So I think it’s best to discuss it will all patients who are of reproductive age. It’s not an easy discussion to have. You’ve just told someone they have cancer and now you tell them they may not be able to have kids. Some people don’t care, or at least they think they don’t care at the time. Some people are more upset about the news of infertility than they are about the cancer. You can’t assume because you look at a patients chart that you know how they feel about fertility. Even if they already have kids or they aren’t married or they are struggling financially, it’s something that has to be discussed.

I had a testicular cancer patient, Sam, a few years ago with late stage disease. When I talked to him about fertility he got very excited – he said it was the most hopeful thing he’d heard since he came to the hospital. Then I wondered if I had given him false hope, because his odds were not too good, In fact they were pretty dismal. But that guy was bouncing off the wall with joy at the thought of banking sperm, and I thought maybe he would benefit from thinking some happy thoughts for a while. He did bank sperm, and it seemed to lift his spirits but in the end, he didn’t survive the cancer.

I had a female patient with a GU cancer who said she wanted no part of a discussion about preserving fertility. She was only 25, but she said she knew she didn’t want kids, and had never wanted them. So I stopped trying to talk about it. She did well and she’s in graduate school now and just got married. At her last check-up, she told me she wished she had listened to me about the fertility. Now that she’s doing well and married she has a new perspective on children and just learned she is infertile. She and her husband are trying to adopt but it’s not an easy process for a cancer survivor. That taught me a lesson. I now insist my patients listen to the infertility talk, even if they say they don’t want kids I try to explain that a lot of people feel differently when the treatment is over and they go on with their lives. I even tell them about Sam and how much hope that sperm banking gave him in his last days. I think as oncologist we have to not only talk about how to manage the disease, but how to prepare for survivorship. Sometimes we have to talk about end-of-life issues too. None of it is easy, but it’s all worth it.

Dr. A, Oncologist