A group of surgeons and oncologists from Stanford University recently published a report that looked at the timing from initial cancer diagnoses to the beginning of surgery or chemotherapy in women who underwent fertility preservation (in the form of oocyte retrieval and cryopreservation, OR) and women who did not (CONtrol). The study found that the time from initial diagnoses to the beginning of chemotherapy was not significantly different depending on whether women chose to undergo fertility preservation (and average of 71 vs 67 days for OR and CON, respectively). The authors conclude, “The time investment required for OR and cryopreservation is manageable and does not significantly prolong the time interval from diagnosis to start of adjuvant chemotherapy.”

Image: Usaonlinehealthnews.com

Obviously, we are working to make sure that women with even a very small window of opportunity before cancer treatment have options for preserving their fertility. Still, it is very heartening to know that for many women, undergoing potential fertility saving measures does not mean they will necessarily delay their treatment.

The most recent healthbeat from the US Department of Health and Human Services briefly discussed the topic of survivors of childhood cancer having children. The point made is that these patients had no increased risk of having children with birth defects, though they were at higher risks for having preterm births and low birth weights. You can listen to this blurb at the HHS site here.

From the NCI Cancer bulletin (www.cancer.gov):

Image: NCI

NCI has launched a new Web portal that provides a single access point to information for adolescent and young adult (AYA) cancer patients aged 15 to 39. About 70,000 AYAs are diagnosed with cancer each year in the United States.

Cancer is the second leading cause of death in this age group. Yet, substantially less attention has been given to young adults with cancer than to children and older adults, and improvement in the survival rate of young adults has not kept pace with that achieved in other patient groups. Reasons for this lack of progress include issues specific to this age group: differences in biology or intolerance of therapy, delay in diagnosis, physicians unfamiliar with the disease, a lack of both available clinical trials and access to these trials, and, often, the psychosocial condition of the patient. Additionally, AYA patients often have special concerns that differ from those of older cancer patients, such as preserving fertility, being able to obtain health insurance and access health care following a cancer diagnosis, and feeling isolated because of a lack of peers who can relate to fighting cancer at their age.

The portal was developed in response to a report by the Adolescent and Young Adult Oncology Progress Review Group (PRG). This PRG, a collaborative effort between NCI and the Lance Armstrong Foundation, was followed by Closing the Gap: A Strategic Plan, developed to address recommendations in the PRG report. The AYA cancer portal is designed to reach newly diagnosed AYA patients with evidence-based information that will help them learn more about their treatment options and participate in treatment-related decisions, explore clinical trial options, get emotional/coping support, and learn about organizations that provide information and support to AYAs.

We are excited to announce that the Oncofertility Consortium’s patient-facing website, www.myoncofertility.org, is featured as a prominent resource on the portal, linking young cancer patients with the information they need to best navigate the difficult fertility preservation decisions that they face when confronting a cancer diagnosis

The portal can be accessed at http://www.cancer.gov/cancertopics/aya.

Next week, October 17, several of our Oncofertility Consortium members will be participating on a panel at the American Society for Bioethics and Humanities conference in Washington, DC. Their panel title is:  “From Lab To Bedside To Patient And Back Again: Gendered Responses To Questions About Fertility And Cancer Treatment And Their Clinical And Research Implications.” Below is an abstract for the meeting, as well as a quick summary of what each presenter will be talking about. If you happen to be attending the meeting, the panel will be held at 5:45-6:45; it promises to be interesting!!

Abstract
Because of recent breakthroughs and improved treatments, more people who are diagnosed with cancer survive. And many of these people are young, either in their childbearing years or survivors of childhood cancer. Indeed, one estimate is that by 2010 one of every 250 adults will be a survivor of childhood cancer. But while more aggressive treatments have allowed more young people to survive cancer, these treatments have also resulted in impaired fertility for some. Oncofertility has emerged as a way to address this threat to fertility for those with cancer, and through biomedical research the field is actively developing new ways to help those afflicted with cancer preserve their ability to have biological children.

Oncologists focus on treating a patient’s cancer, but cancer is more than a physical illness for the patient. Cancer, and its implications, has social, cultural, and familial repercussions for patients as well. One such implication is cancer-related infertility. As a result of improved survivorship rates, cancer-related infertility will become a greater concern for patients and their families as the growing cohort of childhood cancer survivors begins to age. Oncofertility is necessarily interdisciplinary, bridging biomedical and social sciences such as bioethics, law, and religion, in a broader effort to examine issues regarding a person’s fertility concerns, choices, and options. In this panel, we will raise the following questions: How are patients affected by infertility as a result of cancer treatment in their day-to-day lives? How is a cancer patient’s sense of self changed because of the possibility (or reality) of infertility? Are these responses different for men and women? And how do their responses affect treatment options – how do (or should) patients’ responses, desires, and beliefs affect treatment options that are part of standard therapy and/or are part of new research?

Panel members:
1) Jacqueline Jeruss, MD, PhD, Assistant Professor, Department of Surgery, Northwestern University: Dr. Jeruss, a member of the Oncofertility Consortium, will provide an overview of clinical aspects of oncofertility, describing her experience with patients at the bedside. Furthermore, she will explain the goals of the clinical side of the Oncofertility Consortium, how they respond to patient needs and demands, and what clinicians have achieved thus far.
2) Shauna Gardino, MPH, Clinical Research Coordinator, Oncofertility Consortium, Northwestern University: Ms. Gardino will discuss the Oncofertility “Quality of Life” survey she is conducting, specifically, the questions that are asked, why they are asked, and what the results are so far.
3) Sarah Rodriguez, PhD, Research Fellow, Oncofertility Consortium, Northwestern University: Dr. Rodriguez will analyze how the social implications of infertility in our culture, which places a high value on women bearing children, affects women with cancer and their fertility decisions.
4) Lisa Campo-Engelstein, PhD, Research Fellow, Oncofertility Consortium, Northwestern University: Dr. Campo-Engelstein will focus on how men’s experience with cancer and infertility differs from women’s. She will explore how social expectations of masculinity, especially sexual prowess, shape the fertility choices of male cancer patients.

HemOnc Today has published a nice article discussing what responsibility the oncologist has in informing the patient about his/her fertility risks and potential for preservation. The article cites the most recent American Society of Clinical Oncologists (ASCO) meeting, which found that only approximately 25% of oncologists refer their patients for fertility preservation. Furthermore, less than 40% of oncologists were aware of ASCO’s recommendations for patient guidance and navigation regarding fertility preservation. The article also discusses benefits and disadvantages of current fertility preservation methods available for men and women, including gamete cryopreservation, embryo creation and freezing, and ovarian tissue banking.

Related to the last blog on fertility choices in the economic recession, it seems that up to 51% of oncologists don’t mention fertility preservation options to patients because they believe that these measures will be financially out of reach.

To overcome these obstacles in doctor-patient communication, the article suggests that oncologists seek information from the Oncofertility Consortium’s Physician hotline and be very clear in their recommendations to patients, as these can be incredibly influential in the patient’s ultimate decisions about fertility preservation.

By Lisa Campo-Engelstein

A recent report  by the Guttmacher Institute (downloadable pdf is here) found that the recession has significant effects on women’s fertility preferences, contraceptive preferences and use, and access to reproductive services. These effects have been especially significant for lower income women. Nearly half of all women surveyed stated that, due to the economy, they want to delay or reduce childbearing. This effect is not surprisingly given that the average cost of raising a child for eighteen years (not including college) ranges from $143,790 to $289,380, depending on income (U.S. Department of Agriculture). Because of their increased concern to prevent pregnancy, some women are turning to more effective contraceptives and being more careful to use contraception regularly. However, other women are not using contraception as consistently as a way to save money. Additionally, women are delaying reproductive health visits or switching to a cheaper contraceptive to save money.

This economic downturn probably affects cancer survivors and patients as well. Cancer survivors who banked eggs, embryos, or ovarian tissue prior to cancer treatment may delay childbearing because assisted reproductive technology (ART) is so expensive, especially for individuals without insurance who will be paying out of pocket. Cancer patients may choose not to freeze eggs, embryos, or ovarian tissue because of the current cost of storage as well as the future costs of ART and childrearing.

Reference: Guttmacher Institute. September 2009. “A real-time look at the impact of the recession on women’s family planning and pregnancy decisions.” www.guttmacher.org

The third annual meeting of the Oncofertility Consortium will be held next week, September 13-15, in Chicago, Illinois. Over 150 participants from the U.S. and abroad will discuss the latest breakthroughs in the science and clinical applications of fertility preservation methods for cancer patients. More information on the event, including a meeting agenda, can be found here.