Q&A On Fertility After Adolescent or Young Adult Cancer
Each survivor’s risk of late effects of cancer treatment depends on their tumor, specific treatments, age, genetic makeup and other factors. Surgeries, chemotherapies, radiation, stem cell transplants and other treatments take a toll on the body – and sometimes the mind – in many ways. Some late effects make life more difficult; others are life-threatening.
Heart and lung problems are common, as are secondary cancers.
Other late effects can include hearing problems, hormonal imbalances, difficulty growing, mental health needs or cognitive deficiencies, bone density issues and easy bone fractures, fertility and reproductive problems, and more.
We asked St. Baldrick’s Scholar Dr. Hazel Nichols to tell us about some of the reproductive health issues faced by adolescent and young adult (AYA) cancer survivors:
How does cancer treatment impact fertility?
Cancer treatments can potentially affect future fertility. For example, radiation therapy to or near the abdomen, pelvis, or spine can harm nearby reproductive organs. Radiation therapy to the brain can also damage the pituitary gland, which helps control the production of certain hormones needed for pregnancy.
Some types of chemotherapy can affect the ovaries, reducing the number of eggs and changing hormone levels. Having been treated for cancer during adolescence and young adulthood can also affect sexual health, body image, and financial stability during childbearing years.
Read about 2012 St. Baldrick’s Ambassador Sarah’s dreams of becoming a mom here
Do patients or their families receive counseling on these options?
Counseling patients on the effects of cancer treatment on fertility and options for fertility preservation is recognized as a critical part of high-quality cancer care. National guidelines recommend fertility counseling for AYA patients before cancer treatment.
However, fertility counseling has been described as one of the most under prescribed and least implemented services in cancer care. More than half of AYA cancer survivors report needing more information for reproductive planning both before and after cancer treatment. This unmet need has been associated with lower emotional functioning and health-related quality of life.
How is your St. Baldrick’s supported research helping childhood cancer survivors?
Despite advances in fertility preservation options and recognition of fertility counseling as a part of high-quality cancer care, the incidence of post-diagnosis childbirth has remained stable for many years.
My research is working to understand what the needs and challenges are for accessing fertility-related services.
Specifically, I am examining AYA cancer survivors’ age, race, and rural residence in relation to using fertility preservation options. We hypothesized that fertility preservation will be more common at older ages and in more recent diagnosis years, and will be less common for AYAs with a rural residence or African American race. Our research helps identify barriers to use of fertility services to inform strategies to improve cancer care delivery.
We showed that, during 2004-2015, only 1.2% of female AYA cancer survivors froze eggs or embryos for fertility preservation after cancer diagnosis in North Carolina. Younger women were 6 times more likely to use fertility preservation than older women. Women who were Black or who lived in rural areas or had lower socioeconomic status or had children at diagnosis were less than half as likely to use fertility preservation. We believe these results highlight the barriers that that cost creates for accessing fertility preservation, and caution that women who have children already may less often receive fertility counseling around having additional children in the future.
June is National Cancer Survivor Month, a time to celebrate childhood cancer survivors – and to keep the focus on progress. St. Baldrick’s will continue to support research not only to find new cures, but better ones.
(2022). Disparities in fertility preservation use among adolescent and young adult women with cancer. Journal of cancer survivorship : research and practice, 10.1007/s11764-022-01187-y. Advance online publication. https://doi.org/10.1007/s11764-022-01187-y
Help kids to survive and thrive. Support research into better treatments for kids with cancer
Read more on the St. Baldrick’s blog:
Surviving Cancer – Through the Eyes of a 16-year-old
Want to know what it’s like to be a teenage survivor of childhood cancer? We asked 16-year-old Michael G. to share his experience, during National Cancer Survivor Month.
This New Tool Could Mean Better Health For Childhood Cancer Survivors
For childhood cancer survivors, treatment helps them to live, but often that survival comes at a cost. But what are these costs? And how big is the problem? That’s what St. Baldrick’s Fellow Dr. Nickhill Bhakta wanted to figure out. And as it turns out, that data could be a lifesaver.
St. Baldrick’s Fellow Dr. Nickhill Bhakta works at his desk in St. Jude Children’s Research Hospital. With a portion of the grant supported by the St. Baldrick’s Friends for Hope Fund, he developed a special statistical tool to help capture the true volume and complexity of chronic health conditions faced by childhood cancer survivors because of the long-term consequences of their treatment — something that hadn’t been done before. Photos courtesy of St. Jude Children’s Research Hospital
Checking the Life-Threatening Box: A Survivor’s Update
A childhood cancer survivor himself, Gregory J. Aune, MD, PhD, shares his personal experience and thoughts during National Cancer Survivor Month.
(Originally posted on Medium on May 19th, Dr. Aune graciously agreed to share this with St. Baldrick’s.)
Dr. Aune was a St. Baldrick’s Scholar 2014 – 2019, serves as a scientific reviewer and is a member of the Advocacy Committee for the St. Baldrick’s Foundation. He is the Greehey Distinguished University Chair for Cancer Survivorship in Children at Greehey Children’s Cancer Research Institute in San Antonio, Texas.
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June is National Cancer Survivor Month, a time to celebrate childhood cancer survivors – and to keep the focus on progress. Because surviving is just the first step in a lifelong journey.
Research Outcomes: Progress from Bench to Bedside
With your help researchers continue to answer questions, seek out cures, and reduce long-term effects of treatment. Four exciting research outcomes you made possible are detailed below:
Leave No Stone Left Unturned: To Fund the Best Childhood Cancer Research
Your Donations Help Find Cures and Improve Quality of Life for Survivors
St. Baldrick’s is dedicated to scouring the nation in a relentless pursuit to discover and unearth the most promising research. We fund the most innovative researchers so they may provide the most effective and ground-breaking treatments to every single childhood cancer. It’s this tenacity that ensures donors that they’re helping to propel advancements that will find cures for childhood cancers and develop less toxic treatments, giving survivors long and healthy lives. We find and fund the very best of the best. So put your money in the hands of the researchers who offer us all the very best chance to make a huge impact. Please donate today.
The Long and Winding Road to Survivorship
Before the doctors even told us, I knew. Micah had cancer. Even without understanding the enormity of what lay ahead, I knew that it meant my life and worse, my child’s life, would never be the same. Now I’m sharing my son Micah’s story because I believe in the critical need to support childhood cancer research with the St. Baldrick’s Foundation. Please join me in giving hope to the next child faced with a cancer diagnosis.
Most parents simply hope their child grows up to be a good person.
I mostly hope mine just gets the chance to grow up.
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Editor’s Note: Brooke is an Ambassador and Honored Kid who just graduated from Stanford University. As Cancer Survivors Month continues on the St. Baldrick’s Blog, we’re letting her tell the story of how she got to this day in her own words.
On Thursday, September 24, 2015, my friends were finishing up their first week of junior year at Stanford. I was lying in a hospital bed, watching as my brother’s stem cells were infused into my body, replacing the bone marrow that had turned against me.
On Friday, September 25, my friends celebrated their first weekend back together at school. I had a grand mal seizure.
When I was diagnosed with acute myeloid leukemia at the end of my sophomore year of college, I knew that I was going to have a very different college experience from my peers. I had no idea how different it would be.
I had the impression that I would either die or I would live and return to my previous life. I had a high-risk form of leukemia that did not respond to my first round of chemotherapy, and at first it seemed that the death option was more likely.
But when I got into remission on a salvage round of chemotherapy and proceeded to my bone marrow transplant, I was hopeful that a return to “normal life” was possible.
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What jumps out after talking with Shane Callaghan? His positivity. In a recent interview with Shane and his dad, Casey, Shane took center stage with his upbeat, can-do attitude – in spite of a lifetime worth of medical setbacks for a kid who is only 14. Shane has faced multiple treatments for osteosarcoma, which was first diagnosed in October 2015.
The following July, Shane was declared cancer-free. But the cancer in his left leg returned in March 2018. Following his relapse, chemotherapy led to an infection that severely damaged his kidneys. While his kidneys are better, they only function at 50% and are unable to handle heavy doses of chemo. On April 1, 2019, Shane’s left leg was amputated to remove the cancer and ultimately save his life.
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