Roger (not his real name) was 19 when he received an alarming diagnosis: He had Ewing’s sarcoma. To fight his cancer, he was going to need multiple rounds of very intense chemotherapy.
As Connecticut Children’s oncologist Natasha Frederick, MD, MPH, MS, has explained to young adults like Roger, chemotherapy drugs must be potent to kill the cancer. Unfortunately, these same drugs can have devastating effects on other parts of the body.
For some patients, this includes future infertility. In Roger’s case, his chemotherapy carried a significant risk of leaving him sterile. If Roger wanted the option of having his own biological children in the future, he needed to make some important decisions regarding fertility preservation. And he needed to do it while dealing with a new cancer diagnosis. That’s a lot for a 19-year-old to take in all at once.
For Dr. Frederick, the Clinical Director of the Comprehensive Fertility and Sexual Health Team, difficult conversations like this are her specialty. “Many patients newly diagnosed with cancer are at risk for future fertility issues,” she says. “Our goal is to make sure that patients and families understand the risk for infertility and the options available to them for fertility preservation.”
For male patients who are past puberty and at high risk, like Roger, one option is collecting and freezing sperm. For younger, prepubescent patients, Connecticut Children’s, in partnership with the University of Pittsburgh, offers the chance to participate in a cutting-edge clinical trial. It involves a procedure called testicular tissue cryopreservation. A piece of the testicle is removed and frozen with the hope that, at a future date, the tissue may be re-inserted into the patient and resume its normal function.
For girls who have reached puberty, Connecticut Children’s partners with the Center for Advanced Reproductive Services to offer egg and embryo freezing. In cases where that isn’t an option, or for younger, prepubescent girls, Connecticut Children’s offers ovarian-tissue cryopreservation. This experimental method involves removing and freezing the entire ovary or a piece of the ovary before the child starts cancer treatment. When the patient is ready to start a family, doctors reimplant the tissue. This promising technique has proven successful in over 150 patients worldwide to date.
Sexual Health and Cancer
Another part of Dr. Frederick’s program is talking with adolescent and young adult (AYA) patients about sexual health during and after their treatments. Sexual health includes fertility as well as romantic relationships, body image, sexuality, sexual identity and safe sex practices. All of those are, of course, key concerns for adolescents and young adults.
Cancer can have a significant impact on all aspects of sexual health and these patients need to know about the potential short- and long-term problems they might have. Research shows that adolescents and young adults want their oncology doctors to talk to them about these issues, but these conversations rarely take place.
“For these conversations to work,” Dr. Frederick says, “the physician must be nonjudgemental, knowledgeable about the subject matter and comfortable taking a sexual history. The doctor also has to tell the patient which parts of the conversation will remain confidential. It is important to continue the sexual health conversation throughout treatment and into survivorship in a way that is developmentally appropriate for the individual patient.”
Dr. Frederick’s current research focuses on improving sexual health communication between AYA patients and their doctors.
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