Hope Beyond Cancer Treatment for Women

When the doctor told me I had cancer, all I could think of was that I had to fight for a future with my partner that I’d always taken for granted would happen. I was so wrapped up in the diagnosis and treatment suggested by the oncologist that I did not immediately think to ask how the treatment would affect my body long term, and my ability to bear children. The oncologist was focused on saving my life, but I would have appreciated receiving more education around the impact of treatment on my fertility and steps I could have taken to preserve fertility. *

In many cases, cancer surgery or treatments can be more likely than cancer itself to interfere with some parts of the reproductive process and affect a woman’s ability to have children. Different types of surgeries and treatments can have different effects (1).

The risk of infertility varies depending on (1):

The patient’s age and stage of development; for example, before or after puberty, before or after menopause, etc.
The type and extent of surgery; for example, the removal of reproductive organs
The type of treatment given (radiation therapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, stem cell transplant)
The dose of treatment

Infertility in all women is associated with significant psychological distress. Women report that their emotional well-being, relationships, and sexuality are affected, leading to a loss of quality of life (2).

When infertility is caused by cancer or cancer treatment, an already difficult circumstance may become unbearable. Women are forced to weigh up their desire to preserve childbearing potential against possible delays in treatment this may result in (2).

Women may experience infertility as painfully as the cancer itself, resulting in a deep sense of loss and anger (2).

Poster

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Studies Indicate a Lack of Patient Counselling

In the USA, research regarding oncologists’ discussions with premenopausal women regarding fertility changes associated with breast cancer treatment suggests that between one-third to two-thirds of women are not counselled regarding the impact of cancer treatment on their fertility. Rates for other cancers are even lower. (2)

A CANSA funded research study (2020) “Contraceptive needs and fertility intentions of women with breast cancer in Cape Town, South Africa: a qualitative study, by CANSA’s Head of Research, Jane Harries, reported that women received:

Limited information regarding the impact of cancer treatment on future fertility or around fertility preservation options, and few women were familiar with the concept of fertility preservation
Limited information regarding contraceptive use and future fertility planning (post treatment)

A need was identified for a more holistic and multidisciplinary approach to patients’ contraceptive and future fertility needs, despite limited fertility counselling and options for women with cancer in the public sector. (3)

Women to Take Initiative

CANSA advises women about to undergo cancer treatment or surgery to initiate discussions around the impact the treatment or surgery will have on their fertility and the steps that may be taken to preserve fertility and not to rely on the medical team to do so.

They should ask oncologists to explain the risks and chance of success involved with a particular fertility option and it is important for women to understand that no preservation method works a hundred percent of the time.

Oncologists should also consider patients’ preferences, religious or personal beliefs and the cost of available options when discussing preservation methods.

Women are also reminded that they may seek a second opinion or ask for a referral to a fertility or reproductive specialist if they wish to do so (4).

A Story of Hope

Soon after her engagement in 2020, Ashleigh Keuleman was diagnosed with triple negative breast cancer. Her oncologist encouraged her to preserve healthy eggs before starting treatment. After treatment, tests revealed that her ovaries were unproductive, and she was relieved that she had taken the oncologist’s advice. However, halfway through 2021 a miracle happened, her ovaries started functioning again and she started menstruating. The doctors cautioned her that it was highly unlikely although not impossible for a natural pregnancy to occur. In June 2023 Ashleigh and her husband were able to announce that they were expecting their first child – a miracle baby, conceived against the odds.

Emotional Support

CANSA offers free Tele Counselling in 7 languages and women who may be anxious or distressed about fertility related effects of cancer or treatment are encouraged to reach out for support by making an appointment at 0800 22 66 22 or emailing counselling@cansa.org.za – furthermore women and their loved ones and caregivers are encouraged to join support groups (WhatsApp / face to face), or Facebook support groups and to make use of free online resources available on the CANSA website.

*fictitious scenario

References:

(1) How Cancer and Cancer Treatment Can Affect Fertility in Females
https://www.cancer.org/cancer/managing-cancer/side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html

(2) Medical and Psychosocial Aspects of Fertility After Cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719717/#:~:text=Surgical%20treatments%20that%20remove%20the,total%20abdominal%20hysterectomy%20with%20oophorectomy.

(3) Contraceptive needs and fertility intentions of women with breast cancer in Cape Town, South Africa: a qualitative study https://cansa.org.za/breast-cancer-research-prof-jane-harries/

(4) CANSA Media Release: Preserving Hope: Fertility Discussions for Female Cancer Patients
https://cansa.org.za/preserving-hope-fertility-discussions-for-female-cancer-patients/