Coping with the Long-Term and Late Effects of Cancer
Reproductive issues in childhood, adolescent, and young adult cancer survivors
Posted Nov 05, 2017
Success in treating cancer in young people has increased the proportion of those who now live to be adult survivors. Unfortunately, a significant percentage cope with health complications and even the threat of second cancers due to treatment with surgery, chemotherapy, or radiation therapy.1 These long-term effects (those that begin while being treated for cancer and last for 5 years or more) and late effects (those that begin after completion of treatment) vary due to many disease- and treatment-related factors. Long-term and late effects include possible damage to the liver, kidney, bladder, heart and lungs, muscles, bones, and teeth, and to the gastrointestinal, endocrine, and immune systems. These physically challenging aftereffects lead to difficulties in other areas related to young people’s future social, psychological, and socioeconomic development.2
Furthermore, survivors of childhood, adolescent, and young adult cancers may experience difficulties when they later try to conceive. Pediatric and adolescent cancer survivors are less likely to become parents than individuals in the general population.3 Research demonstrates the negative long-term effects of radiation therapy on fertility and the health of offspring of both men and women cancer survivors. This can promote worry among female survivors about possible infertility, cancer treatment’s effect on future children, and the potential for pregnancy to cause a recurrence. Males facing infertility may worry about stigma within the context of a culture that values fatherhood.4
Because as adults, fertility may be important to cancer survivors and related to their quality of life, understanding options in a timely manner is important for young cancer patients. Prior to cancer treatment these may include egg banking for females and sperm banking for males and during treatment shielding of ovaries and testes from radiation. Information about fertility assistance and resources are also available at: http://stupidcancer.org/support/fertility.shtml.
But there is a need to address quality of life issues, specifically in the area of reproductive health. This includes considerations beyond infertility and fertility preservation to include other aspects of psychological and social functioning. These include body image, sexuality, friendships, and romantic relationships. Now a web-based training program is available for allied health professionals such as social workers, psychologists, nurses, and physician assistants working in oncology settings (http://www.rhoinstitute.org/). This training includes psychosocial, biological, clinical, and skill building modules to help them communicate timely and relevant information regarding an array of reproductive health issues (e.g., fertility, sexuality, body image) to their adolescent and young adult oncology patients. Such professionals may be particularly well suited to the role of discussing reproductive health given that some aspects of their training (e.g., psychosocial counseling, coordination of services, health education) facilitate these discussions with patients.
1 PDQ Pediatric Treatment Editorial Board. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version. 2017 Sep 28. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK65832/
2 Moyer, A., Santore, E., & DiRienzo, A. (2014). Coping with long-term and late effects: challenges facing female survivors of childhood, adolescent, and young adult cancer. In M. Paludi (Ed.) The Praeger handbook on women’s cancers: Diagnosis, treatment, recovery and coping. New York: Praeger Publishers.
3 Madanat, L. S., Malila, N., Dyba, T., Hakulinen, T., Sankila, R., Boice, J. D., …& Lahteenmaki, P. M. (2008). Probability of parenthood after early onset cancer: A population-based study. International Journal of Cancer, 123, 2891-2898. doi:10.1002/ijc.23842
4 Marziliano, A., & Moyer, A. (2013). An additional consideration regarding expanding access to testicular tissue cryopreservation: Infertility and social stigma. American Journal of Bioethics, 13, 48-50.