My work has focused on fertility and family building among cancer survivors for over ten years now. My interest in this topic started when I was a postdoctoral fellow in clinical psychology at Memorial Sloan Kettering Cancer Center, specializing in psycho-oncology. The cancer center had a fertility program to ensure at time of diagnosis, all patients of reproductive age received counseling about the ways their upcoming treatment might impact their fertility and reproductive health. This program also helped coordinate referrals to a fertility specialist when needed. At the time, the entire program consisted of a single nurse practitioner, Joanne Kelvin, who was a wonderful and dedicated clinician. She met with each patient and supported them through the process of learning about the risks associated with their treatments, answering all of their questions, and coordinating their care if fertility preservation was desired and possible.
There was growing awareness in the field of oncology about the importance of fertility for patients of reproductive age. However, much of the attention was focused on time of cancer diagnosis. Joanne and I spoke often about the need to provide ongoing care and support for patients as they went through treatment and especially after treatment into long-term survivorship, as they started to think about building their family. Most patients are unable to undergo fertility preservation before cancer treatment begins because of numerous barriers such as high costs, lack of time, and feeling too overwhelmed with a new diagnosis and upcoming treatment. Many patients also never receive fertility counseling and are unaware of the risks their treatments pose to their fertility. In all of these scenarios, survivors may have a lot of questions and worry if and how they will be able to have a child. Counseling about cancer-related infertility risks and giving patients the option to preserve their fertility is important and necessary.
Our early research revealed that many survivors who completed treatment felt lost and uninformed about their options for fertility care and family building. As a clinical psychologist, many of my patients share a similar sentiment. We work together on coping strategies for the many emotions that arise due to their cancer experience and fertility including grief, anxiety, fear, anger, and sadness. We also explore reasons to feel hopeful and the ways family building may intertwine with that.
Over the years, we have led a number of studies to better understand how cancer survivors make decisions about fertility and family building after cancer and the types of support and resources they need and want. Based on this work, we developed Roadmap to Parenthood, a decision aid and planning tool for family building after cancer. The focus of our current research is testing the tool in a randomized clinical trial to see if it is useful to survivors and helps them with family planning for the future. We will also collect information about how to
improve the tool and cancer survivorship care for patients around this topic. As a part of this project, we will interview cancer care providers, primary care providers,
gynecologists, and fertility specialists to learn what education and resources they need to better serve their patients. We hope to help people feel empowered to make decisions and be prepared for the uncertainty and challenges of building and expanding their family after cancer.
By: Catherine Benedict