Fertility Concerns of Cancer Survivors Inadequately Addressed
Surviving cancer leaves many survivors with changes in sexual function, leaving them feeling guilty and a longing for intimacy.
Professor Bogda Koczwara from Flinders Medical Centre in Adelaide told the 35th Congress of the European Society for Medical Oncology (ESMO) in Milan, Italy that these sexuality and fertility concerns are often not adequately addressed by doctors.
Fertility and sexual function concerns are a growing problem among cancer survivors due to a combination of improved cancer treatment outcomes in young cancer survivors and the trend for people to delay having children.
To evaluate the range of fertility and sexuality concerns among these patients, Koczwara and her colleagues interviewed 25 cancer survivors --19 women and 6 men.
Prof Koczwara stated, “Respondents perceived fertility as an important concern that was often inadequately addressed by healthcare providers.”
The researchers found that fertility was important for these patients’ sense of identity and body image. This held true even for the women who had who have already completed their family and the women who had no plans for further children.
Koczwara noted, “That is important, as doctors may not raise these issues with patients who claim not to have plans for further children. As our study points out, maybe we should.”
Sexuality and fertility can be affected by cancer and its treatment in a variety of ways. For some cancers, treatment may involve removal of reproductive organs. For others, the chemotherapy or radiotherapy may affect reproductive organs function either temporarily or permanently. For most patients, cancer treatment, delays reproduction and by making the patient unwell may impact on sexual desire.
In this small study, sexual concerns seemed to be related to changes in body image and sexual identity, and the often discrepant sexual needs of patient and their partner.
For single people, changes in sexual function resulted in anxiety about entering into future relationships.
The study noted an association of feeling of guilt with the lack of desire attributed to cancer treatment. Even though over time, many respondents accepted fertility loss, there continued to be a struggle with the ongoing impact of changes in sexual function and its impact on their relationships.
Prof Koczwara said “There appears to be a need for raising awareness of these concerns among cancer professionals and providing them with information and training regarding these concerns.”
Prof Ian Olver, CEO of Cancer Council Australia, commented that the presentation by Prof Koczwara highlights a major issue that impacts on the quality of life of people who survive cancer.
Olver noted, “Up to 65% patients diagnosed with cancer are still alive in 5 years, and survival is increasing with better treatments. Until recently the emphasis was on treating the cancer but it is being increasingly recognized that a variety of psychosocial problems and late effects of treatment persist and need to be addressed in this population.”
“Perhaps the most surprising aspect of Prof Koczwara’s study is that issues of fertility are important even to those who have completed their families, which highlights the importance of fertility to a person’s identity. The call for greater awareness amongst cancer professionals of sexual and fertility issues should be translated as the need to provide the opportunity for patients to discuss these issues and then have the appropriate support to help in their resolution.”