By S. Fenella Das Gupta, Ph.D., Neuroscience
The malignant growth that is cancer does not discriminate—a person of any race, creed, color, nationality, marital status, gender, sexual orientation, disability or socioeconomic status can be affected.
Our healthcare system does however discriminate between cancer patients.
When it comes to informing patients of the effects of chemotherapy and radiation on their fertility, studies conducted in Sweden and the US reveal some disturbing new findings and trends.
In a recent Swedish study published in the Journal of Clinical Oncology, of nearly 500 cancer survivors (18 to 45 years old), 80 percent of men said their doctor had told them their chemotherapy could affect their reproductive capacities, but only 48 percent of women surveyed said the same.
The study went on to show that only a meager 14 percent of women said they received any information on options to preserve their fertility, versus 68 percent of men.
Although this study is relatively small in size, the results and the conclusions that can be drawn from the study cannot be ignored and are disquieting at the least.
The overall trend shows that women are less likely than men to be informed of how treatment would impact their fertility. Furthermore, they aren’t given enough information once initially diagnosed to make an informed decision about their fertility preservation care.
The disparity between the sexes may be related to the fact that preserving fertility in women is a far more complicated issue than in men.
For example, although the best option for women may be to undergo egg retrieval and/ or IVF before cancer treatment begins, this is neither an easy process nor a guarantee of good egg quality or embryos. It also comes with drawbacks; hormonal stimulation of the ovaries raises estrogen levels, so this isn’t a safe option for women with certain types of estrogen-dependent cancers, including some forms of breast and uterine cancer.
Men on the other hand can have their sperm frozen and banked prior to cancer treatment. This relatively quick and simple process is also comparatively inexpensive ($300-600) compared to female fertility preservation (costs between $12,000 and $20,000; egg freezing is $8000 per cycle and medications range from $2,500-$5,000).
Although fertility counseling figures in the US are better than in Europe, with 61 percent of women cancer patients aware of the possible risks that cancer treatment posed (in a study of 1041 women). There are significant socioeconomic and racial disparities.
Women who hadn’t obtained a Bachelor’s degree were less likely to be counseled on their options. In fact, results revealed that women who were childless, younger, white and heterosexual were more likely to be told about the possible effects of cancer treatments on their fertility than their non Caucasian counterparts.
Trends also suggested possible disparities in access to fertility preservation in women over the age of 35 and those with previous children.
It doesn’t stop there- disparities in access to fertility preservation based on sexual orientation were also observed.
These lapses in treatment are simply unacceptable, especially given that in the US alone, nearly half a million cancer survivors are of child-bearing age. And an average of 50% of all fertile women receiving chemotherapy will enter menopause because of cancer treatment.
In the light of these results, our healthcare system needs to take note that African Americans have the highest death rate and shortest survival rate of any racial and ethnic group in the US for most cancers. Social and economic disparities more than biologic differences have been blamed as the cause. Outreach programs and health care reform are a must, given these trends.
One certain outreach program is the Non Profit organization Fertile Action founded by Alice Crisci. Fertile Action is dedicated to helping women cancer patients negotiate discounts for fertility preservation treatment. Borne from her own struggles to become a mother in the face of cancer and its treatment, Crisci has forged a path recruiting fertility specialists to donate their services and medications pro bono to help the plight of cancer patients facing fertility issues.
This is the start, but is this enough?
Should a non profit such as Fertile Action have to exist to advocate for human egalitarian rights such as these? What do you think needs to change here?
Fenella Das Gupta is a licensed Marriage and Family Therapist ( #47275) working in Northern California,specializing in fertility counseling. She works with individuals and couples as they make their way through the fertility maze. The other part of her work includes making fertility issues a newsworthy item, as she writes for the Petaluma Patch-a subsidiary of the Huffington Post. To read more about fertility issues in the news go to http://petaluma.patch.com/users/fenella-das-gupta-phd-neuroscience-mft/blog_posts