For childhood cancer patients and their families, fertility issues may be the furthest thing from their mind as they make treatment decisions. But cancer therapies can have significant effects on their future fertility as adults — and the right care plan can make all the difference.
“Fertility questions rank very high on surveys of concerns that patients, parents and survivors have,” says Layne Chapple, our Fred Hutchinson Cancer Center – Proton Therapy advanced registered nurse practitioner (ARNP). “One of survivors’ biggest regrets is not having discussed fertility issues prior to treatment.”
Seattle Children’s Hospital recently offered a continuing medical education program on fertility preservation in childhood cancer patients. Our proton therapy childhood cancer specialists — Dr. Ralph Ermoian, Dr. Stephanie Schaub and ARNP Layne Chapple — attended in order to learn how to better serve our patients in this critical area.
Fertility issues are at the forefront of treatment considerations when dealing with pelvic cancers, but even brain cancer treatments can have impacts on fertility.
“Fertility can be impacted by different cancer therapies, such as chemotherapy, radiation therapy or surgery,” says Dr. Schaub, a pediatric and sarcoma radiation oncologist. “That’s why it is essential to partner with the various departments to understand each type of treatment and how this impacts fertility. A collaborative approach to treatment can make sure that the combined plans work best for the patient.”
Radiation oncologists, medical oncologists and surgeons can discuss where to surgically move an ovary so that proton therapy can best target a nearby cancer, and which chemotherapy drugs will lessen the risk of infertility. This will guide a comprehensive recommendation to the patient on their overall risk of fertility issues and help provide proactive solutions for fertility preservation when possible.
“The biggest takeaway for us in this program was how collaborating with all of a patient’s other doctors, including medical oncologists and surgeons, early on — or even before starting treatment — can provide the best results for our patients,” says Dr. Ermoian. “Therefore, the timeline to intervene is urgent. Options to preserve fertility can become more limited after treatment has started.”
Tools discussed in the program include an experimental protocol called testicular tissue cryopreservation. Seattle Children’s is at the forefront of this new option, which allows doctors to preserve sperm tissue from prepubescent and select pubertal boys who are not candidates for sperm banking or sperm extraction. Previously, there were no real options to save this tissue in children who had not yet reached puberty. This is especially important from a radiation oncology perspective because the testicles are extremely sensitive to radiation.
Seattle Children’s also offers ovarian tissue cryopreservation for prepubescent and select pubertal girls who were not able to undergo ovarian stimulation and egg retrieval. This program has become more frequently used at Seattle Children’s but is not yet widely available nationally or internationally. Like the boys, the girls didn’t have options to save ovarian tissues before they reached puberty.
“By creating a Comprehensive Fertility Preservation Program, Seattle Children’s Hospital wants to offer tools and guidance to referring physicians as well as their own doctors,” says Dr. Schaub. “Programs like this one emphasize the advocacy that happens at Seattle Children’s to be thoughtful about patients’ cancer treatment, but also their future, to keep as many doors open as possible.”
“It’s helpful for the patient to understand treatment implications, too,” says Dr. Schaub. “We want to empower them to understand why we are doing what we are doing, so they can help achieve their goals.” Thinking about fertility and hormonal function is important at any age, even in very young children and in adults who don’t plan to have children. Radiation can cause early-onset menopause, which comes with its own health issues.
If you have questions about fertility preservation, how proton therapy can be beneficial and how our doctors can help, please reach out to us at protoninfo@fredhutch.org.
