Page 3509 - Week 10 - Wednesday, 18 September 2019
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Amy arranged to get the cyst drained; then she received the call. This time something definitely was not right. Amy had been right all along. A biopsy confirmed it was a highly aggressive, stage 3 breast cancer. By the time Amy could see a surgeon and arrange a treatment plan, Christmas was fast approaching. She was told she needed to begin chemotherapy the following week. By the time she could see a fertility specialist, she was told it was too late to freeze her eggs. The risk of holding off chemotherapy until after Christmas so that she could harvest her eggs was deemed to be too great. As Amy says:
By the time anyone told me anything about fertility treatment it was just too late. Because of the delay and the misdiagnosis there was no chance for me.
Amy has now finished chemotherapy and has undergone a double mastectomy. She does not know what impact the chemotherapy has had on her fertility, but there is a very real chance that she will not be able to conceive a child. It is not as simple as trying to fall pregnant, either. It can take 12 to 18 months to recover from chemotherapy and be healthy enough to try to conceive.
Discussions about fertility preservation should and often do form part of a broader approach to treating patients with cancer or another serious disease, but these decisions are complex and they also need to be made quickly. Patients have very specific needs that require tailored treatment and close collaboration between the surgeon, medical and radiation oncologists, fertility specialists, and geneticists. The more supported a patient is, the better.
As it stands, fertility preservation conversations are not always a key component of care, and there are barriers to it being a key, prompt component of care. There is no rapid referral system for fertility preservation in the ACT. GPs need to refer patients to cancer specialists, who then refer them to fertility specialists. There are costs involved—financial costs, but also the costs involved when there are delays in getting the appointments, at a time when being prompt, efficient and quick is everything.
Whether this is a key component of care or not, whether things have progressed quickly or not, the fact remains that these decisions are ones which are complicated and overwhelming. Many people have not considered fertility preservation generally, let alone in the face of an overwhelming cancer diagnosis.
Professor Robson says he often gets confused calls from patients and specialists regarding fertility preservation options. Just last week he heard from two women in their 30s in the space of 24 hours. Both were overwhelmed by their cancer diagnosis and fearful that they may not be able to have children. In both cases Professor Robson also responded to calls from the women’s specialists, who lamented that the fertility process was ad hoc, with no clear pathway.
This is not to say that Canberra does not have great hospitals and medical facilities. We do. We have great specialists and medical staff, and great fertility preservation clinics. But with so many specialists and services involved in the process of treating adults of reproductive age with cancer and other serious diseases, some in the public
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