For women whose cancer or cancer treatment may impact As women with cancer explore their treatment options, what should they ask their healthcare team about fertility preservation? Expert Dr. Terri Woodard outlines essential questions to bring to appointments and shares practical tools for self-advocacy.
Dr. Terri Woodard is a reproductive endocrinologist at Texas Children’s Pavilion for Women. Dr. Woodard holds a joint appointment as an Assistant Professor in the Division of Reproductive Endocrinology and Infertility at Baylor College of Medicine and the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center. Learn more about Dr. Woodard.
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Transcript
Jamie Forward:
So, with all of this, the timing of the discussion about fertility is very important.
And, of course, a cancer diagnosis can be a really overwhelming time. So, it’s really important that they advocate for themselves, which I’m sure you would corroborate that.
Dr. Terri Woodard:
Yes.
Jamie Forward:
So, should patients begin this conversation with their healthcare team, and should they start with their oncologist?
Dr. Terri Woodard:
They should start as soon as possible with any healthcare provider that they’re talking to. ASCO developed guidelines back in 2006. ASCO is the American Society for Clinical Oncology. And these guidelines basically state that as healthcare providers, all of us should be invested in making sure that patients are educated about their potential risk of infertility as a result of cancer or its treatment. So, as soon as a woman knows that she is diagnosed, it is appropriate to start asking those questions and ask for a referral to a reproductive medicine specialist.
Jamie Forward:
Okay. And so, what sort of patients should they – or excuse me, what sort of questions should women be asking their healthcare team about this like, where should they start?
Dr. Terri Woodard:
So, the first question is, will the treatment for my cancer significantly impact my fertility? Because there are treatments out there that really, we don’t worry about that should not impact fertility, at all. So, first question is risk assessment. What is my risk? The next question is, well, if I am at risk, are there any things that I can actually do to preserve my fertility? And then, the question following that really should be like, “Well, will I have enough time to do those things to preserve my fertility, and do you think it’s safe or not?”
Jamie Forward:
Sure. And what role should a partner play in this discussion?
Dr. Terri Woodard:
So, it really depends on the patient. So, I find that when talking to a lot of couples, the partner or the spouse kind of defers to the woman because, the partner’s like, “Hey, I just want them to be okay and be comfortable with everything.
I am their support system and whatever they decide, I’m okay with it.” Other couples are much more collaborative, but I think in all cases, it’s wonderful to have the partner involved just as another set of ears. This woman is newly diagnosed, there’s lots of information being thrown at her, and to have someone else hearing it is so important. And someone to kind of bounce their thoughts and ideas off of is very, very useful in decision-making.
Jamie Forward:
Yeah, it’s a really important role, and people don’t often consider it. They’re really a part of the healthcare team. So, what would you say to someone who is hesitant to speak up about family planning? It’s an overwhelming time. Sometimes they’re not even a point where they’re ready to have children, but why is it so important to say something, and speak up, and not be shy about it?
Dr. Terri Woodard:
Yeah, it’s very important because this may be your shot. And I think sometimes patients feel like, “Okay, I’m dealing with this cancer. That’s all I can deal with right now.”
Or maybe they feel like it’s inappropriate to ask their provider, like, “Oh, you know, they’re trying to save me, but yet, I’m talking about fertility.” The point is that this is all part of comprehensive cancer care. And really, we don’t want patients to lose the opportunity to potentially have a family, in the event that they become infertile because of their treatment.
Jamie Forward:
Sure. And, of course, every physician or patient-doctor relationship can be a bit different. So, if a patient’s not feeling supported by their healthcare team in that discussion, what sort of advice do you have for them? Should they consider a second opinion?
Dr. Terri Woodard:
I think it’s always wise to seek a second opinion if you’re not comfortable with who you’re seeing. And even, if I have a complex or difficult case and the patient doesn’t seem comfortable, I encourage a second opinion to get some other eyes and ears on the situation.
And then, I also want to point out that we work in healthcare teams, and we all have different roles. And I would say that a lot of times, people look at the oncologist as the busy one making diagnosis and treatment plans, but often, there are other people that are part of those teams, such as nurses or advanced practitioners. A lot of programs have navigators now. Those are people that a woman might feel more comfortable talking to to help them figure this out.
Jamie Forward:
Yeah, and I think even sending an email through the patient portal saying, “Is there somebody I can talk to?” if you’re nervous about speaking up. If that’s the way you can get it out, I say, early and often. Right?
Dr. Terri Woodard:
Yes.