What most concerns the adolescent and young adult population? “If they are worried about anything, it is sex and having families,” according to Archie Bleyer, MD. Years ago, he said, “oncologists were so worried about just getting them in remission, treating their cancers, and getting them to survive, that the idea of the cured person having a child and being fertile was given a low priority. Now, although we are still struggling with this in terms of getting it applied universally, at least there’s an awareness that before you start chemotherapy or radiation that could make that patient infertile,” methods for preserving fertility should be discussed.

For males, sperm banking, and for females, embryo cryopreservation “are the available standard-of-care options for fertility preservation,” Brandon Hayes-Lattin, MD, reported. “For women, other methods are increasingly being used—techniques that some groups would still classify as experimental, but that have generated healthy pregnancies. These options include egg cryopreservation and even ovarian tissue cryopreservation.”

Dr. Hayes-Lattin was diagnosed with testicular cancer at age 28, when he was a resident. “I was already planning to go into oncology,” said Dr. Hayes-Lattin, who later completed an oncology-hematology fellowship, “but it certainly changed my awareness and perception of not just the medical side, but all the related needs,” such as considering the use of a sperm bank, he said. “Fertility preservation was not something I had really thought much about. I had a young family, and all of a sudden, I had to think about things like life insurance in ways that I had never really paid much attention to before. I became acutely aware of and more interested in these more psychological and practical concerns.”

Create Supportive Environment

It is “absolutely fair game” to ask young adults about lifestyle issues, according to Dr. Hayes-Lattin. “The key is to be open and create an atmosphere that encourages young people to talk about topics such as sex, drugs, and alcohol use, how cancer and its treatment are affecting them medically and psychologically, or whatever is potentially a barrier to them getting the best cancer treatment they need.”

Physicians “need to know about what the patient is doing to him or herself—or wants to do to him or herself—and the potential adverse interactions that can make the therapy worse, more toxic, or less effective, or complicate treatment and create other serious outcomes,” Dr. Bleyer said. “Those issues have to be addressed.” ■