At Diagnosis: Assessing Age-Related Issues

Regardless of when patients receive their diagnosis, their age impacts the next step

Every patient faces unique issues during and after treatment. In the past, oncologists focused primarily on treating the cancer, overlooking some issues related to the patient’s age. But now, doctors are increasingly concerned with the impact of treatment on a person’s future, including treatment-related long-term effects.

For Younger Patients

Younger patients often have to contend with unique challenges, such as coping skills, social concerns, behavioral issues, employment matters and treatment-related infertility. Doctors should discuss these issues, particularly fertility preservation options with all fertile patients—male or female—and, in the case of children, with their parents or guardians.

A single cancer treatment can decrease fertility, so it is essential that a patient’s doctor develop a fertility preservation plan before treatment begins, which may mean delaying treatment to accommodate fertility preservation methods, such as banking sperm or freezing fertilized eggs.

Prostate and testicular cancer therapies can affect sperm production, resulting in low sperm count or infertility. For men wanting to preserve fertility, banking sperm has been a successful technique for decades. If sperm count is low, a process called intracytoplasmic sperm injection requires only one sperm to fertilize an egg. Another technique, called testicular sperm aspiration—where sperm is taken directly from the testicle or from resected testicular tissue—is being tested in men with low sperm count.

For women, certain chemotherapy drugs and hormone treatments, as well as radiation to the pelvic area, can damage the ovaries and other reproductive organs and cause early menopause. Because women are born with a limited number of eggs, or oocytes, damaging them during cancer treatment can leave a woman infertile.

If treatment calls for radiation to the pelvis, the ovaries can be surgically moved away from the field of radiation, called oophoropexy, which reduces the risk of damage by 50 percent. Treatments that temporarily shut down ovarian function during chemotherapy are also being investigated as a means to prevent damage to eggs.

With in vitro fertilization (IVF), an egg is fertilized and frozen, or cryopreserved; it is later thawed and inserted into the uterus. IVF must be done before treatment and may require several weeks to retrieve viable eggs. Hormone injections may be given to promote egg development, but natural methods are also available.

While freezing unfertilized eggs is possible, the success rate is lower than freezing embryos. Once thawed, the egg is fertilized by intracytoplasmic sperm injection and inserted into the uterus. Although freezing unfertilized eggs is still considered experimental, better freezing and fertilization techniques are improving success rates. Researchers are also exploring ways to freeze testicular and ovarian tissue to be transplanted back into the patient after therapy.

Because many of these new fertility procedures are experimental, most are not covered by insurance, and the cost can be as high as $20,000. Even traditional IVF can cost around $10,000 or more. Depending on insurance coverage, some treatments may be provided, especially if they are part of a necessary medical procedure being performed anyway.

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