Preserving fertility during cancer treatments

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Cancer treatment — and cancer itself — can threaten fertility. This is a tremendously important survivorship issue for many people. As an oncologist, I’m often asked questions about preserving fertility during cancer treatment. If this issue affects you, here is an overview of key options.

When should you talk to your cancer team about fertility?

Future children may not be foremost on your mind when you are diagnosed with cancer. Soon afterward, though, it’s worth talking to your doctor about fertility issues, if this is important to you now or might one day become important.

Your doctor can explain:

the risk that your cancer might cause infertility the risk that your treatment might cause infertility options before or during treatment that might help you preserve fertility. What might make infertility more likely to occur?

When an adult has cancer, some factors that raise risk for infertility include:

Age. Infertility is more likely in women who are older at diagnosis. Type of cancer. Some cancers affect fertility, such as Hodgkin’s lymphoma, or prostate cancer in men. Treatments. Some treatments affect fertility by damaging or removing reproductive organs. For example, treating cervical, uterine, or ovarian cancer usually requires removing a woman’s ovaries, fallopian tubes, and uterus. Radiation to the pelvis used to treat colon or uterine cancer can permanently harm ovaries. And some, but not all, chemotherapies needed to effectively treat different cancers may temporarily or permanently cause women to stop having periods (amenorrhea), a surrogate measure for damage to the eggs in the ovaries. This is less likely to happen to younger women. Research on women treated with chemotherapy containing cyclophosphamide shows that amenorrhea occurred in 0% to 15% of women 35 or younger; 30% to 50% of women between 36 and 40; and 70% of women over 40. Can cancer treatments be adapted to preserve fertility?

Sometimes it’s possible to do this, although not always. Special approaches to preserve fertility have been developed for younger women with certain lower-risk cancers. This might entail moving ovaries out of a radiation field. Or it might mean doing less surgery, such as removing only one ovary, or sparing part of the cervix in women with lower-risk cervical cancer or part of the uterus in women with lower-risk uterine cancer.

What else might help preserve fertility?

For men, sperm banking is the go-to option before cancer treatment. This can be costly over time. Also, having cancer may affect sperm production for some men.

For women, options are usually more complicated.

Suppressing the ovaries with a monthly shot of medication during treatment. Some research links this approach with less premature menopause and greater fertility. While this strategy is fairly straightforward, whether it actually works is controversial. It appears to have only modest effects on fertility preservation, mainly in patients with breast cancer. Freezing eggs or embryos before treatment. This option works for women with many types of cancers. To harvest eggs, a woman generally undergoes ovarian stimulation with hormones. Minor surgery is then done to remove the maturing eggs for immediate freezing or fertilization before freezing. The procedure takes two to six weeks, which is too long to wait to treat some cancers. This option can be expensive and is often not covered by insurance. Also, for women with some cancers, such as hormone-sensitive breast cancer, experts are unsure if the high hormonal levels needed to stimulate the ovaries may have an impact on cancer growth. Your doctor can explain more about what is, and isn’t, known. Freezing whole ovaries or slices of ovarian tissue. Only certain specialized centers offer this experimental option. It requires surgery before cancer treatment, but no time for ovarian stimulation, so it may be particularly attractive for women who need to start treatment quickly. At this time, the techniques are experimental. Success rates — that is, successful births — are limited. Some experts are concerned about using this approach for women with cancers known to spread to the ovaries. It may not be safe to implant tissue that may be harboring cancer cells back into a woman who has been cured of a cancer. How can you learn more?

Talk to your health care team about your hopes and concerns.

A reproductive endocrinologist (fertility doctor) can help you learn about available options, processes, and risks. Be sure to ask questions about safety, timing, availability, success rates, and costs of all potential fertility preservation strategies.

Ask your cancer care team about the safety and feasibility of pregnancy after cancer. This is particularly important for women with high-risk cancers and hormone-sensitive cancers, such as breast cancer. Fortunately, the most recent data suggest that pregnancy itself does not worsen breast cancer outcomes. But some concerns remain, especially if women stop taking risk-reducing hormone therapy early in order to become pregnant. Research is underway to learn more about this issue.


Check these web sites for more information and answers to many questions:

Dana-Farber Cancer Institute Fertility Preservation Program LiveStrong Fertility Program The Oncofertility Consortium, a national program housed at Northwestern University Resolve

The post Preserving fertility during cancer treatments appeared first on Harvard Health Blog.

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Alternative therapies for cancer

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You may have seen the ads in the Sunday paper or on TV: “Try this all-natural remedy! Thousands already have!”

Some of these ads grab your attention with the headline, “Here’s something your doctors don’t want you to know.” I highly doubt that your doctor is interested in keeping secrets from you, especially if there was something safe and effective that could improve your health. In addition, the treatments promoted in these ads are typically untested, unproven, and largely unregulated.

While I rarely object to my patients pursuing “alternative remedies” that seem safe, I am concerned when the ads suggest that you can “throw away all those pills” your doctor recommended because the advertised treatment will make them unnecessary. That always seemed like a hazardous claim. A new study suggests that there is danger in relying on unproven treatments over those that have been well-tested.

The new study on alternative cancer treatments

Researchers analyzed data from nearly two million patients with cancer treated at accredited medical centers throughout the US. They only included patients with cancers of the breast, lung, colon, or prostate that had not spread to other areas of the body.

Compared with those who received only conventional cancer treatments (including surgery, radiation treatment, chemotherapy, and/or hormone therapy), those who chose a “complementary” cancer treatment (such as herbs or acupuncture) along with at least one conventional cancer treatment:

tended to be younger, female, have higher socioeconomic status and educational level, and live in Pacific or Intermountain West regions of the United States. declined additional conventional treatments more often. For example, chemotherapy was refused by 34% of those choosing unproven remedies, but by only 3% of the conventional treatment-only group. did not live as long. The five-year survival was 82% in the unproven treatment group, and 87% in the conventional treatment group. had a higher rate of death that appeared to be due to delay or refusal of conventional treatment.

While the difference in five-year survival was small, it was statistically significant. And if this were a comparison of two new treatments, a 5% difference would be considered important.

Caveats about this study

This study was not designed to directly compare non-conventional therapies with conventional ones, and the results do not mean that all unproven remedies are useless. In fact, an unproven treatment may become conventional if rigorous research proves its worth. There are many types of alternative treatments (including herbs, vitamins, homeopathy, yoga, and acupuncture) that might have different effects and have not yet been well studied. Importantly, this study did not examine the interaction of conventional and alternative treatments (which in some cases may cause problems).

In addition, this study did not actually find that complementary treatments along with conventional treatments were harmful. But it did suggest that relying on unproven remedies instead of conventional therapies might be.

Finally, this study did not examine all types of cancer, all types of treatments, or the impact of treatment on quality of life. Different results might have been observed if other outcomes of interest (such as quality of life) had been included.

The bottom line

If you have cancer and are interested in herbs, acupuncture, or other alternative treatments, talk to your doctor. Think twice before declining conventional treatments. But if you do decline recommended treatment, make sure you understand the pros and cons of doing so, including the possibility of shorter survival.

Follow me on Twitter @RobShmerling

The post Alternative therapies for cancer appeared first on Harvard Health Blog.

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Why keep a food diary?

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Many people begin the new year with a resolve to improve their health. This improvement often starts with changing what they eat.

A food diary can be a useful tool in this process. It can help you understand your eating habits and patterns, and help you identify the foods — good and not-so-good — you eat on a regular basis. Research shows that for people interested in losing weight, keeping a journal can be a very effective tool to help change behavior. In one weight loss study of nearly 1,700 participants, those who kept daily food records lost twice as much weight as those who kept no records.

What should you include in a food diary?

Most experts agree that the secret to successful food journaling is accuracy and consistency. So, what should you record? A basic food diary should include the following:

What are you eating? Write down the specific food and beverage consumed and how it is prepared (baked, broiled, fried, etc.). Include any sauces, condiments, dressings, or toppings. How much are you eating? List the amount in household measures (cups, teaspoons, tablespoons) or in ounces. If possible, it is best to weigh and measure your food. If you are away from home, do your best to estimate the portion. When are you eating? Noting the time that you’re eating can be very helpful in identifying potentially problematic times, such as late-night snacking.

Jotting down where you’re eating, what else you’re doing while you’re eating, and how you’re feeling while eating can help you understand some of your habits and offer additional insight.

Where are you eating? Record the specific place you are consuming food, whether it’s at the kitchen table, in your bedroom, in the car, walking down the street, at a restaurant, or at a friend’s home. What else are you doing while eating? Are you on the computer, watching TV, or talking with a family member or a friend? Who are you eating with? Are you eating with your spouse, children, friend, or a colleague, or are you alone? How are you feeling as you’re eating? Are you happy, sad, stressed, anxious, lonely, bored, tired? Tips for successful food journaling

Here are more tips for keeping a successful food diary:

Write down the food or beverage as soon as you consume it. Don’t wait until the end of the day because your recollection is likely to be less accurate. Be as specific as you can with the food or beverage. For example, if you are drinking a latte, note the type and size. Be sure to include any alcoholic beverages you consume. A smartphone app like Lose It! or MyFitnessPal can support your efforts. These apps also offer information on calories and other nutrients. You’ve kept a food diary. Now what?

After completing a week’s worth of food journaling, step back and look at what you’ve recorded. Search for any trends, patterns, or habits. For example, you might consider:

How healthy is my diet? Am I eating vegetables and fruit every day? If so, how many servings? Am I eating whole grains each day? Am I eating foods or beverages with added sugar? If so, how frequently? Do my moods affect my eating habits? Do I reach for unhealthy snacks when I’m tired or stressed? How often do I eat on the run? Set SMART healthy eating goals

Once you’ve identified areas for improvement, set one or two healthy eating goals for yourself. In doing so, use the SMART goal format. That means your goals should be Specific, Measurable, Achievable, Relevant and Time-based. Here are a few examples of SMART goals.

Food diary observation: You average two servings of vegetables per day.
Goal: Eat more vegetables.
SMART goal: Eat three servings of vegetables per day.

Food diary observation: You order takeout three or four nights per week.
Goal: Cook more at home.
SMART goal: Order take out no more than one or two nights per week.

Food diary observation: You eat healthy meals and snacks until about 3 pm, when you hit the office vending machine.
Goal: Eat healthier snacks.
SMART goal: Bring a healthy snack (a piece of fruit and a small handful of nuts) to work every day.

Keeping a food journal can be very informative and move you toward improving your health. Using the data from your food diary to make SMART changes, and continuing to track your progress, is a great place to start your journey for a healthier 2019.

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