Genevieve S. Neal-Perry, MD, PhD at SCCA-UW Medicine talks about the oncoreproduction clinic that helps patients have a family after cancer treatment.
Interview conducted by Ivanhoe Broadcast News in August 2019.
Let’s talk a little about the oncoreproduction. For many, many years, women who had to get chemotherapy just pretty much had to give up their dreams of being a mom. How has what you’re doing helped change that?
NEAL-PERRY: Right. For many years, you’re accurate in that women were told that they had to go immediately into chemotherapy and a discussion around what it meant to their fertility really wasn’t discussed. And it’s been within the last decade that it’s been realized that with the improvement in chemotherapy and cancer treatment, people are thinking about, what does it mean to have a full life? And in many young people, having a full life means being able to be a parent and have children. As a result, some patients have pushback to say, no, my fertility is important. And as a result, doctors, physicians, scientists are listening and trying to identify what will that mean for their cancer? And several studies have shown that delaying treatment doesn’t necessarily change the outcome of their cancer so that we’re able to now, in addition to the advancement of science, freeze eggs, freeze embryos and give these young couples the opportunity to be parents later in life.
How long is the delay?
NEAL-PERRY: Typically, the delay is about two weeks.
Doesn’t seem very traumatic.
NEAL-PERRY: No, it’s not long. And then part of the challenge is really information dissemination, that people thought that in order to do an IVF cycle, in order to freeze eggs, it would take you three months, two months to do, when in fact, studies have shown the biggest delay in terms of a treatment as it pertains to fertility preservation is the initial consult.
Interesting. So the clinic itself, the oncoreproduction clinic, how is that set up? How is that different from someone just going to a fertility clinic and freezing eggs?
NEAL-PERRY: The reason it’s different is because the clinic is specifically focused on patients with a diagnosis of cancer so that when the care is being delivered, the focus is on your diagnosis. Here are the things that you need and really that we’re able to move them forward in that context. So they’re not necessarily going to a clinic where you have people, for a variety of reasons, who are seeking care, as opposed to you have a select population and you can address those select needs and make sure that we can really provide them very direct and focused care as it pertains to their diagnosis.
Is it an actual clinic?
NEAL-PERRY: It is.
OK. So it’s a stand-alone clinic someplace else.
NEAL-PERRY: Oh it’s not a stand-alone clinic.
OK.
NEAL-PERRY: It’s embedded within the SCCA. It’s in the breast cancer clinic, and it’s part of where women’s health is delivered.
OK. What kind of reaction have you gotten from moms and the future moms and dads who come through and basically change their whole lives?
NEAL-PERRY: Wow. I changed their life, but that changes my life as well. So it’s very rewarding for me and my colleagues who participate in providing the care. And one thing that I know that patients have told me, I feel like now I can actually go through and complete treatment. And this gives me more hope as well. And it really does give patients a license to move through the treatment and feel positive about the end of the tunnel.
You treat specifically the fertility side, or do you treat fertility and the oncology side?
NEAL-PERRY: I treat specifically the fertility side and the consequences of the cancer treatment, in terms of whether a treatment results in menopause and what that might mean to that woman’s life or that couple’s life even as it pertains to sexual relations, as well as fertility and menopause-related symptoms.
And how old is the clinic?
NEAL-PERRY: Actually we just turned 1 in October.
Awesome. That’s great. How do you do it? Chenault told us a little bit about the different options you presented her. If you could just tell me about that.
NEAL-PERRY: Depending on the age of a patient, depending on what their diagnosis is and depending on something called ovarian reserve – and the way that I like to think about ovarian reserve is like your ovarian retirement fund. And if someone has a reasonable or decent ovarian retirement fund, then we can talk about freezing eggs. We can talk about freezing embryos if they have a partner or if they have a sperm donor. If they don’t have eggs or it looks like their treatment has to be initiated before we can actually start a fertility preservation cycle, then the things we talk about might be embryo donation, egg donation. People will donate their embryos. For women who may lose their uterus, we talk about a gestation carrier or just a surrogate. For patients who cannot be pregnant, then we talk about adoption, what that would look like, also with the understanding that some cancers may preclude the ability to be an adoptive parent.
Depending on what your treatment will be and what your diagnosis would be, one, we can collect eggs, freeze eggs, freeze embryos. The other thing that we also use that has been shown to be beneficial, particularly in breast cancer patients and we’re still learning in other cancers, is something called Leuprolide or Lupron. And what it does is it basically puts the patient into a biochemical menopause, and it stops their eggs from growing. And most cancer treatments will actually attack cells that are growing. And so if we can stop those cells from growing, we can protect some of those oocytes, which are eggs, from being exposed to cancer and delaying the impact of those cancer treatments on the ovary.
And she chose two of those. So I guess that’s allowed.
NEAL-PERRY: Yes, absolutely. We do that in breast cancer patients because we know it’s actually beneficial for their breast cancer treatment as well. And we will do it in patients who have a diagnosis of colon cancer, G.I. cancers, some of the hematological cancers as well. And the other benefit to that treatment is that women will stop menstruating, particularly in patients who may have a hematological disorder, where they may hemorrhage because their platelet counts are low.
So the surrogate, adoption, the other options rather than freezing your own eggs, do you guys have partners? Do you refer? Or do you actually set that up for patients?
NEAL-PERRY: The good thing is in the state of Washington, the use of surrogates became legal. It was illegal before, but it became legal. So now we have agencies within the state that offer this service. I did have a patient reach out to friends. And so oftentimes, friends who know that their friend has cancer and may not be able to have a pregnancy will actually undergo pregnancy for them, in addition to family members. So it can be achieved in a number of ways. We have a discussion with the patient and help them understand how they might pursue it.
But you guys don’t set them up with a surrogate.
NEAL-PERRY: We don’t select, no. It would be a little bit of conflict of interest. What we do is we actually will help them identify an agency or help them think about ways that they might achieve it.
How many couples have come through the clinic so far?
NEAL-PERRY: For oncology? I would say, in the last month, we had about 10 people.
Which is a lot. Instead people who might not have had the option to ever have kids, that’s got to make you feel so good.
NEAL-PERRY: It does. It really does. Being in the SCCA has also heightened the awareness of other providers. And the good part about being there is that if a provider has a consult, like a sidebar conversation, we can have those conversations and then also helping people remember that this is also an important part of the care and that it’s feasible. And it won’t take as long as you think.
Awesome. What haven’t I asked you?
NEAL-PERRY: One of the other things that is good about this particular clinic is that we partner with the Livestrong Foundation. And through that, we’re able to also help patients obtain medication for free and provide storage as a partner with the Livestrong. I would say that while we talk about fertility preservation and how great that is, I think for patients just to be able to have the opportunity to talk about it, whether or not they pursue fertility preservation, is very empowering because then they can make a decision, and it’s a knowledge-based decision so that they truly understand, what does my treatment mean to my reproduction, what does it mean to just my general reproductive health? And I would say that having those conversations and helping people understand that if you have sexual dysfunction after receiving chemotherapy, it’s not you. Don’t think it’s your problem but that there are things that we can do to help you. And so that’s also a benefit.
I love my job, and I actually don’t think of it as a job. I think of it as an opportunity to give back to a community of individuals who sometimes have forgotten.
Awesome. You’re a perfect spokesman for them, too.
NEAL-PERRY: Thank you.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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Genevieve S. Neal-Perry, MD, PhD
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