Problem Solving In Cancer And Fertility

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Problem Solving in Cancer and Fertility

Problem Solvingin Cancer and FertilityEdited byEleni M Karapanagiotou, MD, PhDConsultant Medical Oncologist, Guy’s Cancer Centre, Guy’s and St Thomas’NHS Foundation Trust, London, UKJulia Kopeika, MD, MRCOG, PhDConsultant Gynaecologist and Subspecialist in Reproductive Medicine and Surgery,Assisted Conception Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UKRuth E Board, BSc, MBChB, PhD, FRCPConsultant in Medical Oncology, Rosemere Cancer Centre, Royal Preston Hospital,Preston, UKCaroline Archer, BSc, MBBS, FRCPConsultant Medical Oncologist, Portsmouth Oncology Centre, Portsmouth HospitalsUniversity NHS Trust, Portsmouth, UKMelanie C Davies, MBBS, MA, MRCP, FRCOGConsultant Gynaecologist, Reproductive Medicine Unit, University College LondonHospitals, London, UKJanine Mansi, MD, FRCP, FACP(UK)Consultant Medical Oncologist, Guy’s and St Thomas’ NHS Foundation Trust andBiomedical Research Centre, King’s College London, UKPublished in association with the Association of Cancer PhysiciansEBN HEALTHOXFORD, UK

EBN HealthAn imprint of Evidence-based Networks Ltd85 NewlandWitney, Oxfordshire OX28 3JW, UKTel: 44 1865 522326Email: info@ebnhealth.comWeb: www.ebnhealth.comDistributed worldwide by:Marston Book Services Ltd160 Eastern AvenueMilton ParkAbingdonOxon OX14 4SB, UKTel: 44 1235 465500Fax: 44 1235 465555Email: trade.orders@marston.co.uk Evidence-based Networks Ltd 2021First edition published 2021All rights reserved. No part of this publication may be reproduced, stored in a retrievalsystem, or transmitted, in any form or by any means, without the prior permission inwriting from EBN Health or Evidence-based Networks Ltd.Although every effort has been made to ensure that all owners of copyright materialhave been acknowledged in this publication, we would be glad to acknowledge insubsequent reprints or editions any omissions brought to the attention in writing ofEBN Health or Evidence-based Networks Ltd.EBN Health and Evidence-based Networks Ltd bear no responsibility for the persistenceor accuracy of URLs for external or third-party internet websites referred to in thispublication, and do not guarantee that any content on such websites is, or will remain,accurate or appropriate.A catalogue record for this book is available from the British Library.ISBN 13   978 0 99559 546 0The publisher makes no representation, express or implied, that the dosages in thisbook are correct. Readers must therefore always check the product information andclinical procedures with the most up-to-date published product information and datasheets provided by the manufacturers and the most recent codes of conduct and safetyregulations. The authors and the publisher do not accept any liability for any errors inthe text or for the misuse or misapplication of material in this work.Series design by Pete Russell Typographic Design, Faringdon, Oxon, UKTypeset by Thomson Digital, Noida, IndiaPrinted by Hobbs the Printers Ltd, Totton, Hampshire, UK

ContentsContributors Preface Acknowledgements viiixiiixvSECTION ONE Perspectives01 The Effects of Cancer and its Treatment on Female Fertility,Richard A. Anderson 102 Fertility Preservation in Women, Julia Kopeika 703 Fertility Preservation in Men, Maj Shabbir 1204 Management of Cancer in Pregnancy, Kate Harding 1905 Drugs Used to Treat Cancer During Pregnancy, Alison L. Jones,Ruth E. Board 2406 Pregnancy After Diagnosis and Treatment of Cancer, Danielle Crawley,Eleni M. Karapanagiotou 3007 Fertility Outcome in Men After Cancer Treatment, Allan Pacey 3408 Premature Ovarian Insufficiency—Diagnosis andOverview of Survivorship Issues, Melanie C. Davies 3809 Egg Donation and Surrogacy, Mari Isdale, Raj Mathur 4310 Hormone Replacement Options for Women with PrematureOvarian Insufficiency After Cancer Treatments, Lisa Webber 5011 Hereditary Cancer Syndromes and Fertility, Annabelle Kerr,Charlotte Tomlinson, Vishakha Tripathi 5512 Counselling—Cancer and Fertility: What Does a Counsellorin a Fertility Clinic Do?, Carmel Dennehy 6013 Ethical Issues in Fertility Preservation forCancer Patients, Francoise Shenfield 65SECTION TWO Case Studies01 Fertility Preservation in Early Breast Cancer, Chara Stavraka, Julia Kopeika 6902 Fertility Preservation in Cervical Cancer, Jonathan Riley, Nicholas Wood 73

viContents03 Fertility Preservation in Testicular Cancer, Majed Shabbir,Neerujah Balachandren 7804 Post-Partum Fertility Preservation, Lukasz Polanski, Julia Kopeika 8205 Colon Cancer With Inherited Genetics: Lynch Syndrome,Christopher Williams, Jenny Seligmann 8706 Ovarian Tissue Cryopreservation in the Setting of Recurrent Cancerand Escalation of Treatment, Dalia Khalife, Julia Kopeika 9207 Fertility Preservation in a Young Man Unable to Produce aSperm Sample, Saira Khalique, Philippa Sangster 9908 A Case of an Unexpected Conception in a Patient WithMetastatic Melanoma on Immune Checkpoint Inhibitors,Prerana Huddar, Ruth Board 10509 An Unexpected Pregnancy in a Woman With MetastaticBreast Cancer, Rachel Broadbent, Alia Alchawaf, Laura Horsley 11110 Accidental Pregnancy During Chemotherapy Treatment,Sarah Hunter, Catherine Oakley, Eleni Karapanagiotou 11511 A Case of Lung Cancer Diagnosed During Pregnancy, Alexandra R. Lewis,Catherine Nelson-Piercy 11912 A Woman Who Wishes to Become Pregnant Following Treatmentfor ER Breast Cancer, Joanna Hack, Eleni M. Karapanagiotou 12313 Pregnancy After Bone Marrow Transplant, Helen Hockings,Melanie C. Davies 12614 Woman With Premature Ovarian Insufficiency After Stem CellTransplant and Total Body Irradiation Seeking Fertility Treatment,Guy Morris, Melanie C. Davies 13215 Premature Ovarian Insufficiency, HRT and VTE, Meera Chauhan,Sean Dulloo, Oyeyemi Akala, Mari Thomas 13716 Premature Ovarian Insufficiency and HRT in Breast Cancer: Managementof Vaginal Symptoms and Hot Flushes, Kathryn Herring, Daniel Rea 14117 Premature Ovarian Insufficiency and Bone Health, Emily Goode,Janine Mansi 14618 Pregnancy After Testicular Failure Caused by Cancer Treatment,Sofia Nyberg, Maj Shabbir, Julia Kopeika 15219 Risk Reducing Bilateral Salpingo-Oophorectomy in BRCA PositiveBreast Cancer, Kathryn Baxter, Nick Wood, Sarah Moon 15720 A Case of a Pregnancy Following Radical Trachelectomy,Yusuf Beebeejaun, Julia Kopeika 162

Contentsvii21 A Case of Ovarian Tissue Cryopreservation in the Setting ofNon-Hodgkin’s Lymphoma, Dalia Khalife, Julia Kopeika 16722 A Case of Breast Cancer in a Transgender Man With BRCA2Mutation, Alison Berner, Leighton Seal, Katie Snape 17223 A Case of Testicular Cancer in a Gay Man, Alison Berner,Daniel Hughes, Daniel Saunders 177Index 181

ContributorsDr Oyeyemi Akala, Medical Oncology Specialist Registrar, University Hospitals ofLeicester NHS Trust, Leicesteroyeyemi.akala@nhs.netDr Alia Alchawaf, Specialist Registrar in Medical Oncology, The Christie NHSFoundation Trust, Manchesteraliaalchawaf@nhs.netProfessor Richard A Anderson, Elsie Inglis Professor of Clinical Reproductive Science,MRC Centre for Reproductive Health, University of Edinburgh, Edinburghrichard.anderson@ed.ac.ukDr Neerujah Balachandren, Clinical Research Fellow in Reproductive Medicine,University College London Hospital, Londonn.balachandren@nhs.netDr Kathryn Baxter, Obstetric and Gynaecology Specialist Trainee, Lancashire TeachingHospitals NHS Foundation Trust, Prestonkbaxter@doctors.org.ukDr Yusuf Beebeejaun, Clinical Research Fellow, King’s Fertility, King’s College Hospital,LondonYusufb1@gmail.comDr Alison Berner, Speciality Trainee and Clinical Research Fellow in MedicalOncology, Barts Cancer Institute and Specialist Registrar in Gender Identity,Tavistock and Portman NHS Foundation Trust, Londonalisonmayberner@gmail.comDr Ruth E Board, Consultant in Medical Oncology, Rosemere Cancer Centre, RoyalPreston Hospital, PrestonRuth.Board@LTHTR.nhs.ukDr Rachel Broadbent, Specialist Registrar in Medical Oncology, The Christie NHSFoundation Trust, c.ukDr Meera Chauhan, Medical Oncology Specialist Registrar, University Hospitals ofLeicester NHS TrustMeera.chauhan@doctors.org.ukDr Danielle Crawley, Specialist Registrar Medical Oncology, Guy’s and St Thomas NHSFoundation Trust, LondonDanielle.Crawley@gstt.nhs.ukDr Melanie C Davies, Consultant Gynaecologist, Reproductive Medicine Unit, University College London Hospitals, Londonmelanie.davies14@nhs.net

ContributorsixCarmel Dennehy, Specialist Counsellor and Psychotherapist in Reproductive Medicine,University College London Hospital, Londoncarmel.dennehy@nhs.netDr Sean Dulloo, Medical Oncology Specialist Registrar, University Hospitals ofLeicester NHS Trust, Leicesterseandulloo@doctors.org.ukDr Emily Goode, Specialist Registrar Medical Oncology, The Royal Marsden Hospital,Londonefgoode@gmail.comDr Joanna Hack, Department of Medical Oncology, University Hospital SouthamptonNHS Foundation Trust, Southamptonjoanna.hack@doctors.org.ukDr Kate Harding, Consultant Obstetrician, Guy’s and St Thomas’ Foundation Trust,LondonKate.harding@gstt.nhs.ukDr Kathryn Herring, SpR Medical Oncology, Queen Elizabeth Hospital, Edgbaston,BirminghamKaty.Herring@uhb.nhs.ukDr Helen Hockings, Medical Oncology Specialist Registrar, St Bartholomew’s Hospital,Londonhahockings@gmail.comDr Laura Horsley, Consultant Medical Oncologist, The Christie NHS FoundationTrust, Manchester.Laura.Horsley@christie.nhs.ukDr Prerana Huddar, ST3 Medical Oncology, Rosemere Cancer Centre, Royal PrestonHospital, Lancashire Teaching Hospitals NHS Trust, Prestonprerana.huddar@lthtr.nhs.ukDr Daniel Johnathan Hughes, Specialist Registrar in Medical Oncology, UCL CancerInstitute, University College, Londondaniel.hughes@kcl.ac.ukDr Sarah Hunter, Medical Oncology Registrar, Guy’s and St Thomas’ Hospital, LondonSarah.hunter@gstt.nhs.ukDr Mari Isdale, Senior Clinical Fellow IVF and Reproductive Medicine, ManchesterFoundation Trust, Manchestermariisdale@gmail.comDr Alison Jones, Consultant Medical Oncologist, The Royal Free London NHSFoundation Trust, Londonajones@theloc.comDr Eleni M Karapanagiotou, Consultant Medical Oncologist, Guy’s Cancer Centre,Guy’s and St Thomas’ NHS Foundation Trust, LondonEleni.Karapanagiotou@gstt.nhs.uk

xContributorsAnnabelle Kerr, Genetic Counsellor, Clinical Genetics Service, Guy’s and St Thomas’NHS Foundation Trust, Londonannabelle.kerr@gstt.nhs.ukDr Dalia Khalife, Specialist in Obstetrics and Gynecology, Subspecialist inReproductive Endocrinology and Infertility, Jumeirah American Clinic, Dubai,United Arab Emirateskhalifehdalia@gmail.comDr Saira Khalique, Speciality Registrar in Medical Oncology, University CollegeLondon Hospitals NHS Foundation Trust, Londonsaira.khalique1@nhs.netDr Julia Kopeika, Consultant Gynaecologist and Subspecialist in ReproductiveMedicine and Surgery, Assisted Conception Unit, Guy’s & St Thomas’ NHSFoundation Trust, LondonYuliya.Kopeika@gstt.nhs.ukDr Alexandra R Lewis, Clinical Fellow, Department of Medical Oncology, The ChristieHospital NHS Foundation Trust, ManchesterAlexandra.lewis@christie.nhs.ukDr Janine Mansi, Consultant Medical Oncologist, Guy’s and St Thomas’ NHSFoundation Trust and Biomedical Research Centre, King’s College LondonJanine.Mansi@gstt.nhs.ukDr Raj Mathur, Consultant in Reproductive Medicine and Surgery, ManchesterUniversity NHS Foundation Trust.rmathur@nhs.netDr Sarah Moon, Consultant Oncologist, University Hospitals of Morecambe BaySarah.moon@mhbt.nhs.ukDr Guy Morris, Clinical Fellow in Reproductive Medicine, Reproductive MedicineUnit, Elizabeth Garrett Anderson Hospital, University College London Hospitals,Londonguy.morris1@nhs.netProfessor Cathy Nelson-Piercy, Consultant Obstetric Physician, Guy’s & St Thomas’Foundation Trust, LondonCatherine.Nelson-Piercy@gstt.nhs.ukDr Sofia Nyberg, Guy’s and St Thomas’ Medical School, King’s College Londonsofia.nyberg@kcl.ac.ukDr Catherine Oakley, Chemotherapy Consultant Nurse, Guy’s and St Thomas’ NHSFoundation Trust, LondonCatherine.Oakley@gstt.nhs.ukProfessor Allan Pacey, Professor of Andrology, University of Sheffield, Sheffielda.pacey@sheffield.ac.ukDr Lukasz Polanski, Subspecialty Trainee in Reproductive Medicine and Surgery,Assisted Conception Unit, Guy’s Hospital, LondonLukasz.Polanski@gstt.nhs.uk

ContributorsxiProfessor Daniel Rea, Professor of Medical Oncology, University of Birminghamd.w.rea@icloud.comDr Jonathan Riley, Specialty Registrar in Obstetrics & Gynaecology, Sharoe GreenUnit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trustjonathan.riley@doctors.org.ukMiss Pippa Sangster, Consultant Urological Surgeon and Andrologist, Clinical Lead forMale Infertility, University College London Hospital NHS Foundation Trustphilippa.sangster@nhs.netDr Daniel Saunders, Consultant Clinical Oncologist, The Christie NHS FoundationTrust, ManchesterDaniel.Saunders@christie.nhs.ukDr Leighton Seal, The Tavistock and Portman NHS Foundation Trust, London and StGeorge’s University Hospitals NHS Foundation Trust, Londonlseal@sgul.ac.ukDr Jenny Seligmann, Senior Lecturer and Consultant Medical Oncologist, LeedsCancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust,Leedsj.seligmann@nhs.netMr Majed Shabbir, Consultant Urological Surgeon, Guy’s & St. Thomas’ Hospital,LondonMajed.Shabbir@gstt.nhs.ukDr Francoise Shenfield, Clinical Lecturer in Infertility, Reproductive Medicine Unit,University College London Hospitals, Londonfrancoise.shenfield@nhs.netDr Katie Snape, Consultant Cancer Geneticist, South West Thames Regional GeneticsService, St George’s University Hospitals NHS Foundation Trust, London.Katie.snape@stgeorges.nhs.ukDr Chara Stavraka, NIHR Academic Clinical Fellow & Specialist Registrar in MedicalOncology, Guy’s & St Thomas NHS Trust, Londonchara.stavraka@gstt.nhs.ukDr Mari Thomas, Consultant Haematologist UCLH, NIHR CardiometabolicProgramme, UCLH/UCL Cardiovascular BRC, Londonmari.thomas@nhs.netCharlotte Tomlinson, Consultant Genetic Counsellor, Clinical Genetics Service, Guy’sand St Thomas’ NHS Foundation Trust, LondonCharlotte.tomlinson@gstt.nhs.ukDr Vishakha Tripathi, Consultant Genetic Counsellor, Clinical Genetics, Guy’s & StThomas’ NHS Foundation Trust, LondonVishakha.Tripathi@gstt.nhs.ukMiss Lisa Webber, Consultant Gynaecologist and Subspecialist in ReproductiveMedicine, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Londonlisawebberteoh@googlemail.com

xii ContributorsDr Christopher Williams, Clinical Research Fellow and Medical Oncology Registrar,Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHSTrust, Leedsc.williams1@leeds.ac.ukMr Nick Wood, Consultant Gynaecological Oncologist, Royal Preston Hospital,Lancashire Teaching Hospitals NHS Foundation TrustNick.Wood@lthtr.nhs.ukEditorsDr Caroline Archer, Consultant Medical Oncologist, Portsmouth Oncology Centre,Portsmouth Hospitals University NHS Trust, Portsmouthcaroline.archer@porthosp.nhs.ukDr Ruth E Board, Consultant in Medical Oncology, Rosemere Cancer Centre, RoyalPreston Hospital, PrestonRuth.Board@LTHTR.nhs.ukDr Melanie C Davies, Consultant Gynaecologist, Reproductive Medicine Unit, University College London Hospitals, Londonmelanie.davies14@nhs.netDr Eleni Karapanagiotou, Consultant Medical Oncologist, Guy’s Cancer Centre, Guy’sand St Thomas’ NHS Foundation Trust, LondonEleni.Karapanagiotou@gstt.nhs.ukDr Julia Kopeika, Consultant Gynaecologist and Subspecialist in ReproductiveMedicine and Surgery, Assisted Conception Unit, Guy’s and St Thomas’ NHSFoundation Trust, LondonYuliya.Kopeika@gstt.nhs.ukDr Janine Mansi, Consultant Medical Oncologist, Guy’s and St Thomas’ NHSFoundation Trust and Biomedical Research Centre, King’s College LondonJanine.Mansi@gstt.nhs.uk

PrefaceThe progress made in cancer diagnosis and treatment has radically improved patient outcomes.More than 50% of people diagnosed with cancer can expect to achieve long-term survival incountries with well-developed healthcare systems. That steady and continuing improvementbrings with it the requirement that we focus on the quality of life of cancer survivors. Cancerprofessionals and patients need to plan carefully together to manage any long-term consequencesof cancer and its treatment that they may encounter. Such “Survivorship Care Plans” are widelyrecommended but not yet comprehensively taken up in all healthcare systems.Increasing cancer survival rates and the trend towards a later parental age for childbirth meanthat there is an increasing chance of a person being diagnosed with cancer before their familyis complete. There are increasing numbers of patients for whom fertility following their cancerand its treatment has to be considered carefully; this is a central issue for these patients andprofessionals. The Association of Cancer Physicians (ACP) has worked with specialists in fertilityon Problem Solving in Cancer and Fertility, bringing together the extensive and ever-increasingbody of information about the way that cancer and its treatment can affect fertility, the waythat fertility can be protected in many patients, and the important aspects of communicationand a patient-centred approach which must underpin the provision of cancer care in this mostimportant and sensitive area. The book will discuss exciting technological developments in thepreservation and promotion of fertility in cancer patients, which has become a fast-moving fieldof research and innovation.Patient concerns about their future fertility are well documented. For example, studies showthat over 50% of women diagnosed with breast cancer and ovarian cancer express substantialconcerns about impacts on fertility; young men diagnosed with cancer place the retention offertility as a high priority. However, good quality discussions about fertility do not always occurbetween cancer patients and healthcare providers. Under some circumstances the cancer careteam may prioritise the treatment on curing a cancer; some cancer professionals may lackknowledge of modern fertility preservation. There will be concerns about any risks of delay intreatment, or about increasing emotional distress if fertility is discussed in detail. However, thesefertility discussions are central to high-quality survivorship for cancer patients in future. The bestcancer care is delivered through a multidisciplinary team; all team members need to be aware offertility issues for their patients, and some team members should take specific responsibilities toconstantly review and audit team practice in this challenging area. The wider multidisciplinaryteam should involve specialists in fertility, and there need to be clear protocols to involve fertilityspecialists appropriately when this is needed.This text on cancer and fertility includes a wide spectrum of issues which are illustrated aschapters and case histories. The perspective chapters cover fertility issues in women and men,including fertility preservation at the time of diagnosis; management, including drugs usedduring pregnancy; and survivorship issues such as conceiving after treatment, premature ovarianinsufficiency, and surrogacy. There are also chapters on issues related to counselling, genetics andethics. The case histories follow the same pathway as the chapters, but using sometimes complexhistories to illustrate the principles and dilemmas.

xiv PrefaceThe case histories are complementary to the chapters, and there are themes linking clinicalscenarios as follows:Female fertility and fertility preservation:Chapters 1, 2 and Case histories 1, 2, 4, 5, 6, 21, 22Male fertility and fertility preservation:Chapters 3, 7 and Case histories 3, 7, 23Cancer in pregnancy:Chapters 4, 5 and Case histories 4, 8, 9, 10,11,Pregnancy after cancer in women and men:Chapters 6, 9 and Case histories 4, 9, 12, 13, 14, 15, 18, 20, 21, 22, 23Genetic issues:Chapter 11 and Case histories 5, 19, 22Premature ovarian insufficiency:Chapters 8, 10 and Case histories 14, 1

Contents Contributors viii Preface xiii Acknowledgements xv SECTION ONE Perspectives 01 The Effects of Cancer and its Treatment on Female Fertility, Richard A. Anderson 1 02 Fertility Preservation in Women, Julia Kopeika 7 03 Fertility Preservation in Men, Maj Shabbir 12 04 Management of Cancer in Pregnancy, Kate Harding 19 05 Drug

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