Mesothelioma Diagnosis and Family Planning: Are They Mutually Exclusive?

“I can’t believe we’re at a point at which we’re discussing fertility at a meeting about mesothelioma,” said a moderator during a session at the International Mesothelioma Interest Group’s (IMIG) meeting at the beginning of May, in Birmingham, United Kingdom.

The speaker at the podium who elicited such a response was Gleneara Bates, MSW, a researcher at Columbia Presbyterian in New York City, and a community education and outreach volunteer for the Mesothelioma Applied Research Foundation. For anyone who knows about mesothelioma, the reason for such a response is clear: With a median overall survival of 12 months, it is commonly accepted that a mesothelioma patient, especially a female one, does not have enough time for parenthood.

Ms. Bates begs to differ.

In her presentation at IMIG, Ms. Bates acknowledged that within the mesothelioma medical community, it is generally known, though not fully understood, that women tend to live longer than men. As she delved further into data, she also explained that that’s only half of the story. In fact, when it comes to peritoneal mesothelioma, premenopausal female patients can live three times (or more) longer than postmenopausal women or men. Some female patients at Columbia Presbyterian in New York City, where Ms. Bates works, are still alive and doing well 8 and 9 years after diagnosis.

“What happened is they were diagnosed, they were very sick, they underwent aggressive treatment, and now, several years out from diagnosis, they find themselves wanting a child but no longer have that option available to them,” said Ms. Bates in an interview with the Mesothelioma Applied Research Foundation.

Ms. Bates became interested in cancer research after watching her mother battle the disease. Following the completion of her master’s degree in social work, Ms. Bates accepted a position at Columbia University Medical Center where she began to study quality of life issues in peritoneal mesothelioma patients treated at that clinic. That line of research, however, only helped to amass a whole new set of questions that she felt needed answers.

“From there, I spent about two years just focusing on creating cell lines from our patients, then treating those cells with the same regimens the patients had received in the clinic. I looked at tissue penetration, how long the platinum lingers in the blood and in the tissue. That got me on the path of seeing differences between mesothelioma in males and females.”

“We then informally reached out to many of our female patients to hear their story. The common thread was that their doctors insisted on immediate treatment without any fertility counseling, something commonly offered to male patients.”

In our conversation, Ms. Bates would only venture to guess as to why such a double standard might exist. One guess is that when survival from an incredibly aggressive cancer is at stake, fertility simply isn’t a priority for the doctor, as much as the patient. The reality is that harvesting and freezing eggs is a more complicated and lengthy process than harvesting and freezing sperm. Some clinicians have argued that the time it takes to complete one such egg harvesting cycle is valuable time that the patient could be undergoing treatment. Ms. Bates disputes this notion by observing that the time between diagnosis and first treatment is rarely less than 10.6 months for premenopausal women, a lengthy window of opportunity to work out any fertility issues of interest to the patient. Not to mention that fertility technology has seen monumental advances in recent years, some possibly beyond the expertise of mesothelioma clinicians.

Another guess is that perhaps certain antiquated social biases related to child rearing, combined with the fact that women make up a very small percentage of mesothelioma patients, might be the cause behind the lack of urgency in updating treatment guidelines to include family planning.

Whether or not her suggestions can become accepted in clinic is yet to be seen, but for Ms. Bates, research continues. She plans on furthering her study into the possibility that certain sex hormones are the reason why women are living longer.

“If that’s true, and if we can identify the cause of prolonged survival in women, we can take that knowledge and apply it to men. Taking a deeper look into this phenomenon can be beneficial for everybody.”

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