This is so important. We like our patients to not only enjoy the remission, but also being able to return to what normal is like. So majority of our treatments, in fact, don't significantly decrease the future chance of having children, except for the high dose melphalanin stem cell transplant. So young patients who are just having a discussion about high dose melphalanin and transplant with their treating physician should probably look into the possibility of collecting the stem for banking or egg for banking. Now this is for future, but for right now, unfortunately, a lot of our treatments continue to have concurrent risk to the fetus. That means increased chance of genetic abnormalities. We don't want to ever repeat the history of thalidomide class drug causing fetal defect. So I'm encouraging all of our myeloma patients to consider adequate contraception, not to expose the partner to chemotherapy unnecessarily, but also as they have a conversation with their treating physician going forward. Bring this up to the forefront. A lot of us are used to treating older individuals. Myeloma is a disease of older adults most of the time with the median age at the time of diagnosis. We definitely don't want to lose an opportunity of preserving the fertility in younger patients, particularly those who are younger than 40 and 50. And there are all kinds of resources out there now that we can tap into. So if it's not mentioned, please share your concern with your treating physician and we're here to help. Your patients, especially the younger ones, may be really interested because I think for your female young patients, it's a really big deal. They're too afraid to talk about difficulty with sex, vaginal dryness, all these things that are complex conversations for young women to have, especially with their cancer doctor who is generally useless about these things. That if you had an OB-GYN who was into cancer, that they would be the perfect person to talk about both pre-transplant, post-transplant fertility preservation and then who should go on hormonal replacement therapy, what the risks of that are, how it will help your bone density as a myeloma patient. There's a whole aspect to this that I think we don't talk about enough for patients. Generally speaking, depending on where you are, the starting point should be the doctor that's treating you for your myeloma. They'll have the best insight as to who is going to be local to you, helpful. They'll probably have somebody who's their go-to person in terms of fertility preservation and they'll also be able to help you navigate any costs or insurance barriers that may or may not be associated with that. The first person you go to is always your treating doctor and then don't be shy to push for these things. If it's most likely it's going to be something that's really important to you and maybe you'll find yourself overwhelmed in the setting of a new cancer diagnosis. But this is something, these are important questions for you in the longer term that you're going to want to make sure you ask upfront.
HealthTree • July 5, 2023