Rebecca Musgrove was a strong advocate for her own health. As a farmgirl and an operating room nurse in Calgary, she had regular Pap screenings and was given the Human Papillomavirus vaccination.
She was able to cure others of their sicknesses.
Until a woman from the walk-in clinic where she had had an ultrasound for some pesky symptoms called to say her results were back and they weren’t good: she had a five-by-five-centimetre tumour on her cervix. Musgrove had a plan; she was prepared. After a series of biopsies, Musgrove received a call from her doctor confirming that she had advanced cancer.
“We talked for a minute,” Musgrove said outside a coffee shop as a thunderstorm gathered behind her. “And then he let me go. “I had an intense scream, and then a very good cry. When he called me back, we talked about what it meant and what next steps would be.”
It was April 31st. In the following weeks, she was referred to an oncologist and had a CT scan. The gynecologist also asked: Has she ever thought of freezing eggs?
She hadn’t. In a matter of days she was in a fertility clinic learning about her options.
Musgrove learned quickly two facts. First, the radiation and chemotherapy necessary to save her life — hysterectomy was only for early cervical cancer, she was told — could end her chance of pregnancy. She would also need five figures if she was to be able to freeze and harvest eggs in order to have a biological baby.
“They called me one day and they said, ‘Don’t take your birth control tomorrow. We’re starting.’ I went in on a Saturday, and it was just a whirlwind of drugs and ultrasounds. And ‘Can you pay us?’” The bill would be more than $17,000.
Dr. Jeff Roberts, a fertility doctor in Vancouver, knows what a blow a cancer diagnosis can be to women who haven’t finished — or maybe even started — their families.
“I tell patients the most important thing is to get through cancer,” he said. “But this is what can be done (for fertility preservation). It is worse for them to undergo treatment and return completely sterilized. That’s not a good time to get the information.”
Roberts stated that cost is an obstacle for those who want to save eggs. Only Quebec and Ontario cover costs associated with fertility treatments. Fertile Future President Roberts, who is also the president, offers small grants in excess of $1,000 to patients with cancer. It’s helped nearly 800 patients since it started in 2010.
Roberts says that at least 3000 Canadian women are in need of medical care to limit their or stop the possibility of having biological children. While it’s difficult to know just how many of them get timely access to fertility preservation, a 2018 paper The files of close to 5,000 females aged between 15 and 39 diagnosed with breast cancer in Ontario during 2000-2017 were examined.
In that period, about 44% of women were referred for fertility consultations between the diagnosis of cancer and the initiation chemotherapy. It was not surprising that women from southern Ontario are more likely to get referred than those in the North. It is difficult to access services.
For growing numbers of children diagnosed with cancer, fertility preservation is also an important issue. About 1,000 new cases of pediatric cancers are diagnosed in Canada each year and, as treatments improve over time, a growing number of kids — currently more than 90 per cent — survive past puberty and into adulthood. For their children to be able to have biological babies, they must think about the future.
Florence Gregoire-Briard is a Montreal pediatric gynecologist. She says that many children who are cured of cancer, but then discover they are infertile, experience anxiety and depression. They are also more likely to engage in risky sexual behaviors.
“A lot of cancer survivors say that learning about their infertility in the future is the same as or worse than being diagnosed with cancer itself,” she said. “It’s heartbreaking.”
Recently, she published “An Intimate Look at the World” review of referral rates for female children diagnosed with cancer from 2018 to 2021 at the Children’s Hospital of Eastern Ontario in Ottawa. Only half of the 89 included patients received fertility counseling.
Dr. Sarah McQuillan is aware that the number could even be greater. As a Calgary pediatric gynecologist, she established a referral system for fertility preservation at her hospital. This was a mandatory step in any cancer diagnosis. Now that she’s back in Canada, she’d like to see the same thing happen here.
“If you standardize a protocol where it’s part of the checklist and it’s more of an opt-out situation, it might enhance care,” McQuillan said. “Families are overwhelmed because there are so many other things to consider and treatment often needs to be started quickly.”
But at least in Central Canada, Gregoire-Briard said, there’s room for hope. Medically assisted reproduction, including fertility preservation for people with cancer, has been covered by the Régie de l’assurance maladie du Québec since November 2021. It has been provided by Ontario since 2015. Canada has a laggard.
Rebecca Musgrove, now two months post-diagnosis, has 12 eggs frozen and a new radio tattoo. For egg retrieval, she needed three injections per day over two weeks. Regular procedures were necessary to irritate her tumor.
As rain began to pound the sidewalk, she chuckled. “Being a nurse, you’ve got to have a dark sense of humour.”
It will take time to see if she is able to have a baby. Musgrove might need to find a surrogate to start a family.
A fellow nurse at Musgrove’s hospital offered to hold bake sales to help her with the cost of her fertility treatment. Musgrove sent her friend a bill photo and she upgraded the bake sale campaign to GoFundMe.
“I would never have asked for money,” Musgrove said. “Never. Growing up in the country, I never had to work. We do things for ourselves.” But with her credit cards smoking and no income from being unable to work, she had little choice. She stated that she was shocked at the speed with which the campaign raised money for her treatment.
“No one tells you cancer costs so much.”
