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    You've Survived Cancer: Now What?

    People who have fought cancer and won may expect to go back to their ordinary lives. But life after cancer can be anything but ordinary.

    Life After Survival continued...

    Survivors may have substantial medical bills to pay down, and some employers are reluctant to hire someone who has had cancer because of fears the person will not physically be able to handle work.

    "All types of discrimination may be faced by survivors," Nessim says. "Sometimes people return to work to find that their job is gone or they've been shifted to a lower position. They may find themselves loaded down with travel assignments in an effort to get rid of them. Employers know the bounds of the Americans with Disabilities Act, and they can be very savvy about how to get around hiring people who have had cancer or other major health problems, such as AIDS."

    The Fertility Issue

    Of the problems faced by cancer survivors, damaged fertility is one of the least understood, says Fertile Hope's Nohr. The side effects of radiation, chemotherapy, or surgery can leave a person infertile.

    "I would estimate that only 10% of oncologists even discuss the fertility issue with female patients who are under 45 before treatment," she says. "That is a big, big problem. Cancer patients are much more empowered now than they have been in the past, getting second opinions and researching their treatment options, but many patients don't understand that some cancer treatments many leave them unable to have children."

    Cancer patients can take special fertility-saving measures before treatment. Adult and adolescent males can make deposits in a sperm bank for future use. Prepubescent boys can have testicular tissue frozen to preserve sperm.

    For women the issues are more complex. A woman's fertility-saving measures depend entirely on her cancer treatment and her particular physiology. Eggs can be extracted and frozen, as can embryos. From there, the measures become increasingly tailored to an individual woman's needs.

    "That's why all women cancer patients who have the potential to bear a child need to see a reproductive endocrinologist before cancer treatment begins," says Nohr. "Oncologists do not know enough about fertility. They tend to be not well educated about these issues, and that's why women need to be very proactive and think farther down the road to protect their fertility if possible."

    That's also, says Nessim, why a survivor support group is so important.

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