Chapter 07: The Evolution of Onco-Fertility

Chapter 07: The Evolution of Onco-Fertility

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Description

In this chapter, Dr. Schover provides an overview of the growth of the field of onco-fertility and acceptance of it within MD Anderson. She first talks about what spurred interest in the issue of fertility, citing the cancer survivorship movement as well as the adolescent/young adult movement. She sketches how the field has changed since the 1980s. She also explains how problems arose because institutions found it easy to cast onco-fertility as a “frill” rather than a service essential to cancer care; researchers were also finding it difficult to get grants to move the field ahead.

Next, Dr. Schover talks about views of onco-fertility at MD Anderson. She explains that she made a proposal for a reproductive health center in 2010, gaining support from several departments and from then-president John Mendelsohn, MD. That plan never came to fruition, but funds were provided to hire faculty for a program.

Identifier

SchoverL_01_20180918_C07

Publication Date

9-18-2018

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Definitions, Explanations, Translations; Survivors, Survivorship; Patients, Treatment, Survivors; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Professional Practice; The Professional at Work

Transcript

T.A. Rosolowski, PhD:

So worldwide entrance to the question and obviously, support for research. So that’s very interesting. What was going on to increase the levels of support, the levels of interest, so that this could happen, do you think?

Leslie Schover, PhD:

Well, I think there was just more attention. I think it was the whole kind of cancer survivorship movement that was starting and more attention to people living longer after having cancer treatment, so more attention being paid to their quality of life.

T.A. Rosolowski, PhD:

You know it’s kind of funny, when I first started doing these interviews here at MD Anderson, it just, it really made me think about the fact of survivorship. I had never thought about the fact that survivorship was a new phenomenon, and with that came this whole territory that needed to be explored. Patients suddenly had to explore it and then their caregivers and researchers had to explore it too. It’s kind of amazing. That, in addition to all of the economic and technological changes that have changed healthcare, and social changes that have made more awareness about sexuality, empowered people to ask for quality of life. This is one of the areas, I mean it’s kind of amazing.

Leslie Schover, PhD:

Also, another thing that was happening around then was the adolescent and young adult movement, which Archie Bleyer was very involved in.

T.A. Rosolowski, PhD:

You know, I’ve never even heard about that.

Leslie Schover, PhD:

Well there, the concept is that there had been this great success with childhood cancer, although we now know that a lot of them have a lot of debilitating [late] effects, but the survival rate for childhood cancers overall has reached like 75 or 80 percent, and the survival rates for a number of adult cancers were increasing as well, although you know, the survival rate for the major solid tumors have—you know, they’ve increased some but much more modestly than you would think, with all the hype that you hear about personalized medicine and everything else. But the group that fell in between the cracks were people between the ages of about 15 and either 25 or 39, depending on how you define it, and the problem was that there was not an increase in survival for that age group. They were really doing poorly and it wasn’t clear whether they should be on clinical trials for children or adults. So, around that same time of the—you know, around the early 2000s, there became much more of a movement to focus attention on the plight of that age group, and to improve treatment protocols for them and to also pay more attention to their psychosocial needs, which of course fertility and sexuality would be very important.

T.A. Rosolowski, PhD:

Absolutely, yeah. We have a few minutes left before we’ve got our time for today, and we’re still going okay with our recorder. What are some other issues in this historical moment of the growth of this discipline, because it’s almost like I don’t know quite what to ask. You kind of know what that arc was for this field. You know, things that were changing, things that were influences. Guide me here in what this territory looked like.

Leslie Schover, PhD:

Well, you know I think when I first started out, during those first five years at MD Anderson, there were maybe, I don’t know, five other people in the United States that were focusing much of their careers on sexuality and cancer. That changed a lot over time. So now there’s a whole younger generation of people who have research careers and grants and things. I think one of the problems though, that became more apparent to me as I continued at MD Anderson the second time, especially I think after about 2008, when the financial crisis hit and grant funding really also became a lot scarcer, was that it was really easy to cast sexuality as a frill. You know frivolous and --compared to smoking cessation or cancer prevention or some of the other issues that people were getting grants in that were fashionable-- it became increasingly more difficult to get grants funded. In the end, one of the reasons I retired a couple of years early was that I hadn’t gotten a grant funded in about three years. That was really a very different experience than I had had before that. I started getting really kind of cynical and concerned about how difficult it was going to be to get grants on this topic, because the grant reviewers typically were not very expert and it was easy for them to say, Oh, why give someone money to do this when you could give money for these other things that we think are more important; inherited cancer syndromes and smoking cessation, and I’m trying to think. Colon cancer prevention and testing and all of those other issues. So.

T.A. Rosolowski, PhD:

Now that, I mean part of that is outside the institution. What about transformations of attitudes towards this field inside the institution, I mean from leadership, from other researchers?

Leslie Schover, PhD:

Well, during the era when everything was focusing so much on personalized medicine and new drug development and everything, and focusing away from some of the more clinical aspects of patient care, I think I also felt that the institution wasn’t as interested as before in trying to solve some of these problems. Also, don’t forget that I was in a research-oriented department the whole time, from 1999 to 2016, so I wasn’t doing direct clinical work. I was doing studies where I was supervising, sometimes masters level people or postdocs, who were doing some direct interventions, but I was more designing interventions and programs and they met some needs of patients here, but we didn’t have a program per se. So actually one of the things that happened --and I have to look back and see what year it was-- but I put together a proposal for a reproductive health center at MD Anderson that would include men and women’s sexuality and fertility. That was probably around, maybe 2010, or something like that. There was support from gynecology and breast, and some from urology. I put together an 80-page proposal, and I got some help from the Business Office, to try to look at revenues and things like that. At that time, the chief medical officer was—and I’m going to do this with the names again. He was a gynecologist and he was in that position for a number of years [Thomas Burke, MD; oral history interview].

T.A. Rosolowski, PhD:

Is this Tom Burke?

Leslie Schover, PhD:

Yeah, Tom Burke, thank you. So, we ended up, I gave the proposal to Tom Burke, and we had a meeting with him and he said this is all very nice, but we don’t have any money for this right now, so why don’t you see what you can do with existing resources. I was very frustrated because there weren’t—there wasn’t really much in the way of existing resources. So, you know, I talked to several people and we kind of hung around for seven or eight months, and I finally said you know, I don’t think Dr. [John] Mendelsohn [oral history interview] --do you think Tom Burke ever showed that proposal to Dr. Mendelsohn? And we said, You know, maybe not. And I said, You know what? I’m going to email him and send it to him and say we got all the way through this with the Business Office and with Dr. Burke, but there just isn’t much in the way of real resources that we can pilot things with, and what do you think of this? In a week, I got back an email and he said, “I don’t know where we’re going to get the money from or exactly what we’re going to do, but I’m going to help you make this happen.”

T.A. Rosolowski, PhD:

Wow.

Leslie Schover, PhD:

It took about three or four years for Tom Burke to look at me without shooting beams of hatred out of his eyes. He was not happy I did that. But I’ll tell you, one of the main things that came out of that was hiring the oncofertility—starting the oncofertility program. We weren’t successful really, in starting the sexuality program, but we did hire Terri Lynn Woodard for oncofertility and I helped mentor her when she first came to the institution. Well, and we also did hire a psychologist, Andrea Bradford, in gynecology, and they already had several gynecologists who were interested in the medical treatment of those problems. So, urology already had a urologist who saw men with erection problems a couple of days a week, so we did get some of the elements of that program and we just never unified it as a program with a chief and a budget and all those things.

T.A. Rosolowski, PhD:

It’s amazing, what a well-placed email can accomplish.

Leslie Schover, PhD:

[Redacted]

T.A. Rosolowski, PhD:

Yeah. Well, I’ll be interested in hearing, next time, you talk about your company and how the work that you did here helped feed that.

Leslie Schover, PhD:

Sure.

T.A. Rosolowski, PhD:

But why don’t we call it quits for today.

Leslie Schover, PhD:

Yeah, I’m getting hoarse.

T.A. Rosolowski, PhD:

Yeah, and I’m sorry we had our glitches.

Leslie Schover, PhD:

Oh, that’s all right, I’m glad we were able to kind of recoup.

T.A. Rosolowski, PhD:

Yeah. I’m delighted that we were able to have a conversation. It’s really interesting and I enjoyed talking to you.

Leslie Schover, PhD:

Okay, well thank you. Yeah, I had a lot more to say than I thought.

T.A. Rosolowski, PhD:

And just let me say, for the record, I’m turning off the recorder at about four minutes after four.

Conditions Governing Access

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Chapter 07: The Evolution of Onco-Fertility

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