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Relationships, sex and fertility for young people affected by cancerTurn to pages 94–105 for some useful addresses, helpful booksand websites, and to chapter 9 to write down questions for yourdoctor or nurse.If you find this booklet helpful, you could pass it on to yourfamily and friends. They may also want information to helpthem support you.2

Let’s talk about you: a guide for young people caring for someone with cancer1 Talking about sex and fertility 52 Coping with thoughts and feelings 133 Cancer and sexuality 214 Fertility 355 Fertility testing 496 Becoming a parent naturally 617 Other choices for having children 678 Further information 899 Your notes and questions 107contents13

1Talking about sex and fertilityTalking to your medical team about sexand fertility 6Talking to your partner, family and friendsabout sex and fertility 835

Relationships, sex and fertility for young people affected by cancerTalking to your medical teamabout sex and fertilityFinding out you have cancer is a frightening experience.You might feel shock, disbelief or several other strongemotions. These are all natural reactions. After the diagnosisit can sometimes feel like events move quickly. Your cancerspecialist or specialist nurse will want to talk to you abouttreatment options and their possible side effects. You’ll needsome time to adjust to the changes in your life and to talk toyour family and friends about what’s happening to you.Cancer and its treatments can have an effect on your sexuality,your ability to enjoy sex or your ability to have children (yourfertility). Someone from your medical team should discuss thiswith you. But you can always bring this subject up yourselfwhenever you feel ready to. It’s important to talk about theseissues with your team, before you start treatment if possible.It can be helpful to know where you can get information aboutsex, relationships and fertility. You could start by asking yourmedical team, or you may prefer to talk to one of the supportorganisations listedon pages 94–101.Whoever you speakto, remember that evenif they don’t know theanswer straight away,they will usually knowsomeone who does.6

Talking about sex and fertilityGetting information may not be enough by itself. It can alsobe helpful to talk through your feelings with someone trainedto help you work out ways of coping. They can also help youfind ways of dealing with the impact of cancer on you and yourrelationships. There’s more information about how to find thiskind of support on pages 16–19.If cancer or its treatment has affected your fertilityCertain kinds of cancer and cancer treatment can havean impact on fertility. If this applies to you then over time,perhaps when the cancer treatment has finished, you mayfind yourself having to make a lot of decisions, such as:• whether to get your fertility checked• whether to go for fertility treatment• what sort of fertility treatments to have• whether or not to stop fertility treatment.Again, having discussions with staff trained to help withdecision-making can be useful. You could talk to staff atthe hospital where you had your treatment, or to one of theorganisations on pages 94–101.7

Relationships, sex and fertility for young people affected by cancerBoyfriends and girlfriends‘We would just do normal things,normal dates. Everything just carried onas normally as we could, and any sort ofissues that were apparent, like the hair loss,we just took in our stride and we wouldtalk them through first and then get over them.’If you have a partner, it’s important to talk to them abouthow you feel about the cancer and its impact on your sex life.This will vary from person to person. Living with cancer doesn’tautomatically stop your sex life, and it can be reassuring thatparts of your life aren’t changed by the fact that you have cancer.If you were already having sex with your partner before yourcancer diagnosis, you may have noticed that one of you wasmore interested in sex than the other. Cancer can exaggeratethese differences. If one person has a change in their level ofdesire, or difficulties due to physical or emotional changes,this may be especially upsetting when there’s the addedcomplication of cancer.counsellor10

2Let’s talk about you: a guide for young people caring for someone with cancerCoping with thoughtsand feelingsYour thoughts and feelings 14Body image 15How to talk about difficult subjects 1613 11

Relationships, sex and fertility for young people affected by cancerYour thoughts and feelingsLots of things affect the way that we think about, feel andexperience anything to do with sex, relationships and havingchildren. No two people are quite the same. Your views arelikely to be affected by many things, including:• whether you’re male or female• your and/or your family’s views on the importance ofbecoming a parent• your sexual orientation• your religious or cultural beliefs.Having cancer and going through treatment may affect yourself-confidence. It can take a while before you’re ready tothink about relationships, sex or having children. You mayalso have to adjust to changes in your situation due to havingcancer. Some of the changes might be to your body and toyour lifestyle, and others might be to the way that you thinkabout yourself and your future, including becoming a parent.However you feel now, this may change over time.For example, some people have a very strong desire to becomea parent throughout their childhood and teens, while othersdon’t even think about it until they’re older.Most young people growing up have thoughts and feelingsabout themselves in terms of sex and sexual attractiveness.As they develop personal relationships, some will also start toexperiment sexually. Some people will already have had somesexual experiences by the time they’re diagnosed with cancer,but others won’t.14

Relationships, sex and fertility for young people affected by cancerHow to talk aboutdifficult subjects‘I wish I’d plucked up the courage to talk abouthow the treatment would affect my sex life.It would really have helped if I’d had someidea what to expect.’Most people find it hard to talk about a deeply personal issuesuch as sex. This might put you off starting a conversationand you may hope that someone, such as a partner, parent,friend, doctor, nurse or social worker, brings the subject upwith you first. They may not always think of discussing sexualityor fertility, but that doesn’t mean that they’re not willing to helpin any way they can.Healthcare and fertility clinic staff who work with peoplewith cancer are used to talking about sensitive matters.They’re experienced in talking with people about sex,feelings and how our bodies work. Most of these staff won’tbe surprised or embarrassed if you talk to them. There shouldalways be a private space available for this type of discussion,and you can ask to talk to someone of the same gender as youif you’d prefer to. Healthcare and fertility clinic staff can referyou to other services if you like, or you may be able to approachservices such as social work or counselling directly – this variesin different parts of the country. There are also specialist andconfidential telephone advice lines that can help you or put youin touch with local services (see pages 94–101).16 14

Relationships, sex and fertility for young people affected by cancerdomesticIf you’d prefer to talk confidentially to a professional in personbut think you’ll find it embarrassing, it might be useful to writedown all your questions in advance. You can then read fromthe list or show it to the person you’re talking to. You could usethe space in chapter 9.Another way is to write a letter or a story for the person youare seeing. You can give this to them when you meet as a wayof starting the discussion. Many people find it useful to takea family member or friend with them when they see a newprofessional. The family member or friend could also makenotes of what’s discussed so that you can read them later.marie curieIt may help to ask for the professional’s telephone number oremail address, in case there’s anything you want to ask afterwards.occupationalfor short)Sometimes when we talk about the sexual or reproductive partsof our body to other people, different words or expressionscan be used that may not be clear. This can lead to confusionor misunderstanding. If someone uses words that you don’tunderstand, it’s okay to ask them to explain – that’s better thangoing away feeling more confused than you were before.What sort of questions can I ask?You may wonder which questions are okay to ask. But you canask about whatever’s important to you. No one will think thatyour questions are silly or weird, and nothing is off-limits.18 16

Coping with thoughts and feelings‘Unless you’ve got a close friend or relativewho’s had cancer, it can be hard to find peopleto speak to who understand what you’re goingthrough. I sometimes felt isolated and neededsupport and reassurance. It doesn’t have to besuch a lonely experience, though. There areprofessionals and organisations that understandand are able to offer support. You shouldn’t beembarrassed to tell anyone how you feel.’If you don’t want anyone else to knowWhenever you seek professional help – whether from a doctor,nurse, social worker, psychologist, counsellor or anyone else –it will usually stay confidential.Your family and partner aren’t allowed to know what you’vediscussed or even that you’ve been to see someone, unless yougive your permission for them to know. This is true even ifyou’re under 16. The only time when a professional can tellsomeone else what you’ve said is if they believe that your life isat risk, and this is very rare. For example, if they think that youmight seriously harm yourself, or if they think that some otherserious harm may happen if they didn’t do something.If the professional feels that they have to tell someone else,they should tell you that they’re going to break your confidence.Sometimes, a professional may ask your permission to talk toother people who are seeing you – for example, a counsellormay ask your permission to tell your doctor that they’ve seenyou. But that decision is entirely up to you.19

3Relationships, I’m still me: sex a and guide fertility for for young people living affected with by cancerCancer and sexualityEffects of cancer and its treatment on yoursex life 22Common questions about sexuality 3321

Relationships, sex and fertility for young people affected by cancerEffects of cancer and itstreatment on your sex lifeYou may worry that cancer, and any damage to your reproductivesystem, might affect your ability to have sexual feelings and toenjoy sex, either now or in the future. The good news is thathaving had cancer won’t automatically affect your sex life.It’s not common for cancer or its treatment to make it physicallydifficult to have sex, but it does happen occasionally. Even if thecancer or its treatment has damaged your reproductive system,you can usually still enjoy sex and relationships.Possible effectsCancer and its treatment can affect people both physicallyand emotionally. It’s important to remember that not everyoneis affected. It’s different for everyone, and it can also changeover time. It can be hard to think about ways of adapting toany changes to your body, but it can also be fun to learn aboutenjoying your sex life in new ways.Cancer or its treatment may affect:• your physical ability to have sex• your body image (how you feel about the way you look)• your feelings• your relationships• other things going on in your life, such as whether you getback into work or studying.22

Cancer and sexualityThe links between all these areas are important. If there’sa problem in one, it might have an impact on the others.In the same way, if there’s an improvement in one area,it can help improve all the others. If you’ve had treatmentrecently, it’s important to give yourself plenty of time to recover.There are often ways of dealing with the physical effects oftreatment on your sex life, and if you want to talk to someoneabout it there’s lots of expert information and support available(see pages 94–101).It can be helpful to know about the different sex organs.There are lots of different names for them, but over the nextpages we’ve used the names we’ll use throughout this booklet.23

Relationships, sex and fertility for young people affected by cancerSome physical effects on menIn boys and men, the sex organs are in the pelvic area (the lowerpart of the abdominal cavity). They include the prostate gland,the testicles and penis. Close by are the bladder, the lower endof the large bowel and some lymph nodes, also known aslymph glands.SpineVas deferensPubic boneEjaculatoryductProstateglandBladderSeminalvesicleRectumPenisUrethraTesticleScrotumThe male sex organs24

Relationships, sex and fertility for young people affected by cancerWhat can help?If you’re having problems getting an erection, this may go awayon its own after a while. However, treatments are available andthese include:• tablets that can help you have an erection, such as sildenafil(Viagra ® ), vardenafil (Levitra ® ) and tadalafil (Cialis ® )• pellets that are put into the tip of the penis• injections into the base of the penis• vacuum pumps that are put over the penis.A vacuum pump is a device that you use to give yourself anerection – a doctor or nurse will show you the pump andexplain how to use it. Although it sounds a bit strange tothink of using a vacuum pump, it can be very effective.It’s also important to remember that you don’t need to havea fully erect penis to have sex. There are many other ways ofhaving satisfying sex. You can talk about this with the doctorsor nurses at your hospital. You could also contact the nurses onour support line on 0808 808 00 00, or you could contact theSexual Advice Association helpline (see page 99).We can send you more information about the effectsof pelvic radiotherapy on men.26

Relationships, sex and fertility for young people affected by cancer25

Relationships, sex and fertility for young people affected by cancerSome physical effects on womenIn girls and women the pelvic area includes the sexualorgans: the ovaries, fallopian tubes, the womb and the vagina.The bladder and the lower part of the bowel are also close by.OvaryBladderVaginaFallopiantubeWombCervixUrethraThe female sex organsSome cancer treatments can cause vaginal dryness. This maybe due to low levels of the female hormone oestrogen.Radiotherapy to the pelvic area may stop the ovaries producingoestrogen. Sometimes the ovaries need to be removed as partof treatment for cancer, and this causes lower oestrogen levels.If you have both your ovaries removed, you will then havean early menopause (also called a premature menopause).This is when your periods stop permanently.An early menopause can also be caused by treatmentthat affects the gland in the brain called the pituitary gland.The pituitary gland produces hormones that control theproduction of oestrogen by the ovaries.28

Relationships, sex and fertility for young people affected by cancerYour specialist nurse or doctor will explain how best to usethem in your particular situation.We have further information about the effects of pelvicradiotherapy on women, which we can send you.Some physical effects on men and womenSome things can affect both men and women:• Your interest in sex may be lowered if the levels of the sexhormones (testosterone or oestrogen) in your body havebeen reduced by your treatment.• Many young people with cancer say that they feel ‘washed out’and as though they have no energy for many months or evenlonger. If this happens to you, you may lose interest in sex,feel unattractive or worry that you’ll never be able to besexually active.• Loss of sexual interest and erection difficulties are often notjust caused by physical changes, but can be affected by theemotional upset and raised anxiety levels that cancer and itstreatments can have on you.• If you’re in pain for any reason, this can make having sexmore difficult.• If you’ve had treatment for bone or muscle tumours in yourlimbs or back, it can sometimes be more difficult to get intoa position to have sex.30

Cancer and sexualityWhat can help?Hormone levels can usually be kept almost normal by takinghormone tablets, using skin patches, applying gel to the skinor having injections. Hormone replacement is important forboth men and women – not only for maintaining sex drivebut to help keep the bones strong.You might be put off having sex because you’re in pain or afraidthat it might be painful. If this is the case for you, it’s worthchecking with your doctor or asking for a referral to a specialistcounsellor, to find out if there’s anything that can get rid of orreduce the pain. You can also experiment with sexual positionsthat may be more comfortable for you.Perhaps the most important thing to realise is that you’regoing through the same problems as many other youngpeople being treated for cancer, and that getting help maysolve or reduce them.If things aren’t going well with your sex life, it’s a good idea toget some help, rather than leaving it. It can be difficult to talkabout sex, but doctors and specialist nurses are used to dealingwith intimate problems. They can often give you advice andsupport, or refer you to a sex therapist or counsellor for morespecialist help. You can also contact them through some of theorganisations listed on pages 94–101.31

Relationships, sex and fertility for young people affected by cancerHow long do physical side effects last?How long the side effects last depends on which parts of yourbody, if any, have been affected:• Nerve damage to the sex organs is long-term in most people.• Effects on male hormone levels may be temporary, but cansometimes be permanent.• In women, low levels of hormones can often go back tonormal if they’re caused by chemotherapy, but thismay take several months or perhaps as long as a fewyears. However, after high-dose chemotherapy, surgery,radiotherapy or pituitary gland damage, the effects maybe long-lasting.In most people, tiredness and a lack of energy graduallybecome less of a problem after a while, although this cantake months or sometimes years.32

Cancer and sexualityCommon questionsabout sexualityCan I pass the cancer on to my partner throughhaving sex?No, cancer is not passed on through sex.Will having sex make the cancer more likely tocome back?No, having sex has no effect on the chances of your cancercoming back.Does my sexual orientation make any difference?Many of the sexual issues that affect heterosexual (‘straight’)people after being treated for cancer also affect people whoare gay, lesbian, bisexual or transgendered. However, somepeople find it hard to ask for professional advice if they’re stillcoming to terms with their sexual orientation. You may alsoworry that healthcare staff will disapprove. If you find it difficultto talk to the professionals you know, there are advice linesthat can put you in touch with people who can help (see pages94–101).Our booklet Sexuality and cancer gives detailedinformation about how to cope with any effects ofthe cancer or its treatment on your sexuality.33

4I’m still me: a guide for young people living with cancerFertilityWhat is fertility? 36Cancer treatments and fertility 41Common questions about fertility 43Preserving fertility 4733 35

Relationships, sex and fertility for young people affected by cancerWhat is fertility?In women, fertility is the ability to become pregnant. In men,it means being able to make a woman pregnant (father achild). The areas of your body that allow you to make babiesare called your reproductive system.Fertility in young womenAll of a woman’s eggs are stored in her two ovaries (see thediagram on page 28). Girls are born with their total numberof eggs in their ovaries and no more are made after that.The menstrual cycleOnce a month, from puberty (the age periods start) tomenopause (when periods stop), one of the ovaries releasesan egg. This process is controlled by hormones produced bythe pituitary gland (in the brain) and the ovaries. It’s knownas the menstrual cycle.When an egg is released from the ovary, it moves along thefallopian tube, where it may be fertilised if you’ve had sexualintercourse and there are sperm present. The egg thenmoves into the womb. If it has been fertilised, you becomepregnant – the fertilised egg embeds itself into the wall of thewomb to develop into an embryo, then into a foetus and theninto a baby.If the egg is not fertilised, it will be released about 14 dayslater through the neck of the womb, together with the liningof the womb, as a period.36

FertilityThe menopauseEventually, as women get older, the hormone levels in the bodychange, eggs are no longer released from the ovaries eachmonth and periods stop. This is known as the menopause.Early menopause Some cancer treatments can stop theovaries from producing the hormones that control themenstrual cycle, and so may cause an early menopause.This means that some women won’t be able to havechildren. This is also known as premature ovarian failureor premature menopause.Other effects on fertility‘The doctors talked to me about the possibleeffects of chemo on fertility, and they alsotold me to keep an eye on my menstrual cyclebecause sometimes your periods can becomeirregular or stop altogether when you’re onchemo. My periods have been okay, though –they stayed regular.’When women go through stressful situations, such as seriousillness, it can affect their periods. Their periods may:• become irregular• stop altogether for a time and then restart• stop and not restart at all.37

Relationships, sex and fertility for young people affected by cancerAny problems that stop you having sex may also stop yougetting pregnant, even if you’re still making healthy eggs.Some types of cancer treatment may cause lasting damageto the heart or kidneys, which may make it inadvisablefor a woman to become pregnant. If this applies to you,your doctor will give you more information about it.Fertility in young menFrom puberty onwards, the testicles (‘balls’) begin toproduce millions of sperm – see the diagram on page 24.The process of producing sperm is controlled by hormones.The sperm are stored in the testicles until they’re releasedfrom the penis during ejaculation (when you ‘come’). The spermare released in a fluid called semen.Some cancer treatments may damage the cells that producesperm, so that no sperm are produced. It’s still possible toproduce a normal amount of semen from the penis, even ifit doesn’t contain any sperm. So some young men are stillable to ejaculate even if the semen can’t fertilise an egg tomake a baby.The male hormone testosterone influences sex drive andaffects the ability to get an erection (‘hard-on’). A differenthormone stimulates the testicles to produce testosterone.Some cancer treatments may reduce the production oftestosterone by the testicles, which may mean that youhave a low sex drive or that it’s difficult or impossible tohave an erection.38

FertilityFor a man to make a woman pregnant, sexual intercoursehas to take place where the man has an erection andejaculates (releases) sperm into the vagina. If an egg is inthe fallopian tube at the right time of the menstrual cycle(see page 36), it can be fertilised by a sperm. The fertilisedegg then buries itself in the lining of the womb and can growto form a foetus and then become a baby.For an erection to happen, the nerves and blood vesselsin the penis and testicles need to be working normally.Surgery or radiotherapy to the pelvic area can sometimesdamage these nerves and blood vessels (see page 25 forfurther information).39

Relationships38

FertilityCancer treatments and fertilityThe main treatments for cancer are chemotherapy, radiotherapy,surgery, stem cell transplants and hormonal therapy.For men, cancer treatments can affect fertility in different ways.Some stop or slow down sperm production, while others maycause problems with getting an erection and/or ejaculatingnormally. If low testosterone levels are contributing to infertility,you can have testosterone replacement therapy. There are alsodrugs and different techniques that can be used to help you getand keep an erection (see page 26).For women, cancer treatments such as chemotherapy canaffect the way the ovaries work and can result in fewer or noeggs being produced. Some treatments can make periodsirregular or stop for a while (known as temporary infertility).Other treatments sometimes cause permanent infertility andbring on an early menopause.Our leaflets Cancer treatment and fertility – informationfor women and Cancer treatment and fertility –information for men give detailed information aboutthe effects different treatments have on fertility.41

FertilityCommon questionsabout fertilityWill my fertility be damaged?Most teenagers and young adults who have had cancer won’thave long-term problems. Often it’s not possible to tell forsome time after treatment what damage, if any, has beendone, and whether the damage is temporary or permanent.As far as we know, most young people who’ve had cancerwill find that the cancer or its treatment doesn’t permanentlydamage their reproductive system. For people who havetemporary damage to their reproductive system, how quicklyit recovers varies from person to person. Full recovery cannever be guaranteed.If you have permanent damage to your reproductive system,you won’t be able to have children naturally. This can bevery distressing and you may need some emotional support(see pages 94–101 for useful organisations).If I’m infertile or have an early menopause, will Ibe able to take HRT?Most young women who have an early menopause fromcancer treatment should be offered hormone replacementtherapy (HRT). Taking replacement hormones has a protectiveeffect on your body. It does this by keeping your hormonelevels similar to the level they’d be at if you hadn’t had cancertreatment. HRT helps to reduce your risk of developingosteoporosis (brittle bones) and heart disease.43

FertilityPreserving fertility‘You do have to make decisions really quickly,and I think you mature really, really quickly.’Preserving fertility in menIt can be difficult to predict if treatment will affect your fertilityor if it will return to normal after treatment. Even if yourchances of becoming infertile are low, you may be referred toa fertility specialist to discuss your options. Freezing and storingsperm is a safe technique that has been successfully carried outfor many years.Our leaflet Cancer treatment and fertility – informationfor men gives more information about collecting andstoring sperm.Preserving fertility in womenFor young women who are having periods, it may be possibleto store fertilised eggs (embryos) before cancer treatmentbegins, even if the treatment is unlikely to affect fertility. To beable to store embryos, your eggs need to be fertilised withsperm from a partner. Before the eggs are fertilised and stored,both of you must sign a consent form and neither can use theembryo to start a pregnancy without the other’s permission.Teenage girls and young women without a partner may be ableto store unfertilised eggs, although the chance of a successfulpregnancy from stored unfertilised eggs is very low.Our leaflet Cancer treatment and fertility – informationfor women talks more about fertility preservation.47

5Relationships, sex and fertility for young people affected by cancerFertility testingAbout fertility testing 50How do men get a fertility test? 54How do women get a fertility test? 5749 47

Relationships, sex and fertility for young people affected by cancerAbout fertility testingAfter treatment, it can take some time for it to become clearwhether your fertility is going to come back. It can be difficultto work out whether any effect on fertility is temporary orpermanent. If you think your cancer or its treatment hasaffected your fertility, you may be able to have tests to findout whether you’re still able to have children.Women may find that it takes a while before their periodsstart again or become regular. Some types of treatmentmay be likely to cause an early menopause.After treatment, even if men are able to have erections andejaculate, it may take a while before they start making spermagain (see page 38).After treatment, it can be hard to decide how long to wait tohave a test to see whether you’re still able to have children.It’s important that you choose the right time for you, althoughsometimes there may be medical factors to take into account.Deciding whether to have a fertility testThis can be a difficult decision, as it may affect other aspectsof your life – such as your relationships with your partner,family members and friends. Everyone is different, and thedecision about whether to have a fertility test is completely yours.You may find it helpful to bear the following things in mind:• A fertility test may not clearly show whether or not youcan have children.50

Fertility testing• You need to feel ready to cope with the results, whatever theyare, so it’s important to know that you have people who cansupport you.• Some people find the uncertainty of not knowing whetherthey’re able to have children more stressful than findingout. Regardless of whether or not they’re in a relationship,or ready to start a family yet, they’d prefer to find out whetherthey can have children. This can help them feel more incontrol and able to start to plan their future. This mightinclude working out how to discuss this information withtheir partner or how to deal with new relationships.• For some people it may be enough to get information aboutthe different options available for becoming a parent – thesecan include medical treatments or adoption (see chapter 7).They may then delay having their fertility tested until later.It’s important to feel emotionally ready to have a fertility test.• Other people in your life, for example your partner or parents,may feel that they need to know whether your fertility hasbeen affected. Although this may seem like a good reasonfor finding out, the decision to have the test is yours.• Think about what effect the test may have on you. If you’reworrying about whether or not you can have children,then finding out whether you’re fertile may really help you.Another way of dealing with worry or feelings is by havingcounselling. You can look at all the options for help beforedeciding whether to have the test.• If you have a partner or other people who may be affectedby the results of the test, it may be helpful to talk through withthem beforehand how you might cope together. Talking canhelp you be clearer about what you’re both hoping for fromthe future and how the results of a fertility test might affect this.51

Relationships, sex and fertility for young people affected by cancerDeciding when to get a fertility test‘They explained that basically it couldreduce fertility... but at the time I meanI was 21, it was like the last thing on my mind.But it has been getting to me recently actually,as I’ve been getting older.’Some people prefer not to find out about their fertility untilthey reach a particular point in their life, such as:• when they feel emotionally strong enough to deal withthe results• when they reach a certain age• when they have met the person they see as theirlong-term partner• when they want to start a family.Your decision is also likely to depend on how you’re copingmore generally after having cancer. It may also be affectedby what else is going on in your life.If you have other major demands, such as taking exams,leaving education, leaving home or starting a new job,these are likely to be stressful and challenging. In this caseyou may not want to add the emotional effects of havinga fertility test.52

Fertility testingWho can help?As fertility testing is a big step to take, you might find it usefulto talk through your thoughts and feelings with other people.These can include:• your partner if you have one• family members• trusted friends• professionals, such as doctors, nurses, social workersor counsellors.53

Relationships, sex and fertility for young people affected by cancerHow do men get afertility test?You can ask your cancer doctor or GP to send you for semenanalysis at a local laboratory. This checks whether you’reproducing sperm, and if so, how many and how active theyare. The doctor would then usually refer you to an NHS fertilityspecialist to discuss the results. These tests are free.If you’ve stored your sperm in a sperm bank, you can askthem to do a semen analysis. You can also ask a private fertilitycentre to do this. The sperm bank or private fertility centre maycharge you for the test.What does the test involve?To have your semen examined, you have to produce a sampleby masturbating (‘wanking’) into a small container. You maybe allowed to produce the sample at home and take it into thelaboratory within an hour of it being produced. However, it’smore common to be asked to produce a sample in a privateroom close to the laboratory. The advantage of this is that thesample can be analysed quickly and is more accurate.How accurate is the test?No laboratory test is 100% accurate. However, the semenanalysis test should be able to tell whether your testiclesare producing sperm. If sperm are being produced, the testalso checks how many there are and how healthy they are.Looking at how well the sperm move and their size and shapecan give doctors an idea of how likely you are to be able to54

Fertility testingmake a woman pregnant. This can let them know whetheryou’re likely to need specialist fertility treatment (called assistedconception treatment).Test resultsIf the test shows normal sperm productionIf the semen analysis shows that your testicles are producingsperm at normal levels, you’ll need to use contraception ifyou’re not planning to be a father at that time.You may find it useful to have the test repeated every year tomake sure the situation hasn’t changed. If you have normal testresults over several years, you may like to think about whetherany frozen samples you have in storage are really needed.Your doctor may discuss this with you and you can also talkit over with the counsellor in the clinic, but there should be nopressure to get rid of the samples if you want to keep them.If the test shows below-normal sperm productionIf the result shows that sperm production is below normallevels, there’s still a possibility that you can become a father.So it’s important to use contraception if you don’t want tobecome a father at that time.You’ll be advised to wait at least three months before havinganother test to see whether the situation has improved.The sperm counts of healthy, fertile men can vary widely,so the sperm count may be higher at the next test.If the test shows no sperm productionIf no sperm are seen in the sample, it might be useful to havethe test repeated. If you’re not actively trying to become afather, it might be reasonable to have a test every year.55

Fertility testingHow do women get afertility test?If you’re having periodsIf you’re having regular periods and aren’t on the pill or takinghormone replacement treatment (HRT), this almost certainlymeans that you’re fertile. However, this doesn’t guarantee thatyou will get pregnant.The usual way to check your fertility is for your doctor to lookat your menstrual cycle and do some blood tests at particulartimes in your cycle. The blood tests look at your sex hormonelevels. The tests can also give some information about thenumber of eggs you may have in your ovaries.Your GP or cancer doctor can do the tests, but they may aska fertility specialist to discuss the results with you.If you’re taking the contraceptive pill or HRT, these canaffect your sex hormone levels and make it difficult to assessyour fertility. You may be asked to stop taking the pill or HRTfor a short time, to help the doctors make the assessment.If you’re sexually active, it’s important to use a reliable formof contraception while you’re having these tests.57

Relationships, sex and fertility for young people affected by cancerIf you’re not having periodsIf you finished your cancer treatment at least six months agoand haven’t had any periods, a blood test can show whetheryour ovaries are still producing eggs.The test can show whether you’ve become menopausal,which means you’ve stopped producing eggs or are producingfewer and fewer eggs.If you’re menopausal, your ovaries may still be releasing anegg every now and again. So your doctor will advise you tostill use contraception if you’re having sex and don’t want tobecome pregnant. Your doctor may also recommend that youstart taking hormones, either as the contraceptive pill or HRT.Unfortunately, it’s not possible to predict accurately whether acancer treatment will definitely cause the menopause. But yourcancer doctor should be able to tell you whether there’s achance of you having an early menopause.If the tests are done on the NHS, they’re free. If you decide tohave testing done privately, you will be charged for this.Do the tests hurt?No, the tests don’t cause any pain, although blood tests canbe uncomfortable.How accurate are the tests?The tests can show quite accurately whether you’re fertile or not.58

Fertility testingTest resultsIf the tests show normal egg productionIf the tests show that your ovaries are producing eggs regularly,or from time to time, you need to use contraception if you’renot planning to become pregnant.You may find it useful to have the test repeated every year orevery few years to make sure that the situation hasn’t changed.If you’re producing eggs and haven’t become pregnant aftertwo years, a test may be arranged at a fertility clinic todetermine whether your fallopian tubes are open.If the tests show low hormone levelsIf your ovaries aren’t producing eggs, or if your hormone levelsare very low, you may be advised to have the tests repeatedafter some time. You can ask your doctor if you’re not surewhether you’ll need more tests. The tests can’t predict whatmay happen in the future, and it’s fine to ask to be tested againif you have changes in your menstrual cycle or any otherrelated symptoms.59

6Relationships, I’m still me: sex a and guide fertility for for young people living affected with by cancerBecoming a parent naturallyDeciding whether to become a parent 62Common questions about pregnancy 63Getting pregnant naturally 6559 61

Relationships, sex and fertility for young people affected by cancerDeciding whether to becomea parentThe decision to try for a baby is a big one for anyone to make.When you’ve had cancer, this brings its own extra challenges.When is it okay to start a family?It’s always strongly recommended to avoid becoming pregnantor becoming a father during treatment for cancer. Some peoplebecome temporarily infertile during treatment. Other peoplemay still be fertile but their eggs or sperm can be temporarilydamaged. A pregnancy from damaged eggs or sperm couldmean there’s a chance of the baby not developing normally.Most doctors advise waiting 18 months after your treatment hasstopped before trying to become pregnant or father a child.You can discuss this with your cancer doctor or specialist nurse.During the time of your cancer treatment, it‘s important to useeffective contraception if you’re sexually active.For women who’ve been told that chemotherapy may makethem have an earlier menopause (see pages 57–58), they maywant to start trying to have a family before they reach theirmid-30s, in case they have their menopause early.When you’re planning to have a child, you’ll need to thinkabout your general health and well-being and how well you’verecovered from cancer. If you finished treatment recently oryou still have ongoing problems, your GP or cancer doctorcan give you advice about when it may be best for you to tryfor a pregnancy.62

Becoming a parent naturallyCommon questionsabout pregnancyFor women, does pregnancy make the cancer morelikely to come back?Research suggests that pregnancy does not make childhoodor teenage cancers more likely to come back.What can I do if I’m worried about becoming aparent and my cancer coming back?This is a very understandable worry. It can be very difficult if youhave a young child and become seriously ill. You may decide towait for a few years after your treatment has ended before tryingto start a family. You can talk to your cancer doctor about whenthey think enough time has passed and the cancer is unlikely tocome back. For many childhood and teenage cancers, this isabout five years after finishing treatment.Can I pass cancer on to my children?There’s been a lot of research into this question. The researchshows that most children who have a parent, or parents, that hadcancer as a young person, are at no greater risk of gettingcancer than anyone else.There’s a very small number of people whose families have afaulty gene that increases their risk of getting certain types ofcancer. Your doctors will tell you if it’s possible that you have afaulty gene that could be passed on to your children. If you’reworried that you may have a faulty gene, you can talk to your63

Relationships, sex and fertility for young people affected by cancercancer doctor. The doctor will be able to arrange for you to seea geneticist (a doctor specialising in these issues) if needed.Can women who’ve had cancer breastfeed their baby?After cancer treatment most women should be able to breastfeedif they want to. Breastfeeding does not make the cancer morelikely to come back.Unfortunately, women who have had radiotherapy to the chestarea may not produce enough milk and will need to bottle-feedtheir baby.Treatment for some brain tumours can reduce the level ofhormones that stimulate the production of milk. Some womenwho’ve had treatment for brain tumours may not produceenough milk to be able to breastfeed.There are also certain medicines that you shouldn’t take if you’rebreastfeeding. If you have any doubts about whether your canceror its treatment may make it difficult for you to breastfeed, youcan discuss this with your cancer doctor, obstetrician or midwife.Is there help for parents who are disabled due tocancer or its treatment?Yes, social services departments can help parents with disabilities.They provide support and equipment where these are needed.You might want to start by talking to the social worker in thehospital where you have your check-ups. You can also go directlyto your local social services department (its telephone numbershould be in the phone book listed under your local council’sname). There are also parent-to-parent support organisations fordisabled parents, and their details are listed on pages 96 and 99.64

Becoming a parent naturallyGetting pregnant naturallyFor a better chance of being able to get pregnant or get yourpartner pregnant naturally, it’s important for you and yourpartner to try to have as fit and healthy a lifestyle as possible.Here are some suggestions to help you get ready for pregnancy:• If you’re a smoker, stop smoking.• Don’t drink alcohol.• Don’t take any recreational drugs.• Ask your doctor whether any medicines that you or yourpartner are taking are absolutely necessary.• Eat a healthy, balanced diet.• Keep your weight within the normal range for your height.• Most people don’t need to take vitamin supplements if theyhave a healthy diet.• Women should take folic acid for at least two months beforetrying for a baby and until the pregnancy has reached 12weeks – your pharmacist can tell you the appropriate dose.• Pregnancy is more likely if you have sex regularly (2–3 timesa week) than if you try to target the ‘right time’ in the monthor have long stretches without sex.Try not to worry if you don’t get pregnant straight away.It can take up to two years for a pregnancy to occur for somepeople. However, if you‘ve followed the tips for pregnancy andit doesn’t seem to be happening, you can talk to your GP orcancer specialist at any time. You may want to have (or repeat)a fertility test, or your partner may want to be tested.65

7Relationships, I’m still me: sex a and guide fertility for for young people living affected with by cancerOther choices forhaving childrenFertility treatment 68Fertility treatment for men 72Fertility treatment for women 76Common questions about fertility treatments 80Adoption and fostering 86Not having children 8765 67

Relationships, sex and fertility for young people affected by cancerFertility treatmentFertility treatment is also called assisted conception. This refersto the medical treatments that can be used to help people whohave difficulty getting pregnant naturally.The term fertility treatment covers a lot of differenttreatments. The main ones are discussed on pages 72–79.Getting fertility treatmentYour starting point for fertility treatment will usually be yourGP. They may arrange for you to have some initial tests andwill refer you to an NHS doctor specialising in fertility issues.You can ask to be referred to a private doctor if you’d like.If you want to have treatment with a partner rather than as asingle person, your partner may also need to have some basicfertility tests, which the GP can arrange. There’s no charge forthese tests for NHS patients.At the fertility clinicThe fertility clinic may be called the department of reproductivemedicine or the assisted conception unit. If you’ve alreadydiscussed your fertility and had any additional tests at one of yourcancer check-ups, the test results will usually have been passed onto your GP. Your GP will send them to the fertility specialist.At the clinic, the specialist will discuss your situation with you.They will answer any questions you have, arrange for somefurther tests and can tell you about any treatments that maybe suitable for you.68

Other choices for having childrenWhich fertility clinic?This depends on whether you’re an NHS patient or whetheryou want to pay for private treatment. If you’re an NHS patient,your GP will usually suggest a referral to a particular clinic.If you’ve already had contact with a fertility unit for sperm orembryo storage, or to have your fertility checked, it may bepossible for you to be referred back to the same clinic.If you want to have private treatment you can choose which clinicto go to, but you may need to get a referral letter from your GP.You can get details of all the assisted conception clinics in thecountry by contacting the Human Fertilisation and EmbryologyAuthority (HFEA – see page 97). The HFEA has a free patients’guide with advice about how to choose a clinic and questionsto ask about the treatments.Will I have to pay for fertility treatment?In some parts of the UK, some types of fertility treatment arefree for people below a certain age. Unfortunately, many peoplehave to pay for treatment. Eligibility varies in different parts ofthe country.Your GP or fertility doctor should be able to let you knowwhether you’re able to have fertility treatment on the NHS.Although there are national guidelines about providing fertilitytreatment, there are still local variations. It’s best to check withthe clinic you’ve been referred to about this.If you’re not eligible for NHS treatment or are worried thatyou may have to wait a long time for treatment in your area,you might consider private treatment. There are no standard69

Relationships, sex and fertility for young people affected by cancercharges for private treatment, so you’ll need to contact clinicsdirectly to find out how much they charge.Clinics should be able to give you information about treatments,including the success rates and costs. You can then make anappointment to discuss the treatment more fully.Tests for fertility treatmentIf you decide to have fertility treatment, you’ll have the sametests mentioned on pages 54–59 to test fertility.If you have a partner, they’ll also need to have some tests.Fertility treatment for people who are single or ina gay or lesbian relationshipIf you’re a woman who’s single or in a lesbian relationshipYou aren’t automatically excluded from treatment if you’re awoman who’s single or in a lesbian relationship. However, it mayaffect your eligibility for free NHS treatment.Staff in fertility clinics will need to know if you’re a woman who’ssingle or in a lesbian relationship. This is so they can advise youabout particular legal aspects that apply to becoming a parent.If you’re a man who’s single or in a gay relationshipThere are currently no fertility treatments available in the UK forsingle men and gay couples.The only way for gay couples to become legal parents is to adopta child or, if they’re in a civil partnership, to use a surrogateand then apply for a Parental Order.70

Other choices for having childrenAdvice and support if you’re single or in a gay orlesbian relationshipIf you’re single or in a gay or lesbian relationship, you can askyour GP about the issues around fertility treatment. You canalso contact one of the national support groups for confidentialadvice, such as Infertility Network UK or Pink Parents (seepages 94–101).71

Relationships, sex and fertility for young people affected by cancerFertility treatment for menThere are different kinds of fertility treatment. The typeyou’re advised to have will depend on the way that canceror treatment has affected your fertility. It might be useful tolook at chapter 4 before reading this information.If your sperm count is lowIf you’ve had cancer treatment and are still producing spermbut only in very low numbers, there may still be a chance ofmaking your partner pregnant naturally. However, if you’vebeen advised to have fertility treatment, you may be offered invitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).These are sometimes called ‘test-tube baby’ treatments, but thebaby is not made in a test-tube.In vitro fertilisation (IVF)Your partner is given a course of drugs to make her ovariesproduce more mature eggs than normal. A small operation isthen done to collect the eggs. A sedative is given to relax her,and a fine needle is put through the top of her vagina and intoan ovary. The eggs can be collected through the needle.The eggs are then fertilised in the laboratory by mixingthem with a preparation of your sperm. Usually only one ofthe resulting embryos is then placed in your partner’s womb,a few days later, in the hope that this will lead to a pregnancy.A pregnancy test can be done about 12 days later. If yourpartner is pregnant, this can be seen on an ultrasound scanafter about three weeks.72

Relationships, sex and fertility for young people affected by cancerUsing donated spermIf you don’t have any frozen sperm, the only fertilitytreatment available is to use sperm that have been donatedby someone else.People who donate sperm are carefully chosen. Their generalhealth is checked and they’re offered counselling to make surethey understand exactly what it means to help infertile peoplein this way. Occasionally it might be possible to use knowndonors or surrogates – such as brothers or friends – but, as withall decisions about surrogacy or donated sperm or eggs, itrequires careful thought and counselling for everyone involved.If you decide to have fertility treatment using sperm from adonor, you will also be offered counselling and informationabout what it involves. There can often be a waiting list forthis treatment.If your partner is fertile, treatment using donated sperm(that have been frozen and stored) is usually medicallystraightforward. The process is the same as the processdescribed on page 73 for couples using frozen sperm.This type of fertility treatment has good success rates andis called donor insemination (DI). If it doesn’t result in apregnancy, your partner may be prescribed hormones tomake the ovaries release more eggs. This process is calledstimulated intrauterine insemination. The donated spermare put directly into your partner’s womb. Treatments usingdonated sperm can also be carried out using the IVF procedure(see page 72).74

Other choices for having childrenIf you can’t have sexual intercourseSome people can’t have sexual intercourse because of physicalchanges caused by the cancer or its treatment. In this situation,it may still be possible for the doctors to take your sperm anduse them in IVF or ICSI treatment (see pages 72–73). This canallow you to have your own biological children. Where this isn’tpossible, you may like to think about using donated sperm(see page 74) or surrogacy (see page 78).We have a video on our website about male fertilitytreatment. Visit macmillan.org.uk/fertilityinmento watch it.75

Relationships, sex and fertility for young people affected by cancerFertility treatmentfor womenThere are different kinds of fertility treatment. The typeyou’re advised to have will depend on the way that canceror treatment has affected your fertility. It might be useful tolook at chapter 4 before reading this information.If you aren’t producing eggsIf you’re not producing any eggs at all, you won’t be able tohave a child unless you stored your embryos or eggs beforeyour cancer treatment. You may, however, be able to usedonated eggs or embryos (see pages 77–78).Using frozen embryosWhen the frozen embryos are needed, they’re thawed andplaced in the womb (usually not more than one at a time)to see if they will implant and develop. Pregnancy rates usingfrozen embryos are generally lower than when using a freshembryo but, even so, healthy babies have been born in this way.Using frozen eggsThis is a newer, more experimental technique, which is muchless successful than using frozen embryos. The eggs are frozenuntil needed. When they’re thawed later they may be fertilisedby sperm (from either your partner or a donor). The successrates for having children with this procedure are very low.76

Other choices for having childrenUsing frozen ovarian tissueA new and experimental technique is to take and store samplesof ovarian tissue that contain some eggs. The ovarian tissue canthen be put back into the body at a later date. This techniqueis at a very early stage of development and hasn’t been widelyused. If you’re suitable for this type of procedure you’ll probablyhave to travel to a specialist hospital for it.Using donated eggs or embryosIf you don’t have any frozen embryos or eggs, the only fertilitytreatment available is to use eggs or embryos that have beendonated by someone else.People who donate eggs or embryos are carefully chosen.Their general health is checked and they’re offered counsellingto make sure they understand exactly what it means to helpinfertile people in this way. Occasionally it might be possible touse known donors or surrogates – such as sisters or friends – but,as with all decisions about surrogacy or donated eggs or sperm,it requires careful thought and counselling for everyone involved.If you decide to have fertility treatment using eggs or embryosfrom a donor, you will also be offered counselling andinformation about what it involves. There can often be awaiting list for this treatment.Using donated eggs If your partner is fertile, you may beadvised to have treatment using donated eggs. The donatedeggs are fertilised with your partner’s sperm in the laboratory.The embryos that are formed are then put into your womb.You’ll need to have treatment with hormones before theembryos are implanted, and during the pregnancy.77

Relationships, sex and fertility for young people affected by cancerSince egg donors are usually young women with good fertility,the chances of a successful pregnancy with this treatment arerelatively high.Using donated embryos If both you and your partner havea fertility problem, you may be advised to try for a pregnancyusing donated embryos. The embryos are eggs that have beenfertilised with sperm and then frozen. The embryos are thawedand put into your womb. You’ll need to take hormones beforethe embryos are implanted, and possibly during the pregnancy.If you can’t have a pregnancy yourselfSurrogacySome women aren’t able to have a pregnancy becausetheir womb has been removed by surgery. In this situation,surrogacy is an option. Surrogacy is where another woman,called the surrogate mother, becomes pregnant and gives birth.If you’re in a heterosexual relationship, the baby is formedby fertilising the surrogate mother’s egg with your partner’ssperm. If you’re in a lesbian relationship, the baby’s formedby fertilising your female partner’s egg with a donor’s sperm.In both situations, this means that your partner is the geneticparent. Fertilisation takes place using the same technique asdonor insemination (see page 74) or IVF (see page 72).The surrogate mother is the legal mother of the baby, but youand your partner can apply to the courts to have full parentallegal responsibilities transferred to you (providing you aremarried or in a civil partnership), so that you become thebaby’s legal parents.78

Other choices for having childrenIf you can’t have sexual intercourseSome people can’t have sexual intercourse because of physicalchanges caused by the cancer or its treatment. In this situation,it may still be possible for the doctors to take your eggs anduse them in IVF or ICSI treatment (see pages 72–73). This canallow you to have your own biological children. Where this isn’tpossible, you may like to think about using donated eggs orembryos (see pages 77–78) or surrogacy (see page 78).79

Other choices for having children81

Relationships, sex and fertility for young people affected by cancerThe form tells the sperm bank or fertility clinic how longyou want the sperm, eggs or embryos to be kept in storage.The standard storage period for sperm is 10 years, but in somecircumstances they can be stored for a maximum of 55 years.The form also states:• the name of any partner that you agree to have fertilitytreatment using the eggs, sperm or embryos• whether you agree to your sample(s) being used for research• what you would like to happen to your sample(s) if you diebefore the maximum storage period of 55 years is reached.Will I be the legal parent?The law is very clear. If you use a licensed fertility treatmentcentre and have a baby using donated sperm, eggs orembryos, the person who gives birth is the legal mother.• If you’re married or in a civil partnership, you automaticallyshare all legal rights and responsibilities as parents.• If you’re not married, you get the same rights as marriedcouples if the male partner consents before treatment thathe intends to become the legal father.• If you’re a single woman going through treatment, you willbe the legal mother and will have full legal rights andresponsibilities for the baby.• If you are a lesbian couple, you can have the same rights asa heterosexual couple if, before treatment, you both consentto being the legal parents of any child born.• If you use sperm or eggs from somewhere that isn’t a licensedfertility treatment centre (for example, through the internet),then the legal protections mentioned above do not apply.82

Other choices for having childrenIf you use a surrogate mother the law is different, and you’llneed to apply to the courts for full parental legal responsibilities.If you aren’t sure about your legal status as a parent, you shouldask for legal advice straight away from a solicitor who specialisesin child and family law, as the legal situation changes fromtime to time.What rights do the children have?Children born after fertility treatment using your own eggs orsperm have exactly the same rights as any child conceivednaturally. Children born after fertility treatment using surrogacyor donated eggs or sperm have a legal right, when they reachthe age of 16, to receive non-identifying information abouttheir donor(s). At 18, people can find out the identity of theirdonor(s). This would only happen after everyone involvedhas had appropriate counselling. At 18, people can alsobe provided with information about any siblings that wereconceived using the same donor(s).It’s generally accepted that children cope better if you’re openwith them from an early age about how they were conceived.If you decide not to tell your child, it’s important to bear inmind that if you tell anyone else at all (such as your parents orfriends), that increases the chance that your child will find outaccidentally at some time. Finding out such facts by accidentcan be distressing and cause emotional harm to the child.83

Relationships, sex and fertility for young people affected by cancerWhat support is available if I have fertility treatment?Using fertility treatment, especially when it involves a donor,is a big step to take and one that you need to feel comfortableabout. If you have a partner, you’ll need to talk about it openlyand honestly with each other. You may also want to discuss itwith family and friends – but it’s important to be aware that noteveryone you know may feel okay about these treatments.Some people like to talk through all the issues withprofessionals that they already know (for example doctors,nurses and social workers). You can also talk to professionalssuch as the counsellors and other staff in the fertility clinics.There are support groups available for people using fertilitytreatments, such as Infertility Network UK (see page 97),which produces a range of helpful leaflets. The support groupDonor Conception Network (see page 96) is for people whohave had children using sperm, egg or embryo donation.It also produces a series of leaflets for prospective parentsand story books for children.How successful are fertility treatments?This is difficult to answer, as it varies according to each person’shealth and medical condition. When you go to see the specialist,they are often able to give you a good idea about your chancesof being able to get pregnant. However, the treatments haveno guarantee of success and many people don’t manage tobecome parents this way.84

Other choices for having childrenWhat if the treatment doesn’t work?It’s always upsetting if the treatment fails. The doctors at theclinic can advise you on what your chances of success might beif you tried again. Of course, having another fertility treatmentmight be affected by whether it feels right for you emotionally.There may also be other issues for you, including whether ornot you have to pay.Counsellors in the fertility clinics can help with talking thisthrough. There are also support groups for people who havedecided to end treatment when they haven’t achieved apregnancy (see pages 94–101).Are there any possible future treatments?There are always new developments in the pipeline.However, sometimes the way they get reported in thenewspapers or on TV can be misleading. You can askyour doctor or check with one of the organisations listedon pages 94–101 to get accurate information about anythingyou hear about.What if my religion says I shouldn’t usethese treatments?Some religions are opposed to any type of fertility treatment.Some don’t support the use of sperm, egg or embryo donation.If this is an issue for you, you may want to discuss it with yourpartner, family or religious adviser. You could also talk inconfidence with a trained counsellor or social worker.85

Relationships, sex and fertility for young people affected by cancerAdoption and fosteringIf medical treatment doesn’t feel the right way for you tobecome a parent, you might consider adoption or fostering.Single people and gay and lesbian couples can also applyto adopt or foster children. There are many children currentlywaiting to be adopted and fostered in the UK. This can be avery rewarding way to enjoy family life.Adoption and fostering aren’t easy routes though, and they’re notright for everyone. Many of the children waiting for adoption orfostering have had to cope with a lot of upset in their lives.Some have a lot of emotional needs and feel insecure as a result.There are very few babies and toddlers in need of adoption.It’s usually slightly older children who need adoptive families,so you miss out on their early lives.Some people go to other countries to adopt and then bring thechildren back to the UK. This can bring even more challengesand needs to be thought through very carefully. Many countrieshave now stopped this type of adoption because so manyadoptive families found it difficult to manage.If you’re interested in finding out more about adoption orfostering, you can ask:• your social worker (if you have one)• your local social services department (who should be listed inthe phone book under the name of your local council)• one of the organisations on pages 94–101 – some haveinformation packs about adoption and fostering.86

8Relationships, sex and fertility for young people affected by cancerFurther informationHow we can help you 90Other useful organisations 94Further resources 10289 87

Relationships, sex and fertility for young people affected by cancerHow we can help youCancer is the toughest fight most of us willever face. But you don’t have to go through italone. The Macmillan team is with you everystep of the way.Get in touchMacmillan Cancer Support89 Albert Embankment,London SE1 7UQQuestions about cancer?Call free on 0808 808 00 00(Mon–Fri, 9am–8pm)www.macmillan.org.ukHard of hearing?Use textphone0808 808 0121 or Text Relay.Non-English speaker?Interpreters are available.Clear, reliable informationabout cancerWe can help you by phone,email, via our website andpublications or in person.And our information is free toeveryone affected by cancer.Macmillan Support LineOur free, confidential phoneline is open Monday–Friday,9am–8pm. Our cancersupport specialists provideclinical, financial, emotionaland practical information andsupport to anyone affected bycancer. Call us on 0808 80800 00 or email us viaour website, macmillan.org.uk/talktousInformation centresOur information and supportcentres are based in hospitals,libraries and mobile centres,and offer you the opportunityto speak with someoneface-to-face. Find your nearestone at macmillan.org.uk/informationcentres90

Further informationPublicationsWe provide expert, up-to-dateinformation about differenttypes of cancer, tests andtreatments, and informationabout living with and aftercancer. We can send you freeinformation in a variety offormats, including booklets,leaflets, fact sheets, and audioCDs. We can also provideour information in Brailleand large print.You can find all of ourinformation, along with severalvideos, online at macmillan.org.uk/cancerinformationReview our informationHelp us make our resourceseven better for people affectedby cancer. Being one of ourreviewers gives you the chanceto comment on a variety ofinformation including booklets,fact sheets, leaflets, videos,illustrations and website text.Need out-of-hours support?You can find a lot ofinformation on our website,macmillan.org.ukFor medical attention out ofhours, please contact your GPfor their out-of-hours service.Someone to talk toWhen you or someone youknow has cancer, it can bedifficult to talk about howyou’re feeling. You can callour cancer support specialiststo talk about how you feel andwhat’s worrying you.We can also help you findsupport in your local area,so you can speak face-to-facewith people who understandwhat you’re going through.If you’d like to hear moreabout becoming a reviewer,email reviewing@macmillan.org.uk91

Relationships, sex and fertility for young people affected by cancerProfessional helpOur Macmillan nurses, doctorsand other healthcare andsocial care professionals offerexpert treatment and care.They help individuals andfamilies deal with cancer fromdiagnosis onwards, until theyno longer need this help.You can ask your GP,hospital consultant, districtnurse or hospital ward sisterif there are any Macmillanprofessionals availablein your area, or call us.Support for each otherNo one knows more aboutthe impact cancer has on aperson’s life than those whohave been affected by itthemselves. That’s why wehelp to bring people withcancer and carers together intheir communities and online.Support groupsYou can find out about supportgroups in your area by callingus or by visiting macmillan.org.uk/selfhelpandsupportOnline communityYou can also share yourexperiences, ask questions,get and give support to othersin our online communityat macmillan.org.uk/community92

Further informationFinancial andwork-related supportHaving cancer can bring extracosts such as hospital parking,travel fares and higher heatingbills. Some people may haveto stop working.If you’ve been affected inthis way, we can help.Call the Macmillan SupportLine and one of our cancersupport specialists will tell youabout the benefits and otherfinancial help you may beentitled to.We can also give youinformation about your rightsat work as an employee, andhelp you find further support.Macmillan GrantsMoney worries are the lastthing you need when you havecancer. A Macmillan Grant isa one-off payment for peoplewith cancer, to cover a varietyof practical needs includingheating bills, extra clothing,or a much-needed break.Find out more about thefinancial and work-relatedsupport we can offerat macmillan.org.uk/financialsupportLearning about cancerYou may find it useful to learnmore about cancer and howto manage the impact it canhave on your life.You can do this online on ourLearn Zone – macmillan.org.uk/learnzone – which offersa variety of e-learning coursesand workshops. There’salso a section dedicated tosupporting people with cancer– ideal for people who wantto learn more about whattheir relative or friend isgoing through.93

Relationships, sex and fertility for young people affected by cancerOther useful organisationsACeBabesCharter House,43 St Leonards Road,Bexhill-on-Sea TN40 1JATel 0800 008 7464Emailadmin@acebabes.co.ukwww.acebabes.co.ukSupports couples using fertilitytreatment, both before andafter birth. The website hasa section for members whohave used egg, sperm orembryo donation.Adoption UKLinden House,55 The Green,South Bar Street,Banbury OX16 9ABTel 01295 752 240(Mon–Fri, 9am–5pm)England helpline 0844 8487900 (Mon–Fri, 10am–4pm)Scotland helpline0131 555 5111(Mon–Fri, 10am–1pm)0844 848 7900(Mon–Fri, 1–4pm)Wales helpline 029 20232221 (Mon–Fri, 10am–2pm)Northern Ireland helpline028 9077 5211(Mon–Fri, 10am–4pm)0844 848 7900(Weds, 8–10pm)Email from the websitewww.adoptionuk.orgRun by adopters, for adoptersand people consideringadoption. Offers information,support and advice, includingbasic legal advice by email.Has a free library of booksand videos, a computer-basedexperience resource bank anda large network of adoptivefamilies (including localvolunteer coordinators).94

Further informationBritish Associationfor Adoption andFostering (BAAF)Saffron House,6–10 Kirby Street,London EC1N 8TSTel 020 7421 2600Email mail@baaf.org.ukwww.baaf.org.ukThe leading UK charity workingin adoption. It produces booksand pamphlets includingadvice notes and guides forprospective foster carers andadoptive parents, birth familiesand children.British Associationfor Counselling andPsychotherapy (BACP)BACP House,15 St John’s Business Park,Lutterworth LE17 4HBTel 01455 883 300Email enquiries@bacp.co.ukwww.bacp.co.uk andwww.itsgoodtotalk.org.ukPromotes awareness andavailability of counselling,and signposts people toappropriate services.Has a database on thewebsite where you can searchfor a qualified counsellor.British Infertility CounsellingAssociation (BiCA)111 Harley Street,London W1G 6AWTel 01372 451 626Email info@bica.netwww.bica.netA specialist infertilitycounselling association.All assisted conception unitshave to provide a counsellingservice by law, but someonly provide a very limitedfree service and additionalsessions have to be paid for.Some BiCA members arewilling to see people privatelyand independently of anytreatment. The website has alist of counsellors and gives anidea of their charges.Childlessness OvercomeThrough Surrogacy (COTS)Moss Bank, Manse Road,Lairg, Sutherland IV27 4ELTel 01549 402 777Email info@surrogacy.org.ukwww.surrogacy.org.ukGives information, advice andsupport to current and potentialsurrogate mothers and would-beparents. A splinter-group calledTriangle provides a contact95

Relationships, sex and fertility for young people affected by cancerservice between surrogatesand intended parents.The College of Sexual andRelationship TherapistsPO Box 13686,London SW20 9ZHTel 020 8543 2707Email info@cosrt.org.ukwww.cosrt.org.ukA national specialist charityfor sex and relationshiptherapy. Has a list of qualifiedpractitioners and clinicsproviding sex or relationshiptherapy in the UK. Send astamped addressed envelopefor details, or visit the website.The Daisy Network:Premature MenopauseSupport GroupPO Box 183,Rossendale BB4 6WZEmaildaisy@daisynetwork.org.ukwww.daisynetwork.org.ukA support group for womenwho have early ovarian failure.The website gives informationabout premature menopauseand related issues.Disabled Parents Network81 Melton Road,West Bridgford,Nottingham NG2 8ENGeneral enquiries/disabled parents’ helpline0300 3300 639Email from the websitewww.disabledparentsnetwork.org.ukA national organisation fordisabled people who areparents or who hope tobecome parents, and theirfamilies, friends and supporters.Donor Conception Network154 Caledonian Road,London N1 9RDTel 020 7278 2608Emailenquiries@dcnetwork.orgwww.dcnetwork.orgThe largest UK network ofparents with children conceivedthrough donated sperm or eggs.96

Further informationFPA (formerly the FamilyPlanning Association)50 Featherstone Street,London EC1Y 8QUEngland, Scotland and Waleshelpline 0845 122 8690Northern Ireland helpline0845 122 8687Email general@fpa.org.ukwww.fpa.org.ukThe leading voluntaryorganisation combiningsexual health and familyplanning. Aims to promotesexual health and familyplanning through information,research and education.GaysCanTel 020 8368 9027(Mon–Sat, 10am–7pm)Emailgayscan@blothlom.org.ukA UK helpline via phone andemail. Gives information andsupport to gay men livingwith cancer and their partners,families and friends.Human Fertilisationand EmbryologyAuthority (HFEA)Finsbury Tower,103–105 Bunhill Row,London EC1Y 8HFTel 020 7291 8200Email admin@hfea.gov.ukwww.hfea.gov.ukThe UK body that regulateslicensed assisted conceptiontreatment and research.Produces free patientinformation on licensedIVF and DI units in the UK,with success rates for live birthsand information on how tochoose a clinic.Infertility Network UKCharter House,43 St Leonards Road,Bexhill-on-Sea TN40 1JAAdvice line 0800 008 7464Email admin@infertilitynetworkuk.comwww.infertilitynetworkuk.comProvides information, support,telephone counselling andhelpful contacts for peoplewith fertility difficulties.97

Relationships, sex and fertility for young people affected by cancerThe Institute ofPsychosexual Medicine12 Chandos Street,Cavendish Square,London W1G 9DRTel 020 7580 0631Email admin@ipm.org.ukwww.ipm.org.ukHas a comprehensive listof doctors throughout thecountry who are trained inpsychosexual medicine.London Lesbian andGay SwitchboardPO Box 7324,London N1 9QSHelpline 020 7837 7324(Mon–Sun, 10am–11pm)Email admin@llgs.org.ukwww.llgs.org.ukThe helpline gives advice,information and referrals tothe lesbian, gay, bisexualand transgendered (LGBT)community, and to theirfamilies and friends.More to LifeCharter House,43 St Leonards Road,Bexhill-on-Sea TN40 1JATel 0800 008 7464Email admin@moretolife.co.ukwww.infertilitynetworkuk.com/moretolifeAn initiative run throughInfertility Network UK toacknowledge that somepeople will not be successful inbecoming parents even thoughthey want to be. The helplineand website help people whoare no longer having fertilitytreatment and are lookingat the opportunities of livingwithout children.Pink ParentsUnit 29, Hillier Road,Devizes, Wiltshire SN10 2FBTel 01380 727 935Emailenquiries@pinkparents.org.ukwww.pinkparents.org.ukAims to promote equalityand diversity and eliminatediscrimination in relation tolesbian, gay and bisexualparents, parents-to-be andtheir children.98

Further informationOutsiders Club/Sex andDisability HelplineBCM Box Lovely,London WC1N 3XXHelpline 07074 993 527Tel 020 7354 8291Email sexdis@outsiders.org.ukwww.outsiders.org.ukA UK-wide community ofpeople who feel sociallyisolated because of physicaldisabilities. Helps people gainconfidence, make new friendsand find partners. Outsidersruns the Sex and DisabilityHelpline, for professionals anddisabled people with sexualproblems. Produces leafletscovering all aspects of sex forpeople who are disabled.RelatePremier House,Carolina Court,Lakeside,Doncaster DN4 5RATel 0300 100 1234www.relate.org.ukOffers advice, relationshipcounselling, sex therapy,workshops, mediation,consultations and support –face-to-face, by phone andthrough the website.The Sexual AdviceAssociation(formerly the SexualDysfunction Association)Suite 301, Emblem House,London Bridge Hospital,27 Tooley Street,London SE1 2PRHelpline 020 7486 7262(Mon, Weds, Fri, 9am–5pm)Email info@sexualadviceassociation.co.ukwww.sda.uk.netA charity that aims to improvepeople’s sexual health andwell-being, and to raiseawareness of how sexualconditions affect thegeneral population.Surrogacy UKPO Box 323,Hitchin,Hertfordshire SG5 9AXEmail membership.secretary@surrogacyuk.orgwww.surrogacyuk.orgUK-based voluntaryorganisation that providesinformation and support foranyone with an interest insurrogacy. Its aim is to helppeople interested in havinga family through surrogacy.99

Relationships, sex and fertility for young people affected by cancerUK Council forPsychotherapy (UKCP)2 nd Floor, Edward House,2 Wakley Street,London EC1V 7LTTel 020 7014 9955Email info@ukcp.org.ukwww.psychotherapy.org.ukHolds the nationalregister of psychotherapistsand psychotherapeuticcounsellors, listing thosepractitioner members whomeet exacting standardsand training requirements.Women’s Health Concern4–6 Eton Place,Marlow SL7 2QATel 01628 478 473www.womens-healthconcern.orgProvides informationand advice ongynaecological problems.General cancersupport organisationsCancer Black Care79 Acton Lane,London NW10 8UTTel 020 8961 4151(Mon–Fri, 9.30am–4.30pm)Emailinfo@cancerblackcare.orgwww.cancerblackcare.orgOffers information andsupport for people withcancer from ethniccommunities, their families,carers and friends. Welcomespeople from different ethnicgroups including African,Asian, Turkish and African-Caribbean communities.Irish Cancer Society43–45 Northumberland Road,Dublin 4, IrelandCancer Helpline1800 200 700 (Mon–Thurs,9am–7pm, Fri, 9am–5pm)Email helpline@irishcancer.iewww.cancer.ieOperates Ireland’s onlyfreephone cancer helpline,which is staffed by nursestrained in cancer care.100

Further informationMaggie’s CancerCaring Centres8 Newton Place,Glasgow G3 7PRTel 0300 123 1801Email enquiries@maggiescentres.orgwww.maggiescentres.orgLocated throughout thecountry, Maggie’s Centresoffer free, comprehensivesupport for anyone affectedby cancer. Access information,benefits advice, and emotionalor psychological support.Cancer SupportScotland – Tak TentFlat 5, 30 Shelley Court,Gartnavel Complex,Glasgow G12 0YNTel 0141 211 0122Email info@cancersupportscotland.orgwww.cancersupportscotland.orgOffers information and supportto cancer patients, families,friends and healthcareprofessionals. Runs anetwork of monthly supportgroups across Scotland.Provides counselling andcomplementary therapies.Tenovus9 th Floor, Gleider House,Ty Glas Road, Llanishen,Cardiff CF14 5BDFreephone helpline0808 808 1010Tel 029 2076 8850Email post@tenovus.comwww.tenovus.org.ukProvides a variety of servicesto people with cancer andtheir families, includingcounselling and a freephonecancer helpline.The UlsterCancer Foundation40–44 Eglantine Avenue,Belfast BT9 6DXFreephone helpline0800 783 3339Helpline emailinfocis@ulstercancer.orgTel 028 9066 3281Email info@ulstercancer.orgwww.ulstercancer.orgProvides a variety of servicesfor people with cancer andtheir families, including afree telephone helpline,which is staffed by speciallytrained nurses with experiencein cancer care.101

Relationships, sex and fertility for young people affected by cancerFurther resourcesRelated MacmillaninformationYou may want to order someof the booklets and leafletsmentioned in this booklet.These include:• Cancer treatment and fertility– information for men• Cancer treatment and fertility– information for women• Sexuality and cancerTo order, visit be.macmillan.org.uk To order the factsheets mentioned in thisbooklet, call 0808 808 0000. This information is alsoavailable online.Macmillanaudio resourcesOur high-quality audiomaterials, based on ourvariety of booklets, includeinformation about cancertypes, different treatmentsand living with cancer.To order your free CDvisit be.macmillan.org.ukor call 0808 808 00 00.VideosWe have a video on our websiteabout male fertility treatment,at www.macmillan.org.uk/fertilityinmenHelpful booksand leafletsThe cancer survivor’scompanion: practical waysto cope with your feelingsafter cancerGoodhart & Atkins, 2011,£14.99This guide is packed withpractical and simple self-helptools to tackle issues such asworry and anxiety, depressionand low mood, anger, lowself-esteem and body image,relationships and sex, fatigue,sleep and relaxation.102

Further informationThe cancersurvivor’s handbookT Priestman, 2009, £7.99For people who have finishedwith active cancer treatmentand are preparing to startliving ‘normally’ again.Looks at existing relationships,work concerns, money worriesand relationships.FutureLeukaemia CARE, 2009, freeInformation and advice forpeople who have finishedtreatment for leukaemiaand are trying to get backto a ‘normal’ life. Coverstopics such as changesto relationships, fatigue,emotions, sexuality, fertility,finances and work.Intimacy and sexuality forcancer patients and theirpartners: a booklet of tipsand ideas for your journeyof recoveryThe Sexual Advice Association,Brandenburg et al, 2010, freeThis booklet aims to helpcancer patients and theirpartners understand sexualdifficulties that may occur aftercancer and to begin to thinkabout overcoming them.Useful websitesA lot of information aboutcancer is available on theinternet. Some websitesare excellent; others havemisleading or out-of-dateinformation. The sites listedhere are considered bynurses and doctors to containaccurate information and areregularly updated.Macmillan Cancer Supportwww.macmillan.org.ukFind out more about livingwith the practical, emotionaland financial effects of cancer.Our website contains expert,accurate and up-to-dateinformation on cancer andits treatments, including:• all the information fromour 100+ booklets and350+ fact sheets• videos featuring real-lifestories from people affectedby cancer and informationfrom medical professionals103

Relationships, sex and fertility for young people affected by cancer• how Macmillan can help,the services we offer andwhere to get support• how to contact our cancersupport specialists,including an email formto send your questions• local support groupssearch, links to othercancer organisationsand a directory ofinformation materials• a huge online community ofpeople affected by cancersharing their experiences,advice and support.www.cancerhelp.org.uk(Cancer Research UK)Contains patient informationon all types of cancer and hasa clinical trials database.www.cancer.gov(National Cancer Institute –National Institute ofHealth – USA)Gives comprehensiveinformation on cancerand treatments.www.cancer.org(American Cancer Society)Nationwide community-basedvoluntary health organisationdedicated to eliminatingcancer as a major healthproblem. It aims to do thisthrough research, education,advocacy and service.www.click4tic.org.uk(TIC – Teen Info on Cancer)Macmillan’s cancerinformation site writtenspecifically for young people.www.nhs.uk(NHS Choices)NHS Choices is the online‘front door’ to the NHS. It isthe country’s biggest healthwebsite and gives all theinformation you need to makechoices about your health.www.nhsdirect.nhs.uk(NHS Direct Online)NHS health informationsite for England – coversall aspects of health, illnessand treatments.104

Further informationwww.nhs24.com(NHS 24 in Scotland)Health information sitefor Scotland.www.nhsdirect.wales.nhs.uk(NHS Direct Wales)Provides health informationfor Wales.www.n-i.nhs.uk(Health and Social Carein Northern Ireland)The official gateway to healthand social care services inNorthern Ireland.www.patient.co.uk(Patient UK)Provides good qualityinformation about health anddisease. Includes evidencebasedinformation leaflets ona wide range of medical andhealth topics. Also reviewsand links to many healthandillness-related websites.www.youthhealthtalk.orgContains information aboutsome cancers, and has videoand audio clips of peopletalking about their experiencesof cancer and its treatments.105

9Let’s talk about you: Relationships, a guide for sex young and fertility people for caring young for people someone affected with by cancerYour notes and questions105 107

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Disclaimer, thanks and sourcesDisclaimerWe make every effort to ensure that the information we provide is accurate, but itshould not be relied upon to reflect the current state of medical research, which isconstantly changing. If you are concerned about your health, you should consulta doctor. Macmillan cannot accept liability for any loss or damage resulting fromany inaccuracy in this information or third-party information, such as informationon websites to which we link. We feature real-life stories in all of our articles.Some photographs are of models.ThanksThis booklet has been written, revised and edited by Macmillan Cancer Support’sCancer Information Development team. It has been approved by our medicaleditor, Dr Terry Priestman, Consultant Clinical Oncologist.With thanks to: Dr Marilyn Crawshaw, Independent Researcher Practitionerand Honorary Fellow; Gavin Maynard-Wyatt, TYA Lead Cancer Nurse;Jonathan Waxman, Flow Foundation Professor of Oncology; Dr Isabella White,Remedi/Macmillan Clinical Research Fellow in Cancer Rehabilitation and ClinicalResearch Fellow in Psychosexual Practice; Dr Robin Yates, Consultant, AssistedConception Unit; and the people affected by cancer who reviewed this edition.Some patient quotes sourced from Youthhealthtalk – www.youthhealthtalk.orgSources8 th code of practice. 2011. Human Fertilisation and Embryological Authority.Ajala T et al. Fertility preservations for cancer patients: a review. 2010.Obstetrics and Gynaecology International.Anderson R. Do doctors discuss fertility issues before they treat young patients withcancer? 2008. Human Reproduction 23 (10).Assessment and treatment for people with fertility problems. 2004. National Institutefor Health and Clinical Excellence (NICE).113

Relationships, sex and fertility for young people affected by cancerImproving outcomes in children and young people with cancer. 2005.National Institute for Health and Clinical Excellence (NICE).Morgan et al. Sex, drugs and rock ‘n’ roll: caring for adolescents and young adultswith cancer. 2010. Journal of Clinical Oncology 28 (32).Royal College of Physicians, The Royal College of Radiologists, Royal College ofObstetricians and Gynaecologists. The effects of cancer treatment on reproductivefunctions: guidance on management. Report of a working party. 2007. RCOG. London.Schover LR. Sexuality and fertility after cancer. 1997. John Wiley & Sons. New York.114

5 waysyou canhElP someoneRelationships, sex and fertility for young people affected by cancerCan you do something to help?We hope this booklet has been useful to you. It’s just one of ourmany publications that are available free to anyone affected bycancer. They’re produced by our cancer information specialistswho, along with our nurses, benefits advisers, campaigners andvolunteers, are part of the Macmillan team. When people arefacing the toughest fight of their lives, we’re there to supportthem every step of the way.We want to make sure no one has to go through cancer alone,so we need more people to help us. When the time is right for you,here are some ways in which you can become a part of our team.withcAncerShare your cancer experienceSupport people living with cancer by telling your story,online, in the media or face to face.Campaign for changeWe need your help to make sure everyone gets the right support.Take an action, big or small, for better cancer care.Help someone in your communityA lift to an appointment. Help with the shopping.Or just a cup of tea and a chat. Could you lend a hand?Raise moneyWhatever you like doing you can raise money to help.Take part in one of our events or create your own.Give moneyBig or small, every penny helps.To make a one-off donation see over.Call us to find out more0300 1000 200macmillan.org.uk/getinvolved113

Please fill in yourpersonal detailsMr/Mrs/Miss/OtherNameSurnameAddressPostcodePhoneEmailPlease accept my gift of £(Please delete as appropriate)I enclose a cheque / postal order /Charity Voucher made payable toMacmillan Cancer SupportOR debit my:Visa / MasterCard / CAF CharityCard / Switch / MaestroCard numberValid fromIssue noExpiry dateSecurity numberDon’t let the taxmankeep your moneyDo you pay tax? If so, your gift willbe worth 25% more to us – at noextra cost to you. All you have todo is tick the box below, and thetax office will give 25p for everypound you give.I am a UK taxpayer and Iwould like Macmillan CancerSupport to treat all donationsI have made for the four yearsprior to this year, and alldonations I make in the future,as Gift Aid donations, until Inotify you otherwise.I confirm I have paid or will pay an amount ofIncome Tax and/or Capital Gains Tax in eachtax year, that is at least equal to the tax thatCharities & CASCs I donate to will reclaim onmy gifts. I understand that other taxes such asVAT and Council Tax do not qualify and thatMacmillan Cancer Support will reclaim 25p oftax on every £1 that I give.Macmillan Cancer Support and our tradingcompanies would like to hold your details inorder to contact you about our fundraising,campaigning and services for people affectedby cancer. If you would prefer us not to use yourdetails in this way please tick this box.In order to carry out our work we may need topass your details to agents or partners who acton our behalf.SignatureDate / /If you’d rather donate online go to macmillan.org.uk/donatePlease cut out this form and return it in an envelope (no stamp required) to:Supporter Donations, Macmillan Cancer Support, FREEPOST LON15851,89 Albert Embankment, London SE1 7UQ #27530

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Cancer is the toughest fight most of uswill ever face. If you or a loved one hasbeen diagnosed, you need a team ofpeople in your corner, supporting youevery step of the way. That’s who we are.We are the nurses and therapists helping you throughtreatment. The experts on the end of the phone.The advisers telling you which benefits you’re entitled to.The volunteers giving you a hand with the everydaythings. The campaigners improving cancer care.The community supporting you online, any time.The fundraisers who make it all possible.You don’t have to face cancer alone.We can give you the strength to get through it.We are Macmillan Cancer Support.Questions about living with cancer?Call free on 0808 808 00 00 (Mon–Fri, 9am–8pm)Alternatively, visit macmillan.org.ukHard of hearing? Use textphone0808 808 0121, or Text Relay.Non-English speaker? Interpreters available.© Macmillan Cancer Support, 2012. 4 th edition. MAC11679.Next planned review 2014. Macmillan Cancer Support, registeredcharity in England and Wales (261017), Scotland (SC039907) andthe Isle of Man (604).Printed using sustainable material. Please recycle.