‘Hit me like a brick wall’: women’s accounts of balancing cancer survivorship with fertility concerns while dealing with gynaecological cancer

Abstract

Objective This study explored the impact of gynaecological cancer on women’s expectations for motherhood, their concerns regarding their fertility, and how they negotiated these concerns in the survivorship context. Methods Semi-structured interviews were conducted with 42 Australian women with gynaecological cancer, aged between 27 to 53 years, who were on average five years post-diagnosis (range 1–10 years). Thematic discourse analysis, from a material-discursive-intrapsychic approach, was used to explore how women narrated their fertility-related concerns in the broader social and healthcare contexts. Results While narrating their experiences of having gynaecological cancer, the women in our study negotiated their accounts within two competing discourses – the pronatalist discourse and the survivorship discourse. Women’s talk appeared conflicted by the social expectation to become a ‘good’ mother and focus on ensuring their fertility, while also managing the ‘survivorship’ imperative to focus exclusively on ‘fighting’ and beating cancer. Many women struggled to negotiate their fertility concerns and treatment decisions because of these two competing discourses. Conclusion Dominant discourses around survival and prioritising motherhood create enormous conflict for women with gynaecological cancer coping with fertility concerns. Helping women to develop meaningful narratives is needed, particularly for women with ovarian cancer.