Attitudes on fertility issues in breast cancer patients: an Italian survey

Abstract

Background: Fertility issues should be discussed with young women before the start of any anticancer treatment. The study is aimed to investigate the attitude on fertility among Italian oncologists and breast surgeons dealing with BCa, and to report the consensus achieved on specific statements. Methods: One hundred and sixty-two panelists anonymously expressed an opinion through a web-based platform on 19 statements based on the Delphi method. Results: Ninety-one percent of oncologists considered important to discuss with patients about fertility issues and 83% believed estrogens could stimulate the growth of hidden cancer cells in ER + tumors. Difficulties in accessing fertility preservation procedures were mainly due to patients' reluctance, but also to lack of coordination with the assisted reproduction specialists. No full consensus was reached on the prognostic role of pregnancy after BCa. Fifty-four percent of oncologists declared that pregnancy does not affect oncologic prognosis. Treatment with GnRHa during chemotherapy was considered the only mean for preserving ovarian function. Conclusions: Fertility preservation in BCa patients is a well-accepted practice among Italian oncologists. A poor knowledge of this specific issue emerged from the survey, even if a certain degree of agreement was observed on most fertility-related issues.

Childbearing across borders: Fertility and parenthood attitudes and decisions among breast cancer survivors in USA and Portugal

“…However, similar to other studies [18, 19, 20], there is still a subset of patients who do not have fertility discussions, which suggests the frequency of fertility discussions is sub-optimal in clinical settings. Prior research has highlighted oncologists' lack of knowledge towards fertility preservation options among one of the reasons contributing to a lack of fertility discussions [21]. One interesting finding from our study highlights the family medicine physician as a potential source of fertility information in Portugal.…”

The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients

“…Nevertheless, oncologists face several barriers to have this discussion, including lack of knowledge and safety concerns, insufficient resources and lack of linkage with reproductive units [33]. As recently shown in an Italian survey, 93% of medical oncologists acknowledged having poor insight into the subject, more than 80% were not in favor of performing a hormonal manipulation for cryopreservation procedures, and 90% underscored a lack of coordination between oncology and reproductive units [12]. The PREFER-FERTILITY study aims to support and to improve the discussion around fertility issues among oncologists and patients before treatment with the ultimate goal to implement the referral of young women interested in fertility preserving procedures to reproductive unit.…”

“…Embryo/oocyte cryopreservation, cryopreservation of ovarian tissue and the use of temporary ovarian suppression with luteinizing hormone-releasing hormone analogs (LHRHa) during chemotherapy are the available options to preserve fertility in breast cancer patients [11]. Despite a growing literature on this topic over the past years, there are still several obstacles limiting the access to fertility preservation procedures [11, 12]. Moreover, very limited data are available on the number of patients that take active steps towards the available strategies for fertility preservation and on the reasons for refusal of these procedures after oncofertility counseling.…”

“…The frequent need for gonadotoxic chemotherapy and prolonged treatment periods up to 10 years after diagnosis with adjuvant endocrine therapy in women with hormone receptor-positive breast cancer are possible explanations for these findings. Moreover, among physicians, there is still a general misconception on the possible negative prognostic effect of pregnancy in patients with breast cancer being a hormonally driven disease, and on the possible negative impact of prior anticancer treatments on pregancy outcomes [12]. The available data on the topic do not support this concern and pregnancy after breast cancer should not be in principle discouraged but should be monitored closely [9, 15].…”

Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America

“…A recent Italian survey showed that 46% of the surveyed oncologists believed that pregnancy affects the prognosis of young women with breast cancer, and 49% supported the statement that an increase in estrogen levels during pregnancy might stimulate the growth of hidden cancer cells 16 . Similarly, 30% of the physicians responding to the BCY3 survey agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence 12 .…”