Fertility in Women of Reproductive Age After Breast Cancer Treatment: Practice Patterns and Outcomes

McCray, Devina K. S.; Simpson, Ashley; Flyckt, Rebecca; Liu, Yitian; O’Rourke, Colin; Crowe, Joseph P.; Grobmyer, Stephen R.; Moore, Halle C. F.; Valente, Stephanie A.

doi:10.1245/s10434-016-5308-y

Cited by 40 publications

(29 citation statements)

References 44 publications

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“…Among female survivors surveyed as part of a cohort of adolescent and young adult survivors identified through a Surveillance, Epidemiology, and End Results linkage, fewer than one‐half stated that strategies to preserve their fertility were discussed prior to the initiation of treatment . Other recent reports have found similarly low rates of attention to fertility, although some have found rates as high as 85% . The study that to our knowledge reported the highest rate of attention included only patients seen at National Cancer Institute‐designated comprehensive cancer centers, although the results of the current study did not demonstrate a difference in attention to fertility between community and academic sites …”

Section: Discussioncontrasting

confidence: 71%

“…18 Other recent reports have found similarly low rates of attention to fertility, although some have found rates as high as 85%. [19][20][21][22] The study that to our knowledge reported the highest rate of attention included only patients seen at National Cancer Institutedesignated comprehensive cancer centers, although Cancer June 1, 2019 the results of the current study did not demonstrate a difference in attention to fertility between community and academic sites. 21 In a representative, Swedish, population-based study of survivors diagnosed between the ages of 18 and 40 years from 2003 through 2007, approximately 48% reported that they received information regarding the impact of treatment on fertility, and 14% reported that they received information concerning fertility preservation.…”

Section: Discussioncontrasting

confidence: 50%

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A randomized study to improve care for young women with breast cancer at community and academic medical oncology practices in the United States: The Young and Strong study

Partridge

Ruddy

Barry

et al. 2019

Cancer

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Background The authors conducted a cluster randomized study to determine the effect of an exportable educational intervention for young women with breast cancer (YWI) on improving care. Methods Sites were randomized 1:1 to the YWI or a contact time control physical activity intervention (PAI) stratified by academic or community site. Up to 15 women aged ≤45 years with newly diagnosed breast cancer were enrolled at each of 14 academic sites and 10 were enrolled at each of 40 community sites. The primary endpoint, attention to fertility, was ascertained by medical record review. Statistical inferences concerning the effect of the intervention used general estimating equations for clustered data. Results A total of 467 patients across 54 sites were enrolled between July 2012 and December 2013. The median age of the patients at the time of diagnosis was 40 years (range, 22‐45 years). Attention to fertility by 3 months was observed in 55% of patients in the YWI and 58% of patients in the PAI (P = .88). Rates were found to be strongly correlated with age (P < .0001), and were highest in patients aged <30 years. Attention to genetics was similar (80% in the YWI and 81% in the PAI), whereas attention to emotional health was higher in patients in the YWI (87% vs 76%; estimated odds ratio, 2.63 [95% confidence interval, 1.20‐5.76; P = .016]). Patients rated both interventions as valuable in providing education (64% in the YWI and 63% in the PAI). Conclusions The current study failed to demonstrate differences in attention to fertility with an intervention to improve care for women with breast cancer, although attention to fertility was found to be higher than expected in both groups and emotional health was improved in the YWI group. Greater attention to young women with breast cancer in general may promote more comprehensive care for this population.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussioncontrasting

confidence: 50%

A randomized study to improve care for young women with breast cancer at community and academic medical oncology practices in the United States: The Young and Strong study

Partridge

Ruddy

Barry

et al. 2019

Cancer

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“…There remains a significant lack of reproductive counseling prior to breast cancer treatment initiation worldwide [ 13 ]. Many women are unaware that their chances of future parenthood might be affected by hormonal therapy or chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, a recent study published in October 2016 and conducted at the Cleveland Clinic between 2006 and 2014 showed that less than one-third of women had a documented fertility discussion with their physician prior to treatment. Of those who did receive documented counseling, nearly 90% sought some form of fertility preservation, demonstrating the massive impact of formal education sessions on cancer patients’ childbearing choices [ 13 ]. Potential barriers to fertility counseling include physicians’ level of knowledge about fertility preservation, attitudes and comfort level with the topic, patient preferences, and financial obstacles [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Fertility in Breast Cancer Survivors in the Middle East: A Retrospective Study

et al. 2020

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Introduction By the time they complete breast cancer therapy, many young patients are still of childbearing age. We aim to estimate the incidence of pregnancies in women who completed treatment and examine the percentage of patients who received fertility counseling before initiation of therapy. Material and methods Electronic health records of breast cancer patients between 2008 and 2014 at AUBMC were screened for exclusion criteria of having metastatic disease or known infertility, still receiving therapy, and being above 42 years at diagnosis. Data about therapy and tumor characteristics was obtained for the included survivors who were interviewed as well via telephone for information about fertility preservation counseling, pregnancy occurrence, and delivery. Results 451 breast cancer patients were identified. 39 patients remained after application of exclusion criteria. 30.76% (n = 12) wanted more children at the time of diagnosis. 10.25% (n = 4) of all 39 patients treated for breast cancer achieved one or more pregnancy after a median time of 3.83 years after completion of therapy. 25% (n = 3) of women who wanted more children at diagnosis (n = 12) were able to conceive. 23.07% (n = 9) of patients discussed fertility with their primary oncologist prior to treatment initiation. 35.89% (n = 14) of patients were aware of fertility preservation technique availability, but none of these patients used one. Conclusions The observed rate of pregnancy is comparable to the literature. There is a lack in fertility counseling of breast cancer patients, and the rate of use of fertility preservation techniques is very low despite prior knowledge about their availability.

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Fertility concerns and treatment decision‐making among national sample of young women with breast cancer

de Kermadec,

Zheng,

Rosenberg

et al. 2023

Cancer Medicine

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BackgroundDiagnosis of breast cancer in young women has been shown to affect their decision‐making with regard to fertility and family planning. Limited data are available from populations across the U.S. regarding this issue; thus, we sought to describe fertility concerns and efforts to preserve fertility in a national clinical trial population of young breast cancer patients.MethodsThe young and strong study was a cluster‐randomized controlled trial testing an intervention program for young women with breast cancer. Patients were surveyed within 3 months after diagnosis and at 3, 6, and 12 months after. Surveys asked about sociodemographics, psychosocial domains, fertility concerns, and fertility preservation strategies. Univariable and multivariable models were used to investigate sociodemographic, clinical, and psychosocial predictors of fertility concerns.ResultsOf 467 women from 54 clinical sites across the U.S. (14 academic, 40 community), 419 were evaluable regarding fertility concerns. Median age was 40 years (range 22–45), 11% were Black, 6% Hispanic, and 75% had children. Tumor stage was I (35%), II (51%), or III (14%); 82% received chemotherapy. At time of the treatment decision, 133 (32%) participants had fertility concerns, among whom 47% indicated this affected their treatment decisions. Sixty percent of participants reported having discussed fertility with their physician. Twenty percent of those with fertility concerns used fertility preservation strategies. History of difficulty becoming pregnant and younger age were associated with higher odds of fertility concerns in multivariable modeling.ConclusionMany young women with newly diagnosed breast cancer are concerned about fertility in a way that impacts their treatment decisions. Concerns were discussed, but few used fertility preservation strategies. These findings have implications for counseling young patients.

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Fertility in Women of Reproductive Age After Breast Cancer Treatment: Practice Patterns and Outcomes

Cited by 40 publications

References 44 publications

A randomized study to improve care for young women with breast cancer at community and academic medical oncology practices in the United States: The Young and Strong study

A randomized study to improve care for young women with breast cancer at community and academic medical oncology practices in the United States: The Young and Strong study

Fertility in Breast Cancer Survivors in the Middle East: A Retrospective Study

Fertility concerns and treatment decision‐making among national sample of young women with breast cancer

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