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Survey of young women with breast cancer to identify rates of fertility preservation (FP) discussion and barriers to FP care

  • Fertility Preservation
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To identify the proportion of reproductive age women with breast cancer that engaged in a fertility preservation discussion and reproductive endocrinology and infertility (REI) consultation.

Methods

This cross-sectional survey recruited women 18–42 years who were diagnosed with breast cancer from 2006 to 2016 by phone or email and asked them to complete an online survey. Demographic characteristics, barriers to FP, utilization of FP consultation, and FP procedures (oocyte and embryo cryopreservation) were analyzed.

Results

A majority of women (64%) did not have FP discussed by any provider. Older women and those who were parents at the time of diagnosis were less likely to engage in a FP discussion. However, there were no significant differences in partner status or cancer stage between women with or without FP discussions. Of the women who desired future children prior to the cancer diagnosis, 93% received chemotherapy; however, only 34% of these women had a consultation with an REI. The most common reasons for declining FP consultation were already having their desired number of children (41%), financial barriers (14%), and concern about delaying cancer treatment and cancer recurrence (12%). Forty percent of women who desired future children and met with an REI pursued FP procedures.

Conclusion

Younger women were more likely to receive FP counseling. FP consultations and procedures were low even in women who desired future fertility, with the predominant barriers being cost, fears concerning a delay in cancer treatment, and future cancer recurrence.

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References

  1. Bland KI, Menck HR, Scott-Conner CE, Morrow M, Winchester DJ, Winchester DP. The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer. 1998;83(6):1262–73. https://doi.org/10.1002/(sici)1097-0142(19980915)83:6<1262::aid-cncr28>3.0.co;2-2.

  2. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. https://doi.org/10.3322/caac.21208.

    Article  PubMed  Google Scholar 

  3. Poorvu PD, Frazier AL, Feraco AM, Manley PE, Ginsburg ES, Laufer MR, Partridge AH. Cancer treatment-related infertility: a critical review of the evidence. JNCI Cancer Spectr. 2019;3(1):pkz008. https://doi.org/10.1093/jncics/pkz008.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Silvestris E, Dellino M, Cafforio P, Paradiso AV, Cormio G, D’Oronzo S. Breast cancer: an update on treatment-related infertility. J Cancer Res Clin Oncol. 2020;146(3):647–57. https://doi.org/10.1007/s00432-020-03136-7.

    Article  PubMed  Google Scholar 

  5. Stensheim H, Cvancarova M, Moller B, Fossa SD. Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer. 2011;129(5):1225–36. https://doi.org/10.1002/ijc.26045.

    Article  CAS  PubMed  Google Scholar 

  6. Selter J, Huang Y, Grossman Becht LC, Palmerola KL, Williams SZ, Forman E, Wright JD. Use of fertility preservation services in female reproductive-aged cancer patients. Am J Obstet Gynecol. 2019;221(4):328 e321-328 e316. https://doi.org/10.1016/j.ajog.2019.05.009.

    Article  Google Scholar 

  7. Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Oktay K. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10. https://doi.org/10.1200/jco.2013.49.2678.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rienzi L, Cobo A, Paffoni A, Scarduelli C, Capalbo A, Vajta G, Ubaldi FM. Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study. Hum Reprod. 2012;27(6):1606–12. https://doi.org/10.1093/humrep/des088.

    Article  PubMed  Google Scholar 

  9. Kim J, Turan V, Oktay K. Long-term safety of letrozole and gonadotropin stimulation for fertility preservation in women with breast cancer. J Clin Endocrinol Metab. 2016;101(4):1364–71. https://doi.org/10.1210/jc.2015-3878.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, Rosen MP. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2012;118(6):1710–7. https://doi.org/10.1002/cncr.26459.

    Article  PubMed  Google Scholar 

  11. Korkidakis A, Lajkosz K, Green M, Strobino D, Velez MP. Patterns of referral for fertility preservation among female adolescents and young adults with breast cancer: a population-based study. J Adolesc Young Adult Oncol. 2019;8(2):197–204. https://doi.org/10.1089/jayao.2018.0102.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Patel P, Kohn TP, Cohen J, Shiff B, Kohn J, Ramasamy R. Evaluation of reported fertility preservation counseling before chemotherapy using the quality oncology practice initiative survey. JAMA Netw Open. 2020;3(7):e2010806. https://doi.org/10.1001/jamanetworkopen.2020.10806%JJAMANetworkOpen.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Quinn GP, Vadaparampil ST, Lee JH, Jacobsen PB, Bepler G, Lancaster J, Albrecht TL. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol. 2009;27(35):5952–7. https://doi.org/10.1200/jco.2009.23.0250.

    Article  PubMed  Google Scholar 

  14. Yee S, Buckett W, Campbell S, Yanofsky R, Barr RD. A national study of the provision of oncofertility services to female patients in Canada. J Obstet Gynaecol Can. 2012;34(9):849–58. https://doi.org/10.1016/s1701-2163(16)35384-1.

    Article  PubMed  Google Scholar 

  15. Jones G, Hughes J, Mahmoodi N, Smith E, Skull J, Ledger W. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update. 2017;23(4):433–57. https://doi.org/10.1093/humupd/dmx009.

    Article  PubMed  Google Scholar 

  16. Panagiotopoulou N, Ghuman N, Sandher R, Herbert M, Stewart JA. Barriers and facilitators towards fertility preservation care for cancer patients: a meta-synthesis. Eur J Cancer Care (Engl). 2018;27:e12428-1. https://doi.org/10.1111/ecc.12428.

    Article  Google Scholar 

  17. Cohen L, Hamer J, Helwig C, Fergus K, Kiss A, Mandel R, Warner E. Formal evaluation of PYNK: breast cancer program for young women-the patient perspective. Curr Oncol. 2016;23(2):e102–8. https://doi.org/10.3747/co.23.2773.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Goldfarb SB, Kamer SA, Oppong BA, Eaton A, Patil S, Junqueira MJ, Gemignani ML. Fertility preservation for the young breast cancer patient. Ann Surg Oncol. 2016;23(5):1530–6. https://doi.org/10.1245/s10434-015-5036-8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marklund A, Lundberg FE, Eloranta S, Hedayati E, Pettersson K, Rodriguez-Wallberg KA. Reproductive outcomes after breast cancer in women with vs without fertility preservation. JAMA Oncol. 2021;7(1):86–91. https://doi.org/10.1001/jamaoncol.2020.5957%JJAMAOncology.

    Article  PubMed  Google Scholar 

  20. Chin HB, Howards PP, Kramer MR, Mertens AC, Spencer JB. Which female cancer patients fail to receive fertility counseling before treatment in the state of Georgia? Fertil Steril. 2016;106(7):1763-1771.e1761. https://doi.org/10.1016/j.fertnstert.2016.08.034.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Di Mattei VE, Perego G, Taranto P, Rancoita PMV, Maglione M, Notarianni L, Candiani M. Factors associated with a high motivation to undergo fertility preservation in female cancer patients. Front Psychol. 2021;12:782073. https://doi.org/10.3389/fpsyg.2021.782073.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Oktay K, Harvey BE, Loren AW. Fertility preservation in patients with cancer: ASCO clinical practice guideline update summary. J Oncol Pract. 2018;14(6):381–5. https://doi.org/10.1200/JOP.18.00160.

    Article  PubMed  Google Scholar 

  23. Oktay K, Turan V, Bedoschi G, Pacheco FS, Moy F. Fertility preservation success subsequent to concurrent aromatase inhibitor treatment and ovarian stimulation in women with breast cancer. J Clin Oncol. 2015;33(22):2424–9. https://doi.org/10.1200/JCO.2014.59.3723.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Arecco L, Blondeaux E, Bruzzone M, Ceppi M, Latocca MM, Marrocco C, Lambertini M. Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis. Hum Reprod. 2022;37(5):954–68. https://doi.org/10.1093/humrep/deac035%JHumanReproduction.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Rauh-Hain JA, Zubizarreta J, Nitecki R, Melamed A, Fu S, Jorgensen K, . . . Keating NL. Survival outcomes following pregnancy or assisted reproductive technologies after breast cancer: a population-based study. Cancer. 2022;128:3243-3253 https://doi.org/10.1002/cncr.34371.

  26. National Summary report SARTcors. 2023 Retrieved May 3, 2023 from https://sartcorsonline.com/CSR/PublicSnapshotReport?ClinicPKID=0&reportingYear=2020.

  27. Salama M, Lambertini M, Christianson MS, Jayasinghe Y, Anazodo A, De Vos M, Woodruff TK. Installing oncofertility programs for breast cancer in limited versus optimum resource settings: empirical data from 39 surveyed centers in Repro-Can-OPEN Study Part I & II. J Assist Reprod Genet. 2022;39(2):505–16. https://doi.org/10.1007/s10815-022-02394-3.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Walter JR, Xu S, Woodruff TK. A call for fertility preservation coverage for breast cancer patients: the cost of consistency. J Natl Cancer Inst, 2017, 109(5) https://doi.org/10.1093/jnci/djx006.

  29. Dolmans MM, von Wolff M, Poirot C, Diaz-Garcia C, Cacciottola L, Boissel N, Andersen CY. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers. Fertil Steril. 2021;115(5):1102–15. https://doi.org/10.1016/j.fertnstert.2021.03.008.

    Article  CAS  PubMed  Google Scholar 

  30. Elgindy E, Sibai H, Abdelghani A, Mostafa M. Protecting ovaries during chemotherapy through gonad suppression: a systematic review and meta-analysis. Obstet Gynecol. 2015;126(1):187–95. https://doi.org/10.1097/aog.0000000000000905.

    Article  CAS  PubMed  Google Scholar 

  31. Leonard RCF, Adamson DJA, Bertelli G, Mansi J, Yellowlees A, Dunlop J, Anderson RA. GnRH agonist for protection against ovarian toxicity during chemotherapy for early breast cancer: the Anglo Celtic Group OPTION trial. Ann Oncol. 2017;28(8):1811–6. https://doi.org/10.1093/annonc/mdx184.

    Article  CAS  PubMed  Google Scholar 

  32. Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, Sullivan E. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update. 2019;25(2):159–79. https://doi.org/10.1093/humupd/dmy038.

    Article  PubMed  Google Scholar 

  33. Huang SM, Tseng LM, Yang MJ, Chang A, Lien PJ, Hsiung Y. Developing a web-based oncofertility tool for reproductive-age women with breast cancer based on social support framework. Support Care Cancer. 2022;30(7):6195–204. https://doi.org/10.1007/s00520-022-07046-x.

    Article  PubMed  Google Scholar 

  34. Speller B, Sissons A, Daly C, Facey M, Kennedy E, Metcalfe K, Baxter NN. An evaluation of oncofertility decision support resources among breast cancer patients and health care providers. BMC Health Serv Res. 2019;19(1):101. https://doi.org/10.1186/s12913-019-3901-z.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2019;112(6):1022–33. https://doi.org/10.1016/j.fertnstert.2019.09.013.

  36. Jones GL, Hughes J, Mahmoodi N, Greenfield D, Brauten-Smith G, Skull J, Bekker HL. Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol. BMJ Open. 2017;7(3):e013219. https://doi.org/10.1136/bmjopen-2016-013219.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 90 Plain Street, Providence, RI, 02905, USA

    May-Tal Sauerbrun-Cutler

  2. Breast Oncology at Sanofi Genzyme, Boston, MA, USA

    Sonali Pandya

  3. Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA

    Olivia Recabo

  4. Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA

    Christina Raker & Melissa A. Clark

  5. Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA

    Melissa A. Clark

  6. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA

    Katina Robison

Authors
  1. May-Tal Sauerbrun-Cutler
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  2. Sonali Pandya
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  3. Olivia Recabo
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  4. Christina Raker
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  5. Melissa A. Clark
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  6. Katina Robison
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by May-Tal Sauerbrun-Cutler, Olivia Recabo, and Christina Raker. The first draft of the manuscript was written by May-Tal Sauerbrun-Cutler and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to May-Tal Sauerbrun-Cutler.

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Sauerbrun-Cutler, MT., Pandya, S., Recabo, O. et al. Survey of young women with breast cancer to identify rates of fertility preservation (FP) discussion and barriers to FP care. J Assist Reprod Genet 40, 2003–2011 (2023). https://doi.org/10.1007/s10815-023-02850-8

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  • DOI: https://doi.org/10.1007/s10815-023-02850-8

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