Skip to main content

Advertisement

Log in

Occurrence and recall rates of fertility discussions with young breast cancer patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Fertility preservation is an important issue for premenopausal cancer patients; however, not all patients receive counseling about chemotherapy-induced infertility and potential mitigation strategies. We aimed to identify characteristics of premenopausal breast cancer patients less likely to receive fertility counseling. We also investigated patient recall of chart-documented fertility discussions and patient attitudes toward fertility preservation.

Methods

The study was approved by our institution’s Institutional Review Board. All female patients with invasive primary breast cancer of any type, aged 40 or younger at the time of diagnosis, who were diagnosed during or up to 5 years prior to the study period were eligible. The study was conducted between February 2012 and October 2013. Enrolled patients completed an anonymous survey, and their medical charts were subsequently reviewed to identify provider documentation of fertility discussions, referral to fertility specialists, or implementation of fertility preservation. Patient comments regarding their fertility were solicited and examined thematically.

Results

Forty-nine patients consented to participate. Fertility discussions were documented by providers in 55 % of patients. Patients aged over 35 and multiparous patients were significantly less likely than their counterparts (p < 0.01 in both cases) to have had chart-documented fertility discussions. Only 52 % of patients with chart-documented discussions recalled having had such a conversation. Patient comments highlighted the difficulty of considering fertility at the time of diagnosis and also the risks and obstacles facing fertility preservation.

Conclusions

Despite increasing awareness, fertility is not universally discussed with premenopausal breast cancer patients at the time of diagnosis; older and multiparous patients are at particular risk of not receiving fertility counseling. Even when such discussions are documented, only about half of patients recall the conversation. Patient-reported barriers to fertility preservation include lack of education combined with the stress of diagnosis, financial costs, and perceived treatment toxicities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, Alteri R, Robbins AS, Jemal A (2014) Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 64:252–271. doi:10.3322/caac.21235

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. DeSantis C, Ma J, Bryan L, Jemal A (2014) Breast cancer statistics, 2013. CA Cancer J Clin 64(1):52–62. doi:10.3322/caac.21203

    Article  PubMed  Google Scholar 

  4. Kasum M, Beketic-Oreskovic L, Peddi PF, Oreskovic S, Johnson RH (2014) Fertility after breast cancer treatment. Eur J Obstet Gynecol Reprod Biol 173:13–18. doi:10.1016/j.ejogrb.2013.11.009

    Article  PubMed  Google Scholar 

  5. Petrek JA, Naughton MJ, Case LD, Paskett ED, Naftalis EZ, Singletary SE, Sukumvanich P (2006) Incidence, time course, and determinants of menstrual bleeding after breast cancer treatment: a prospective study. J Clin Oncol 24(7):1045–1051. doi:10.1200/JCO.2005.03.3969

    Article  PubMed  Google Scholar 

  6. Partridge AH, Burstein HJ, Winer EP (2001) Side effects of chemotherapy and combined chemohormonal therapy in women with early-stage breast cancer. J Natl Cancer Inst Monogr 30:135–142

    Article  PubMed  Google Scholar 

  7. Christinat A, Pagani O (2012) Fertility after breast cancer. Maturitas 73(3):191–196. doi:10.1016/j.maturitas.2012.07.013

    Article  PubMed  Google Scholar 

  8. Partridge AH, Gelber S, Peppercorn J, Sampson E, Knudsen K, Laufer M, Rosenberg R, Przypyszny M, Rein A, Winer EP (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22(20):4174–4183. doi:10.1200/JCO.2004.01.159

    Article  PubMed  Google Scholar 

  9. Ruddy KJ, Gelber SI, Tamimi RM, Ginsburg ES, Schapira L, Come SE, Borges VF, Meyer ME, Partridge AH (2014) Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol 32(11):1151–1156. doi:10.1200/JCO.2013.52.8877

    Article  PubMed Central  PubMed  Google Scholar 

  10. Senkus E, Gomez H, Dirix L, Jerusalem G, Murray E, Van Tienhoven G, Westenberg AH, Bottomley A, Rapion J, Bogaerts J, Di Leo A, Neskovic-Konstantinovic Z (2014) Attitudes of young patients with breast cancer toward fertility loss related to adjuvant systemic therapies. EORTC study 10002 BIG 3–98. Psychooncology 23(2):173–182. doi:10.1002/pon.3384

    Article  PubMed  Google Scholar 

  11. Matthews ML, Hurst BS, Marshburn PB, Usadi RS, Papadakis MA, Sarantou T (2012) Cancer, fertility preservation, and future pregnancy: a comprehensive review. Obstet Gynecol Int 2012:953937. doi:10.1155/2012/953937

    Article  PubMed Central  PubMed  Google Scholar 

  12. Blumenfeld Z, Katz G, Evron A (2014) ‘An ounce of prevention is worth a pound of cure’: the case for and against GnRH-agonist for fertility preservation. Ann Oncol 25(9):1719–1728. doi:10.1093/annonc/mdu036

    Article  CAS  PubMed  Google Scholar 

  13. Tomasi-Cont N, Lambertini M, Hulsbosch S, Peccatori AF, Amant F (2014) Strategies for fertility preservation in young early breast cancer patients. Breast 23(5):503–510. doi:10.1016/j.breast.2014.05.024

    Article  PubMed  Google Scholar 

  14. Lee S, Ozkavukcu S, Heytens E, Moy F, Oktay K (2010) Value of early referral to fertility preservation in young women with breast cancer. J Clin Oncol 28(31):4683–4686. doi:10.1200/JCO.2010.30.5748

    Article  PubMed Central  PubMed  Google Scholar 

  15. Treves R, Grynberg M, Parco S, Finet A, Poulain M, Fanchin R (2014) Female fertility preservation in cancer patients: an instrumental tool for the envisioning a postdisease life. Future Oncol 10(6):969–974. doi:10.2217/fon.13.265

    Article  CAS  PubMed  Google Scholar 

  16. Kim J, Mersereau JE (2014) Early referral makes the decision-making about fertility preservation easier: a pilot survey study of young female cancer survivors. Support Care Cancer. doi:10.1007/s00520-014-2526-3

    Google Scholar 

  17. Peccatori FA, Azim HA Jr, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, Pentheroudakis G, Group EGW (2013) Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi160–170. doi:10.1093/annonc/mdt199

    Article  PubMed  Google Scholar 

  18. Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K, American Society of Clinical O (2013) Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(19):2500–2510. doi:10.1200/JCO.2013.49.2678

    Article  PubMed  Google Scholar 

  19. Duffy CM, Allen SM, Clark MA (2005) Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol 23(4):766–773. doi:10.1200/JCO.2005.01.134

    Article  PubMed  Google Scholar 

  20. Scanlon M, Blaes A, Geller M, Majhail NS, Lindgren B, Haddad T (2012) Patient satisfaction with physician discussions of treatment impact on fertility, menopause and sexual health among pre-menopausal women with cancer. J Cancer 3:217–225. doi:10.7150/jca.4408

    Article  PubMed Central  PubMed  Google Scholar 

  21. Vadaparampil ST, Christie J, Quinn GP, Fleming P, Stowe C, Bower B, Pal T (2012) A pilot study to examine patient awareness and provider discussion of the impact of cancer treatment on fertility in a registry-based sample of African American women with breast cancer. Support Care Cancer 20(10):2559–2564. doi:10.1007/s00520-012-1380-4

    Article  PubMed  Google Scholar 

  22. Letourneau JM, Smith JF, Ebbel EE, Craig A, Katz PP, Cedars MI, Rosen MP (2012) Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer. Cancer 118(18):4579–4588. doi:10.1002/cncr.26649

    Article  PubMed Central  PubMed  Google Scholar 

  23. Gorman JR, Malcarne VL, Roesch SC, Madlensky L, Pierce JP (2010) Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat 123(2):477–485. doi:10.1007/s10549-010-0768-4

    Article  PubMed Central  PubMed  Google Scholar 

  24. Perz J, Ussher J, Gilbert E (2013) Loss, uncertainty, or acceptance: subjective experience of changes to fertility after breast cancer. Eur J Cancer Care 23(4):514–522. doi:10.1111/ecc.12165

    Article  Google Scholar 

  25. Quinn GP, Vadaparampil ST, Lee JH, Jacobsen PB, Bepler G, Lancaster J, Keefe DL, Albrecht TL (2009) Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol 27(35):5952–5957. doi:10.1200/JCO.2009.23.0250

    Article  PubMed  Google Scholar 

  26. Kim J, Oktay K, Gracia C, Lee S, Morse C, Mersereau JE (2012) Which patients pursue fertility preservation treatments? A multicenter analysis of the predictors of fertility preservation in women with breast cancer. Fertil Steril 97(3):671–676. doi:10.1016/j.fertnstert.2011.12.008

    Article  PubMed Central  PubMed  Google Scholar 

  27. Bastings L, Baysal O, Beerendonk CCM, Braat DDM, Nelen WLDM (2014) Referral for fertility preservation counselling in female cancer patients. Hum Reprod 29(10):2228–2237. doi:10.1093/humrep/deu186

    Article  CAS  PubMed  Google Scholar 

  28. Lambertini M, Pinto AC, Del Mastro L (2014) Fertility issues in young breast cancer patients: what women want. J Thorac Dis 6(6):584–588. doi:10.3978/j.issn.2072-1439.2014.06.12

    PubMed Central  PubMed  Google Scholar 

  29. Armuand GM, Wettergren L, Rodriguez-Wallberg KA, Lampic C (2014) Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis. Support Care Cancer 22(10):2805–2812. doi:10.1007/s00520-014-2279-z

    Article  PubMed Central  PubMed  Google Scholar 

  30. Forman EJ, Anders CK, Behera MA (2009) Pilot survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. J Reprod Med 54(4):203–207

    PubMed Central  PubMed  Google Scholar 

  31. King JW, Davies MC, Roche N, Abraham JM, Jones AL (2012) Fertility preservation in women undergoing treatment for breast cancer in the UK: a questionnaire study. Oncologist 17(7):910–916. doi:10.1634/theoncologist.2012-0064

    Article  PubMed Central  PubMed  Google Scholar 

  32. Adams E, Hill E, Watson E (2013) Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes. Br J Cancer 108(8):1602–1615. doi:10.1038/bjc.2013.139

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Ancoli-Israel S, Liu L, Rissling M, Natarajan L, Neikrug AB, Palmer BW, Mills PJ, Parker BA, Sadler GR, Maglione J (2014) Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study. Support Care Cancer 22(9):2535–2545. doi:10.1007/s00520-014-2204-5

    Article  PubMed Central  PubMed  Google Scholar 

  34. Deprez S, Amant F, Smeets A, Peeters R, Leemans A, Van Hecke W, Verhoeven JS, Christiaens MR, Vandenberghe J, Vandenbulcke M, Sunaert S (2012) Longitudinal assessment of chemotherapy-induced structural changes in cerebral white matter and its correlation with impaired cognitive functioning. J Clin Oncol 30(3):274–281. doi:10.1200/JCO.2011.36.8571

    Article  PubMed  Google Scholar 

  35. Ganz PA (2012) Doctor, will the treatment you are recommending cause chemobrain? J Clin Oncol 30(3):229–231

    Article  PubMed  Google Scholar 

  36. Kirkman M, Winship I, Stern C, Neil S, Mann GB, Fisher JR (2014) Women’s reflections on fertility and motherhood after breast cancer and its treatment. Eur J Cancer Care 23(4):502–513. doi:10.1111/ecc.12163

    Article  CAS  Google Scholar 

  37. Vloeberghs V, Peeraer K, Pexsters A, D’Hooghe T (2009) Ovarian hyperstimulation syndrome and complications of ART. Best Pract Res Clin Obstet Gynaecol 23(5):691–709. doi:10.1016/j.bpobgyn.2009.02.006

    Article  PubMed  Google Scholar 

  38. Campo-Engelstein L (2010) Consistency in insurance coverage for iatrogenic conditions resulting from cancer treatment including fertility preservation. J Clin Oncol 28(8):1284–1286

    Article  PubMed Central  PubMed  Google Scholar 

  39. Day L (2009) What is documentation for? Am J Crit Care 18(1):77–80. doi:10.4037/ajcc2009419

    Article  PubMed  Google Scholar 

  40. Duffy C, Allen SM, Dube C, Dickersin K (2012) Oncologists’ confidence in knowledge of fertility issues for young women with cancer. J Cancer Educ 27(2):369–376. doi:10.1007/s13187-011-0304-1

    Article  PubMed Central  PubMed  Google Scholar 

  41. Mayer DK, Nekhlyudov L, Snyder CF, Merrill JK, Wollins DS, Shulman LN (2014) American Society of Clinical Oncology clinical expert statement on cancer survivorship care planning. J Oncol Pract 10(6):345–351

    Article  PubMed  Google Scholar 

  42. Balthazar U, Deal AM, Fritz MA, Kondapalli LA, Kim JY, Mersereau JE (2012) The current fertility preservation consultation model: are we adequately informing cancer patients of their options? Hum Reprod 27(8):2413–2419. doi:10.1093/humrep/des188

    Article  PubMed  Google Scholar 

  43. Jona K, Gerber A (2010) MyOncofertility.org: a web-based patient education resource supporting decision making under severe emotional and cognitive overload. Cancer Treat Res 156:345–361. doi:10.1007/978-1-4419-6518-9_26

    Article  PubMed Central  PubMed  Google Scholar 

  44. Garvelink MM, ter Kuile MM, Fischer MJ, Louwe LA, Hilders CG, Kroep JR, Stiggelbout AM (2013) Development of a decision aid about fertility preservation for women with breast cancer in The Netherlands. J Psychosom Obstet Gynaecol 34(4):170–178. doi:10.3109/0167482X.2013.851663

    Article  PubMed  Google Scholar 

  45. Patel A, Roston A, Uy A, Radeke E, Roston A, Keith L, Zaren HA (2015) Reproductive health and endocrine disruption in women with breast cancer: a pilot study. Support Care Cancer 23(2):411–418. doi:10.1007/s00520-014-2381-2

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge Patricia Nolan, MD, MPH (Brown University School of Public Health, Providence, RI) for statistical assistance and for reviewing early drafts of this manuscript.

Conflict of interest

The authors have no conflicts of interest (financial or otherwise) to disclose. The authors have full control of all primary data and willingly grant the journal permission to review original data if requested.

Ethical approval

The study was approved by the Institutional Research Board of Women and Infants Hospital in Providence, RI.

Previous poster presentation

Banerjee R, Tsiapali E. “Predictors of Lack of Fertility Discussions with Breast Cancer Patients.” 15th Annual Meeting, American Society of Breast Surgeons (Las Vegas, NV). May 2, 2014.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ekaterini Tsiapali.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 28 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Banerjee, R., Tsiapali, E. Occurrence and recall rates of fertility discussions with young breast cancer patients. Support Care Cancer 24, 163–171 (2016). https://doi.org/10.1007/s00520-015-2758-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2758-x

Keywords

Navigation