Elsevier

The Breast

Volume 27, June 2016, Pages 22-26
The Breast

Original article
Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral?

https://doi.org/10.1016/j.breast.2016.02.012Get rights and content

Highlights

  • Fertility discussion rates and fertility preservation (FP) usage is low among young women with breast cancer.

  • A dedicated program with a nurse navigator is associated with higher frequency of FP referrals.

  • FP usage does not appear to significantly delay time to onset of systemic chemotherapy.

Abstract

Purpose

To assess whether a dedicated program for young breast cancer patients, including a nurse navigator, improves the frequency of: a) fertility discussion documentation and b) fertility preservation (FP) referrals.

Methods

A retrospective chart review and prospective survey were undertaken of breast cancer patients diagnosed at age 40 or younger between 2011 and 2013 who received adjuvant or neo-adjuvant chemotherapy at two academic cancer centers in Toronto, Canada. The Odette Cancer Centre (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Patient demographics, tumor pathology, treatment and fertility discussion documentation prior to systemic chemotherapy administration were extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected.

Results

Eighty-one patient charts were reviewed at both OCC and PM. Forty-seven and 49 at OCC and PM returned surveys for a response rate of 58% and 60% respectively. Chart reviews demonstrated no difference in the frequency of fertility discussion documentation (78% versus 75% for OCC and PM, p = 0.71); however, surveys demonstrated higher rates of recall of fertility discussion at OCC (96% versus 80%, p = 0.02). A greater proportion of women were offered FP referrals at OCC, as observed in chart reviews (56% versus 41%, p = 0.09), and surveys (73% versus 51%, p = 0.04). Time to initiation of chemotherapy did not differ between women who underwent FP and those who did not.

Conclusion

A dedicated program for young breast cancer patients is associated with a higher frequency of FP referrals without delaying systemic therapy.

Section snippets

Background

An important concern for young women with early-stage breast cancer is future fertility [1]. Many women will require adjuvant systemic chemotherapy [2], which often has a detrimental effect on fertility [1]. While adjuvant tamoxifen is not toxic to the ovary, the need to take this drug for several years, during which time pregnancy is contraindicated [3], results in further fertility reduction due to the normal effects of aging. With increasing numbers of women having children at later ages,

Study design

A comparative cohort study comprising a retrospective chart review and prospective survey was undertaken, with OCC forming the experimental group, and Princess Margaret Cancer Centre (PM), which does not have a dedicated program for younger women, forming the control group. Electronic patient records (EPR) were retrospectively reviewed at both sites. The same cohort of women was prospectively sent surveys to corroborate information identified in EPR. Both cancer centers are academic, tertiary

Patient characteristics

Eight-one patients were identified at both OCC and PM. Baseline characteristics are listed in Table 1. Overall the cohorts were well matched with the exception of a greater proportion of nulliparous women at PM compared to OCC. Within these cohorts, 47 and 49 women at OCC and PM returned surveys, for a response rate of 58% and 60% respectively. Survey respondents were similar to the larger groups with respect to demographic variables.

Fertility discussions

Chart reviews identified that for 63 (78%) women at OCC and

Discussion

Our study demonstrates that implementation of a dedicated program for young cancer patients with a nurse navigator is associated with a higher probability of fertility discussion and FP referrals for young breast cancer patients based on patient surveys, but does not appear to increase documentation rates.

The higher FP referral rate at OCC is particularly striking, as the patients from that institution were less likely to be nulliparous at the time of diagnosis. The survey finding that 96% of

Conflict of interest statement

The authors have no conflicts of interest to declare.

Acknowledgments

This work was supported by internal departmental funds from Princess Margaret Cancer Centre. Institutional Research Ethics Board approval from the Sunnybrook Odette Cancer Centre and the Princess Margaret Cancer Centre in Toronto, Ontario, Canada was obtained prior to study commencement.

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