A. J. Bartholomew1, M. L. Haslinger2, M. C. Masciello1, L. M. Bozzuto2, E. V. Tsiapali2 1Georgetown University Medical Center,School Of Medicine,Washington, DC, USA 2Georgetown University Medical Center,Department Of Surgery,Washington, DC, USA
Introduction: Approximately 10% of new breast cancer diagnoses occur in premenopausal women annually. Oncologic management can involve systemic chemotherapy, endocrine therapy, or radiation depending on tumor characteristics. These treatments can compromise ovarian function, leading to premature menopause and impaired fertility. Thus, the importance of fertility preservation discussions (FPD) prior to treatment intervention is paramount. We aim to better characterize FPD in premenopausal breast cancer patients, to quantify utilization of fertility preservation care, and to identify patient demographics associated with low rates of FPD.
Methods: A multi-institutional, retrospective chart review was performed on patients aged 18-40 with invasive breast cancer undergoing treatment from 2005 through 2015. Patient, tumor, and treatment characteristics were collected including age, ethnicity, parity, marital status, insurance, tumor staging, receptor status, and systemic treatment. Charts were reviewed for evidence of documented FPD, and, when identified, the specialty of the physician, timing of discussion in relation to treatment, and subsequent usage of fertility treatment were recorded. Statistical analysis was performed to evaluate the influence of variables on whether a FPD occurred, and to investigate differences in counseling patterns between hospitals given a disparity in patient population demographics.
Results: Of the 227 premenopausal women in this cohort, only 103 (45.6%) had a documented FPD with their provider. Following discussions, 29 (28.2%) patients saw a fertility specialist prior to treatment. Of the FPD that occurred, 52% occurred prior to surgery, 96% before chemotherapy, and 95% prior to endocrine therapy. These discussions were initiated by the medical oncologist (82%), surgical oncologist (17%), and by an oncology nurse navigator (1%); 22% of patients had a FPD with multiple providers throughout treatment. Of note, two medical oncologists accounted for 40% of the discussions. Multiparous women were significantly less likely to have a documented fertility discussion (p < 0.001). All other variables examined, including age, ethnicity, and insurance, were not significantly associated with FPD. Rates did not differ between hospitals, despite a significant baseline difference in ethnicity of the patient population.
Conclusion: An alarmingly low level of documented FPD persists in premenopausal women with invasive breast cancer. Women with more children were significantly less likely to receive fertility counseling from their providers. A concerning 5% of discussions occurred after treatment that compromises fertility. These results highlight the need for improved provider attention to fertility preservation education in premenopausal breast cancer patients. Future interventions should consider the use of electronic medical record reminders and increased physician education to ensure that all patients are counseled prior to treatment.