Carlos A Carmona1,2, Samantha Yee3, Maureen Seminsky1, Karen Glass2,3, Shu Foong4,5, Eli Lipson6, Nancy N Baxter7,8,9, Christine M Friedenreich5,10, Kelly Metcalfe11,12, Susan Isherwood5, Mohammad R Akbari12,13, Steven Narod12,13, May Lynn Quan5, Ellen Warner14,15. 1. Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada. 2. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 3. CreATe Fertility Centre, Toronto, ON, Canada. 4. Regional Fertility Program, Calgary, AB, Canada. 5. University of Calgary, Calgary, AB, Canada. 6. University of Guelph, Guelph, ON, Canada. 7. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. 8. Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 9. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. 10. Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada. 11. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. 12. Women's College Research Institute, Toronto, ON, Canada. 13. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 14. Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada. ellen.warner@sunnybrook.ca. 15. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. ellen.warner@sunnybrook.ca.
Abstract
BACKGROUND: Prompt referral by their surgeon enables fertility preservation (FP) by young women with breast cancer (YWBC) without treatment delay. Following a FP knowledge intervention, we evaluated surgeon and patient reports of fertility discussion, FP referral offer and uptake, and FP choices and reasons for declining FP among patients enrolled in the Reducing Breast Cancer in Young Women, prospective pan-Canadian study. METHODS: Between September 2015 and December 2020, 1271 patients were enrolled at 31 sites. For each patient, surgeons were sent a questionnaire inquiring whether: (1) fertility discussion was initiated by the surgical team; (2) FP referral was offered; (3) referral was accepted; a reason was requested for any "no" response. Patients were surveyed about prediagnosis fertility plans and postdiagnosis oncofertility management. RESULTS: Surgeon questionnaires were completed for 1068 (84%) cases. Fertility was discussed with 828 (84%) and FP consultation offered to 461 (47%) of the 990 YWBC with invasive disease. Among the 906 responding YWBC, referral was offered to 220 (82%) of the 283 (33%) with invasive disease who stated that they had definitely/probably not completed childbearing prediagnosis. Of these, 133 (47%) underwent FP. The two most common reasons for not choosing FP were cost and unwillingness to delay treatment. CONCLUSIONS: Although the rates of surgeon fertility discussion and FP referral was higher than most reports, likely due to our previous intervention, further improvement is desirable. FP should be offered to all YWBC at diagnosis, regardless of perceived childbearing intent. Cost remains an important barrier to FP uptake.
BACKGROUND: Prompt referral by their surgeon enables fertility preservation (FP) by young women with breast cancer (YWBC) without treatment delay. Following a FP knowledge intervention, we evaluated surgeon and patient reports of fertility discussion, FP referral offer and uptake, and FP choices and reasons for declining FP among patients enrolled in the Reducing Breast Cancer in Young Women, prospective pan-Canadian study. METHODS: Between September 2015 and December 2020, 1271 patients were enrolled at 31 sites. For each patient, surgeons were sent a questionnaire inquiring whether: (1) fertility discussion was initiated by the surgical team; (2) FP referral was offered; (3) referral was accepted; a reason was requested for any "no" response. Patients were surveyed about prediagnosis fertility plans and postdiagnosis oncofertility management. RESULTS: Surgeon questionnaires were completed for 1068 (84%) cases. Fertility was discussed with 828 (84%) and FP consultation offered to 461 (47%) of the 990 YWBC with invasive disease. Among the 906 responding YWBC, referral was offered to 220 (82%) of the 283 (33%) with invasive disease who stated that they had definitely/probably not completed childbearing prediagnosis. Of these, 133 (47%) underwent FP. The two most common reasons for not choosing FP were cost and unwillingness to delay treatment. CONCLUSIONS: Although the rates of surgeon fertility discussion and FP referral was higher than most reports, likely due to our previous intervention, further improvement is desirable. FP should be offered to all YWBC at diagnosis, regardless of perceived childbearing intent. Cost remains an important barrier to FP uptake.
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