Addressing the risk of infertility in young women with breast cancer (BC): A quality improvement (QI) intervention.

Abstract

72 Background: Many young women with early BC require systemic therapy (ST) which can result in ovarian damage leading to infertility. Fertility preservation (FP) can be performed prior to ST, however uptake is low. Data suggest oncology providers do not routinely discuss the risk of treatment related infertility (TRI) or FP with young women with BC. Methods: We created a QI protocol to ensure providers address fertility needs of young women with early BC. Non-pregnant women age 18-44 years with stage I-III BC who have not initiated ST are identified by screening clinic schedules. Clinicians are asked to follow a QI protocol requiring assessment of patients’ childbearing potential (CBP), risk for TRI and fertility goals (FG). If appropriate, FP is discussed and consultation with a fertility specialist arranged. A clinical team member completes a provider documentation form (PDF) summarizing the QI protocol steps accomplished. Results: Since implementation of the QI protocol, there have been 80 eligible women (mean age 38.6). At least one PDF was completed for 56 (70%), with the majority completed by breast surgeons. Among those with a completed PDF, 48 (86%) were of CBP, all but one of whom planned ST associated with a risk of infertility. According to the PDF, the risk of TRI was discussed in 34 (72%) while FG were assessed in 44 (94%), with 8 (18%) desiring fertility and 8 (18%) undecided about FG. Discussion of FP by the provider and/or a fertility specialist was documented in the PDF for 85% of those who desired fertility or who were undecided. In comparison to the PDF, discussion of FG was recorded in provider notes in 36 (45%) women with documentation in both provider notes and the PDF for 29 (36%). Provider notes documented discussion of FG in 94% of the women who desired fertility or who were undecided according to the PDF. Conclusions: Implementation of a QI protocol with required documentation ensures providers address fertility needs of young women with BC. Providers do not discuss the risk of TRI as frequently as assessing FG. Efforts are ongoing to increase completion rate of our PDF and to incorporate it into the electronic medical record. Follow-up regarding ST and uptake of FP in our cohort is ongoing.