Abstract
PurposeFemale breast cancer (BC) patients exposed to gonadotoxic chemotherapy are at risk of future infertility. There is evidence of disparities in the discussion of fertility preservation for these patients. The aim of the study was to identify factors influencing the discussion of fertility preservation (FP).Material and MethodsWe analyzed consecutive BC patients treated by chemotherapy at Institut Curie from 2011-2017 and aged 18-43 years at BC diagnosis. The discussion of FP was classified in a binary manner (discussion/no discussion), based on mentions present in the patient’s electronic health record (EHR) before the initiation of chemotherapy. The associations between FP discussion and the characteristics of patients/tumors and healthcare practitioners were investigated by logistic regression analysis.ResultsThe median age of the 1357 patients included in the cohort was 38.7 years, and median tumor size was 30.3 mm. The distribution of BC subtypes was as follows: 702 luminal BCs (58%), 241 triple-negative breast cancers (TNBCs) (20%), 193 HER2+/HR+ (16%) and 81 HER2+/HR- (6%). All patients received chemotherapy in a neoadjuvant (n=611, 45%) or adjuvant (n= 744, 55%) setting. A discussion of FP was mentioned for 447 patients (33%). Earlier age at diagnosis (discussion: 34.4 years versus no discussion: 40.5 years), nulliparity (discussion: 62% versus no discussion: 38%), and year of BC diagnosis were the patient characteristics significantly associated with the mention of FP discussion. Surgeons and female physicians were the most likely to mention FP during the consultation before the initiation of chemotherapy (discussion: 22% and 21%, respectively). The likelihood of FP discussion increased significantly over time, from 15% in 2011 to 45% in 2017. After multivariate analysis, FP discussion was significantly associated with younger age, number of children before BC diagnosis, physicians’ gender and physicians’ specialty.ConclusionFP discussion rates are low and are influenced by patient and physician characteristics. There is therefore room for improvement in the promotion and systematization of FP discussion.
Highlights
Breast cancer (BC) is the most frequent cancer in women [1], and about 7% of BC diagnoses concern women under the age of 40 years [2]
Any discussion on damages on fertility induced by chemotherapy counted as “fertility preservation (FP) Discuss”
We first extracted specific string character patterns by text mining (TM), using specific key words associated with a high likelihood of FP discussion having occurred (“oncofertility”, “IVM”, “frozen oocytes”, “frozen embryos”, “(fertility)”, “ov* fragment preservation”, “ov* cryopreservation”, “ov* cryoconservation”), making it possible to identify the keyword concerned directly in the electronic health records (EHR)
Summary
Breast cancer (BC) is the most frequent cancer in women [1], and about 7% of BC diagnoses concern women under the age of 40 years [2]. Survival rates are continually improving, thanks to advances in early detection and treatment. Mean age at first pregnancy is continuing to increase, due to changes in society, and the question of fertility and pregnancy after BC is being raised increasingly frequently [3]. Oncological treatments may impair the fertility of premenopausal patients with BC. Chemotherapy may induce premature ovarian failure, depending on the woman’s age and the drugs used, their dose and the duration of treatment [4]. Adjuvant endocrine therapy, which is generally recommended for five years in patients with hormone-responsive cancers, can delay parenthood, due to the potential teratogenicity of the treatment [5]
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