Young Breast Cancer Survivors Research Articles

Abstract PO2-12-01: Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors

Abstract Background: Young BC survivors are at risk for impaired QOL in part due to issues that are unique to their life stage. We sought to characterize trajectories of QOL in the 5 years following diagnosis among young BC survivors as well as evaluate patient and clinical characteristics associated with poorer or deteriorating QOL trajectories over time. Methods: Women diagnosed with stage I-III BC at age ≤40 enrolled in the Young Women’s BC Study, a prospective cohort in North America, who completed ≥2 study surveys through 5 years of post-diagnosis follow-up. QOL was evaluated with the Cancer Rehabilitation Evaluation System (CARES) physical, psychosocial, and sexual subscale scores. Demographic, treatment, and clinical characteristics were ascertained through surveys and chart review. Longitudinal trajectories for each CARES subscale were defined using group-based trajectory modeling; associations between patient/clinical characteristics and trajectory group membership were estimated for each subscale using multivariable multinomial logistic regression. Results: Among 900 women, median age at diagnosis was 36 (range: 17-40) 89% were white, 2% Black, and 4% Hispanic. At baseline, 73% were partnered, 61% parous and 49% perceived themselves as financially comfortable. Most had hormone-receptor positive (74%), HER2-negative (70%) BC, and most received chemotherapy (82%); 36% underwent mastectomy with radiation. Physical and psychosocial scores each clustered into 4 trajectories, with >75% of participants clustering in groups reflecting excellent or good QOL that was stable over time and few (6% for physical and 4% for psychosocial) clustering into groups that reflected poorer QOL at baseline that did not improve over time. Sexual health trajectories were more variable, clustering into 5 trajectories, with over half of participants clustered into groups reflecting good (35%) or excellent (20%) QOL that remained relatively stable over time, 22% clustered into a trajectory that was poor at baseline but moderately improved over follow-up, 13% in a group that reflected deteriorating from moderate-to-poor QOL and 11% in a group with poor QOL at baseline that did not improve over time. In multivariable regression analyses (Table), factors associated with clustering in a poorer trajectory (vs. clustering in an excellent trajectory), in multiple QOL domains included baseline financial discomfort (associated with poorer QOL across all 3 domains), mastectomy+radiation (vs. lumpectomy, associated with poorer QOL across all 3 domains); chemotherapy receipt (associated with poorer physical and sexual health trajectories); and baseline BMI >25 (vs. 18.5-24.9, associated with poorer physical and poorer/deteriorating sexual health trajectories). Conclusions: Young BC survivors follow distinct QOL trajectories in survivorship. While most will not experience substantial QOL impairment through the first 5 years following diagnosis, a substantial minority report persistently poor or deteriorating QOL. The association between more extensive local therapy and poorer physical/psychosocial/sexual health trajectories underscores the importance of communicating the potential for negative QOL outcomes when women are making surgical decisions. Additionally, the pervasive impact of financial wellbeing on multiple QOL domains supports the potential value of systematic screening for and addressing of financial distress to prevent or mitigate financial toxicity in survivorship Factors associated with clustering in poorer/deteriorating (vs. excellent) QOL trajectories *Reference trajectory=excellent QOL Citation Format: Tal Sella, Zheng Yue, Kathryn Ruddy, Shari Gelber, Rulla Tamimi, Jeffrey Peppercorn, Lidia Schapira, Virginia Borges, Steven Come, Eric Winer, Ann Partridge, Shoshana Rosenberg. Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-01.

Abstract PO2-11-08: Divorce and marital dissolution after Breast Cancer diagnosis in young breast cancer survivors in Mexico

Abstract Background: The current literature suggests that facing breast cancer can have significant effects on the relationship, for the better or for the worse. The needs of younger women with breast cancer are receiving increased attention, as 23.1% of all newly diagnosed invasive cancer occur in women age 50 or younger. Marital relationships, in particular, may be strained for younger cancer patients as they face health, emotional, and financial stressors from their cancer. The few studies that are available to date have examined the effect of breast cancer diagnosis on marital and relationship Purpose: We examined marital outcomes among young locally advanced breast cancer patients in our institution Methods: Eligible participants were women with diagnosis of breast cancer stage I–III, were at least 6 months post diagnosis, and age 50 or younger at the time of diagnosis. Demographic data collected. Participants reported their marital o relationship status at time of breast cancer diagnosis and after at least 6 moth post diagnosis, whether they were currently married or a member of an unmarried couple, divorced, widowed or separated Other variables examined regarding a possible separation, the reasons for separation, the influence of the cancer on the relationship, the positive or negative perception of the impact of cancer on the relationship, the highest educational attainment and employment status. Descriptive statistics, percentages, frequencies, mean values and standard deviations were calculated. Results: In total, 75 patients were eligible for inclusion with a total of 250 patient with diagnosis of locally advanced breast cancer. The median age was 44 (range 30–48). Most of the patients, stage I or II tumors (55%). The divorce or separation rate was 36%, higher than reported in the literature (14.5%). Among those who were separated, 77% reported that cancer contributed to the separation or divorce. Also, for those who stayed together, 81% reported an impact of the cancer on the relationship, of which 50% reported a negative impact. Of those who had separated, none were in a new relationship. Conclusions: The emotional burdens of cancer may lead to marital stress for younger cancer survivors.; support systems are needed to assist them in the years following diagnosis. Because the marital relationship has multiple dimensions, it is also important to explore and identify those areas of the couple's life that are affected by the experience Citation Format: Saúl Campos-Gomez, Andrea Ovando Trujillo. Divorce and marital dissolution after Breast Cancer diagnosis in young breast cancer survivors in Mexico [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-11-08.

Abstract PO3-11-10: Second primary non-breast cancers in young breast cancer survivors

Abstract Adolescent and young adults (AYAs) (15-39 years) have a heightened risk of developing a second primary malignancy due to extended periods of survivorship, higher incidence of germline cancer predisposing variants, and increased susceptibility to treatment-induced malignancies. Research on survivors of specific AYA cancer types, including breast cancer (BC) survivors, is limited. Among BC survivors, while much survivorship research focuses on risk of locoregional recurrence or contralateral BC, little is known about overall risk, and risk factors, of developing second non-breast primaries. This prospective cohort study examined women diagnosed with BC from 2006-2016 at age ≤40 years enrolled in the Young Women’s BC Study (YWS) (N=1297). Women were excluded from the analytic cohort if initially diagnosed with Stage IV breast cancer (N=64). To enable investigation of how BC treatments may impact second primary risk, women were also excluded if they reported another cancer before primary BC diagnosis (N=3). Patient characteristics, treatment information, and clinical events were collected via serial surveys. Tumor characteristics and detailed treatment data were obtained from medical record review. Five- and 10-year risk of second non-breast primary was estimated via the cumulative incidence function after applying the Fine-Gray competing risks model with time starting at primary BC diagnosis. Death, metastasis, or diagnosis with a second primary BC were considered as competing events. Univariate and multivariate Fine-Gray sub-distribution models were used to estimate sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CI) for second non-breast primary cancer risk. Risk factors considered included age, race, body mass index, smoking, alcohol use, income, family history of cancer, germline pathogenic variant (PV) carrier status, tumor stage, grade, and ER status, primary surgery type, and receipt of radiation, chemotherapy, or endocrine therapy (yes/no). Multivariate models tested individual associations with additional adjustment for radiation therapy and PV carrier status, as both are consistently associated with second primary in the literature. Over a median follow-up of 10.1 years (inter-quartile range (IQR) =7.9-12.1 y), 47 patients (4%) developed a second non-breast primary cancer. Median age at second non-breast primary was 43 years (IQR=39-46), and median time between primary BC and second non-breast primary was 7.3 years (IQR=4.1-9.3). Second primary types included melanoma (n=10), thyroid (n=10), ovarian (n=4), sarcoma (n=4), uterine (n=3), rectal (n=3), bladder (n=2), cervical (n=2), head and neck (n=2), lung (n=2), lymphoma (n=2), pancreatic (n=2), and kidney (n=1). During the study, 22 patients (2%) developed a second primary BC, 167 (19%) developed metastasis, and 15 (1%) died from causes other than BC. Among the patients who developed a second primary BC, two later developed another non-breast cancer (ovarian and brain cancer). When incorporating competing risks, five and 10-year cumulative incidence of second non-breast primary was 1.4% and 3.2%, respectively. No patient or treatment factors were statistically significantly associated with second non-breast primary in univariate or multivariate models, including radiation and PV carrier status. In this population of young BC survivors, 10-year cumulative incidence of second non-breast primary cancer was 3.2%, with the most common second cancers being melanoma and thyroid cancer. Incidence rates of all second primary cancer types in this cohort were higher than population-based incidence rates for healthy women under 50 years of age, highlighting the importance of long-term surveillance for other cancer events in this young population. While risk of second non-breast primary was not associated with primary BC treatment in this study, cases were limited, and the follow-up interval was relatively short. Citation Format: Bessie Zhang, Kristen Brantley, Shoshana Rosenberg, Gregory Kirkner, Laura Collins, Kathryn Ruddy, Rulla Tamimi, Lidia Schapira, Virginia Borges, Ellen Warner, Steven Come, Eric Winer, Ann Partridge. Second primary non-breast cancers in young breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-10.

Abstract PO5-11-04: Sexuality and fertility profiles, Health-Related Quality of Life and other living conditions of young breast cancer survivors in France: a national cross-sectional study by the French Network of Cancer Registries (FRANCIM)

Abstract Introduction In recent decades, the living conditions of breast cancer (BC) survivors have received particular attention, especially among the youngest who face problems related to fertility and sexuality. The main objective of this population-based study was to identify clinical, social and economic determinants of sexuality, fertility and Health Related Quality of Life (HRQoL), and describe other living conditions of young BC survivors in France. Methods Non-metastatic invasive BC women diagnosed from 2009 to 2016, aged ≤ 40 years at diagnosis were identified through the FRANCIM Network. Participants completed self-reported questionnaires including standardized measures (sexuality, HRQoL, anxiety, depression, social deprivation and social support), and fertility issues from June 2021 to December 2022. Sexuality profiles were identified by ascending hierarchical classification and fertility profiles were identified by latent class models. The main determinants of HRQoL were identified using mixed regression model. Results In total, 563 BC survivors from 14 French cancers Registries participated in the survey (response rate of 31%). The mean age at diagnosis was 35.9 (SD=3.8). Main tumors characteristics were AJCC stage 2-3 (61%), Hormone Receptor positive (76%), HER2 positive (24%), and Tumor grade ≥2 (91%). Patients underwent lumpectomy (72%), chemotherapy (85%), radiotherapy (85%), endocrine therapy (71%) and targeted therapies (23%). More than 5 years after diagnosis, 48% reported sexual dysfunction. About 47% of women received information about the impact of BC treatment on fertility, and 34% about fertility preservation. Among 18% of women who had a pregnancy project at diagnosis, 35% became pregnant after treatment. The number of spontaneous pregnancies decreases from 97% before diagnosis to 36% after treatment whereas the number of pregnancies with Medically Assisted procreation increases respectively from 8% to 10%. The average score of general health scale was 60.9. The highest average score of HRQoL was in the physical functioning scale (82.2) and the lowest was in vitality (48.2). Ascending hierarchical clustering allowed to identify 3 distinct sexuality profiles from worse sexual function to better respectively: profile 1 (20%), profile 2 (30%) and profile 3 (50%) of the studied population. Social deprivation and treatment with endocrine therapy (especially tamoxifen) were associated with an increased risk of sexual dysfunction. We identified 3 classes using a latent class model. In class 1, women had a pregnancy project at diagnosis but few of them had children and were referred to a reproduction specialist. At the end of treatments, the pregnancy rate was high in this group. Class 2 includes women who have a pregnancy project at diagnosis and who have given up at the end of treatment. At diagnosis, women in class 3 had children and had no specific pregnancy plans and they were menopausal at time of study with therefore a low rate of pregnancy after treatments. Classes differed in age at diagnosis (p=0.0000), fertility preservation (p=0.0000), information received about treatment impact on fertility (p=0.0002) and fertility preservation (p=0.0000), comorbidities (p=0.0040) and income (p=0.0000). The main determinants of general health were anxiety (p=0.0006), depression (p< 0.0001) and comorbidities (p= 0.0065). Conclusions This study showed that more than five years after the diagnosis of BC, almost one in two young BC survivors, diagnosed before 40 years old, experienced difficulties related to sexuality. Specific interventions in the field of supportive care (recourse to specialists, psychological support and improvement of communication within the couple) for this population should focus in managing sexual dysfunction and improving HRQoL. It would also be suitable for women to receive the necessary information on fertility at diagnosis at diagnosis in order to prepare them for after cancer. Citation Format: Emerline Assogba, Caroline Mollévi, Anne-Sophie Woronoff, Agnès Dumas, Ariane Mamguem, Charles Coutant, Isabelle Desmoulins, Sylvain Ladoire, Sandrine Dabakuyo. Sexuality and fertility profiles, Health-Related Quality of Life and other living conditions of young breast cancer survivors in France: a national cross-sectional study by the French Network of Cancer Registries (FRANCIM) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-04.

Abstract PO2-11-05: Pregnancy Trends Following Breast Cancer Treatment: Insights from a Large Single-Center Experience

Abstract Background The treatment of breast cancer (BC), particularly chemotherapy and long-term endocrine therapy (ETx), can have an impact on fertility which young women with BC have concerns about. This study was therefore conducted with the objective of providing comprehensive real-world data on pregnancy following BC treatment, aiming to shed light on this crucial aspect of survivorship and potentially guide clinical practice and patient counseling. Methods A retrospective analysis was conducted using medical records of women aged 18-40 years diagnosed with BC at a single tertiary medical center between December 2010 and September 2020. The pregnancy rate and timing in relation to characteristics and treatment were analyzed, along with the outcomes of discontinuing ETx for the purpose of pregnancy. Statistical analyses including Kaplan-Meier curves and Cox regression were performed. Results The study included 995 patients, with a mean age at diagnosis of 31.5 years. Of these, 115 (11.6%) patients became pregnant after BC treatment. Patients with a prior history of pregnancy had a lower likelihood of conception post-treatment (HR=0.39, 95% CI: 0.24-0.67, P< 0.001). Women with hormone receptor positive BC was also associated with lower pregnancy rates than with hormone receptor negative BC (HR=0.52, 95% CI: 0.36-0.77, P=0.001). Age at diagnosis and chemotherapy did not significantly impact pregnancy rates (P=0.251 and P=0.140, respectively). Among 662 women with hormone receptor positive BC, there were 76 (11.5%) women who discontinued ETx for the purpose of pregnancy and 69.7% (53 out of 76) achieved pregnancies. The median duration of medication before cessation among these women was 26.5 months and the duration of ETx did not significantly affect pregnancy rates (P=0.204). Recurrence after discontinuation of ETx for pregnancy was observed in 17% (13 out of 76) of cases. The median breast cancer-free interval among these cohort was 71 months. Late recurrence, occurring after 5 years of treatment, was observed in 77% (10 out of 13) of cases. Among the patients who experienced recurrence, 62% (8 out of 13) were loco-regional, while 38% (5 out of 13) were distant recurrences and the success rate of achieving pregnancy was 69% (9 out of 13), while 31% (4 out of 13) did not get pregnant. Conclusion This study provided real-world data regarding the influence and outcomes of ETx on pregnancy in young BC survivors. The discontinuation of ETx for the purpose of pregnancy appears to result in successful conception. Recurrence rates after therapy discontinuation for pregnancy were observed in a subset of cases, with late and loco-regional recurrences being more common. Results of uni- and multi-variable cox proportional hazards model evaluating time to pregnancy * The pregnancy rate was calculated using Kaplan-Meier (KM) estimates. Pregnancy rate according to ETx and its discontinuation Pregnancy rate according to duration of ETx prior to Discontinuation for pregnancy * The p-value was calculated using Chi-square analysis Citation Format: Young-jin Lee, Tae-Kyung Yoo, Sae Byul Lee, Jisun Kim, Il-Yong Chung, Beom Seok Ko, Jong Won Lee, Byung Ho Son, Hee Jeong Kim, Jeonghee Ahn, Seonok Kim. Pregnancy Trends Following Breast Cancer Treatment: Insights from a Large Single-Center Experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-11-05.

Abstract PO4-01-11: Ovarian function suppression (OFS) use beyond five years?: Young breast cancer patient preferences

Abstract Background. Breast cancer (BC) is the leading cause of cancer-related death in young women worldwide, and late recurrence of hormone receptor-positive disease plays a substantial role. Adjuvant endocrine therapy with 5 years of ovarian function suppression (OFS) and an aromatase inhibitor or tamoxifen is recommended for many young patients with high risk hormone receptor-positive BC. Data are limited regarding extended endocrine therapy among premenopausal BC survivors, and non-existent to inform treatment decisions regarding extending OFS beyond 5 years. We sought to evaluate young BC survivors’ perceptions and preferences regarding extending OFS beyond 5 years, and consideration of a potential future study to assess the role of extended OFS. Methods. From January-April 2023, email invites were sent to the Young Survival Coalition (YSC) listserv (N=14,291) specifically asking members with a history of invasive BC (≤45 years at diagnosis; stage I-III without metastatic recurrence) receiving OFS injections for adjuvant endocrine treatment to complete a one-time anonymous online survey. The survey was designed to capture information regarding current endocrine therapy use, patient-provider communication regarding extended endocrine therapy including OFS, OFS-related concerns (rating 0-5 [low: 0-1, moderate: 2-3, severe: 4-5]), and interest in a potential future clinical trial utilizing OFS beyond 5 years. Descriptive statistics were utilized to summarize responses, and two-sided Fishers exact tests and chi-square analyses were used for comparisons. Results. A total of 1,030 YSC members completed the survey, and 615 were analyzed due to eligibility and completeness of data. The majority were from the United States (n=579, 94.1%) or Canada (n=8, 1.3%), were non-Hispanic white (n=452, 73.5%), non-Hispanic Black (n=46, 7.5%), or Hispanic (n=43, 7.0%), and had been diagnosed with stage II BC (n=316, 51.4%). The average age at survey was 38.1 years (SD=5.15, range=22-54) and at initial BC diagnosis was 34.6 years (SD=4.96, range=20-49). Most (n=510, 83.0%) were within their first 5 years of OFS treatment while 14.5% (n=89) had already been receiving OFS for more than 5 years. Many respondents (n=344, 55.9%) reported discussing OFS use beyond 5 years with their provider, of whom 39.8% (n=245) reported their provider recommending they continue OFS for more than 5 years. Despite reporting moderate and severe concerns regarding OFS side effects (n=476, 77.4%), inconvenience of injection visits (n=272, 44.2%), and high cost of medication (n=223, 36.3%), most respondents (n=396, 64.4%) would consider continuing OFS beyond 5 years if it would reduce risk of BC recurrence. For nearly half of respondents (n=289, 47.0%) a risk reduction of at least 5% would be required for extended OFS to be worthwhile compared to the remaining 46.3% (n=285) who indicated interest for < 5% risk reduction. When asked hypothetically if they would take part in a clinical trial to determine efficacy of OFS use beyond 5 years, the majority were interested (n=357, 58.0%). Respondents who were interested were less likely to be concerned about the high cost of medication (p=0.003) however they were also less likely to take OFS beyond 5 years if it only led to 1-2% BC risk reduction (p=0.006) compared to those who were not interested. There were no other proportional differences on any other outcome. Conclusion. Many BC survivors and providers are already considering incorporation of OFS beyond 5 years into adjuvant endocrine therapy despite harboring concerns and lack of data. Efforts to determine the efficacy and benefits of extended OFS are necessary given the risk of late recurrence in this population as well as the potential for significant short- and long-term toxicities. The results from this survey study suggest that future clinical trials evaluating potential benefits and risks of long-term OFS use among young BC survivors are needed and likely feasible. Citation Format: Kate Dibble, Tal Sella, Kathryn Ruddy, Craig Snow, Amanda Nixon, Patricia Spears, Karla Ballman, Lisa Carey, Ann Partridge. Ovarian function suppression (OFS) use beyond five years?: Young breast cancer patient preferences [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-01-11.

Abstract PO5-11-05: Fertility, sexuality and other unmet needs of young breast cancer survivor during and at the end of treatment in France: a national qualitative study by the French Network of Cancer Registries (FRANCIM)

Abstract Introduction In recent decades, the living conditions of breast cancer (BC) survivors have received particular attention, especially among the youngest who face problems related to fertility and sexuality. Integrating women's needs into medical decisions is becoming increasingly essential for high-quality care. This study aimed to describe and understand the experiences of young women after BC, examined the scope and content of information transmitted on fertility and sexuality during routine appointments during the management of BC, and identify unmet support needs. Methods This study follows on from a quantitative study using self-questionnaires, in which patients met the following inclusion criteria (Non-metastatic invasive BC women diagnosed from 2009 to 2016, aged ≤ 40 years at diagnosis were identified through the FRANCIM Network). Interviews were conducted with a sample of 29 women drawn at random from among eligible women who completed the self-questionnaires in the quantitative study. The sample were stratified by age, department, socio-professional category and socio-economic level. Individual face-to-face semi-structured interviews were conducted either by videoconference or face-to-face, in patient's homes or in any other location of their choice during October to December 2022. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results Findings revealed that during treatments, women would like physicians (oncologists, surgeons, radiologists, gynecologist, etc.) to be more empathetic, more humane, and show tact and attentiveness when announcing the disease and treatments during the course of care. They would like to be better informed about the post-treatment side effects and better prepared by the physicians, for the feeling of abandonment felt in the aftermath of cancer due to the absence of medical appointments. The mains unmet needs of BC survivors were more numerous at the end of the treatments. In fact they more deplore the lack of coverage and reimbursement of aesthetic care and paramedical care essential to women to compensate for the persistent side effects and the repercussions of the disease and post-cancer treatments (eg: a more aesthetic and better reimbursed breast reconstruction at the end of the treatments, support by psychologists, etc.). With regard to sexuality, in the absence of systematic information for patients on the side effects of treatments on sexuality at diagnosis, it would be desirable to ask the woman if she would like to be informed. In addition, psychological support for the couple during and after treatment in terms of sexuality is necessary to avoid divorce and separation. In terms of fertility, there is a lack of systematic information for young women on the side effects of treatment on fertility, as well as questioning by physicians about any pregnancy plans women may have at the time of diagnosis. The introduction of fertility preservation with the possibility of it being systematically offered to all young women at diagnosis is important (or, failing that, the subject should be discussed more with the women), as it represents a gap in support). For women who had a pregnancy plan at diagnosis, the majority felt a lack of listening by doctors and adaptation of care to their pregnancy plan at diagnosis. Conclusions This study showed that, despite the high quality of care provided to young women diagnosed with BC in France, they felt they had unmet needs in terms of sexuality, fertility and access to paramedical care at the end of treatment. Indeed, these women face psychological suffering that they would like physicians to see beyond their physical suffering based on their experience. The results of this study could help public authorities and physicians improve care and life after cancer for young women diagnosed with BC. Citation Format: Emerline Assogba, Agnès Dumas, Cynthia Morgny, Myriam Borel, Véronique Brun, Nicolas Nicolas Meunier-Beillard, Ariane Mamguem, Charles Coutant, Isabelle Desmoulins, Sandrine Dabakuyo. Fertility, sexuality and other unmet needs of young breast cancer survivor during and at the end of treatment in France: a national qualitative study by the French Network of Cancer Registries (FRANCIM) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-05.

Second Primary Breast Cancer in Young Breast Cancer Survivors

Among women diagnosed with primary breast cancer (BC) at or younger than age 40 years, prior data suggest that their risk of a second primary BC (SPBC) is higher than that of women who are older when they develop a first primary BC. To estimate cumulative incidence and characterize risk factors of SPBC among young patients with BC. Participants were enrolled in the Young Women's Breast Cancer Study, a prospective study of 1297 women aged 40 years or younger who were diagnosed with stage 0 to III BC from August 2006 to June 2015. Demographic, genetic testing, treatment, and outcome data were collected by patient surveys and medical record review. A time-to-event analysis was used to account for competing risks when determining cumulative incidence of SPBC, and Fine-Gray subdistribution hazard models were used to evaluate associations between clinical factors and SPBC risk. Data were analyzed from January to May 2023. The 5- and 10- year cumulative incidence of SPBC. In all, 685 women with stage 0 to III BC (mean [SD] age at primary BC diagnosis, 36 [4] years) who underwent unilateral mastectomy or lumpectomy as the primary surgery for BC were included in the analysis. Over a median (IQR) follow-up of 10.0 (7.4-12.1) years, 17 patients (2.5%) developed an SPBC; 2 of these patients had cancer in the ipsilateral breast after lumpectomy. The median (IQR) time from primary BC diagnosis to SPBC was 4.2 (3.3-5.6) years. Among 577 women who underwent genetic testing, the 10-year risk of SPBC was 2.2% for women who did not carry a pathogenic variant (12 of 544) and 8.9% for carriers of a pathogenic variant (3 of 33). In multivariate analyses, the risk of SPBC was higher among PV carriers vs noncarriers (subdistribution hazard ratio [sHR], 5.27; 95% CI, 1.43-19.43) and women with primary in situ BC vs invasive BC (sHR, 5.61; 95% CI, 1.52-20.70). Findings of this cohort study suggest that young BC survivors without a germline pathogenic variant have a low risk of developing a SPBC in the first 10 years after diagnosis. Findings from germline genetic testing may inform treatment decision-making and follow-up care considerations in this population.

"The Materials Didn't Really Seem to Apply to Me": A Focus-Group Study on Young Women's Needs and Perspectives on Breast Cancer Educational Material.

Young women breast cancer survivors face unique challenges in navigating diagnosis and treatment information while also navigating their own life demands (i.e., fertility, childcare, careers). Special consideration to printed and online cancer educational materials distributed to young women should be evaluated for their suitability, but few studies have investigated the educational preferences and needs of young women cancer survivors. We sought to explore young women breast cancer survivors' needs and preferences regarding cancer educational material from diagnosis to survivorship. We used a qualitative design with convenience sampling of young women breast cancer survivors who completed active treatment at a medical center within the last 5years to participate in semi-structured online focus groups from November 2020 to May 2021. Thirty-three young women (75.8% White, 12.1% Black, 12.1% other) participated in one of seven online focus groups, each lasting approximately 2h. Four dominant themes emerged from the data: (1) initial interaction with online materials; (2) reasons for seeking printed and online materials; (3) disconnection of visuals; and (4) recommendations. Our findings revealed that young women were initially hesitant to seek online information, but later sought printed and online information after specific endorsement of materials. Current breast cancer materials lack content specific to young women's needs (i.e., reconstruction options), and graphics have little age and racial diversity. Oncology nurses may consider novel methods of education delivery, such as short videos to be shared easily on social media for specific content like scarring results and reconstruction options.

Cryopreservation of ovarian tissue for fertility preservation in breast cancer patients: time to stop?

Fertility preservation is currently offered to young women with breast cancer to increase their chances of motherhood after a potentially gonadotoxic treatment. Ovarian stimulation with oocyte vitrification and cryopreservation of ovarian tissue remain the most commonly used methods of choice. Whichever method is preferred is very much dependent on the practice and experience of the clinics, although for breast cancer in particular one method might be superior to the other. Cryopreservation of ovarian tissue is inevitably associated with the iatrogenic reduction of the ovarian reserve of a patient and should only be offered to women with a high risk of premature ovarian insufficiency following treatment. However, for younger breast cancer survivors, pregnancy and delivery rates are reassuringly high, even after chemotherapy. Despite its widespread use, few women come back to make use of their cryopreserved tissue. We argue that cryopreservation of ovarian tissue is not an appropriate option for breast cancer patients and discuss the reasons for this opinion.

Suffering and adjustment: a grounded theory of the process of coping with financial toxicity among young women with breast cancer.

To explore the process of coping with financial toxicity among young women with breast cancer and formulate a grounded theory that serves as a foundation for creating intervention strategies aimed at supporting cancer survivors. A qualitative study using the Corbin and Strauss variant of grounded theory. A series of in-depth interviews were carried out with young women with breast cancer (n = 29) using the theoretical sampling method. We analyzed data by coding core categories in the patients' coping processes and developing theory around these categories. Data collection and analysis were performed simultaneously. A substantial theory of the process of coping with financial toxicity among young female breast cancer survivors was constructed. Two core concepts, suffering and adjustment, were identified. Young women with breast cancer suffered from financial toxicity, which was related to risk factors, coping resources, and unmet needs. To overcome financial toxicity, young women with breast cancer adjusted by reshaping consumption concept, re-dividing of family functions, re-planning of occupation career, and rebuilding life confidence. This qualitative study constructed a theory delineating the coping strategies employed by young women with breast cancer in response to financial toxicity, offering profound insights into the intricacies of cancer-related financial toxicity. Identifying risk factors, enhancing coping resources, and meeting unmet needs would be helpful to patients' adjustment to financial stress.

The Effect of Body Image, Self-esteem and Depression on Sexual Function in Young Breast Cancer Survivors

The Effect of Body Image, Self-esteem and Depression on Sexual Function in Young Breast Cancer Survivors

Health-related quality of life of premenopausal young breast cancer survivors undergoing endocrine therapy

PurposeThe incidence of breast cancer in premenopausal women in South Korea is higher compared to the West. This study aimed to identify factors associated with the health-related quality of life (HRQoL) among survivors with premenopausal young breast cancer undergoing endocrine therapy by examining the effects of menopausal symptoms, social support, and resilience on HRQoL. MethodsCross-sectional study was used to select survivors with breast cancer undergoing endocrine therapy. The study instruments used included a basic information questionnaire, Menopause Rating Scale, Multidimensional Scale of Perceived Social Support, Connor–Davidson Resilience Scale, and Health-Related Quality of Life Instrument with 8 items. Researchers utilized independent t-tests, one-way analysis of variance, Pearson's correlation coefficients, and multiple linear regression to analyze the data. The data were collected from August to September 2021, and the questionnaire was administered via a link posted on a bulletin board of an online breast cancer survivors community. Finally, 133 questionnaires were included in the final analysis. ResultsAmong 150 participants, 133 completed the questionnaires. HRQoL was higher in the groups with a monthly income of ≥5 million KRW (β = 0.231, p = .011), fewer menopausal symptoms (β = −0.399, p < .001), and higher social support (β = 0.170, p = .038), and lower in the group receiving endocrine therapy and OFS (β = −0.192, p = .010). The explanatory power for HRQoL of premenopausal young breast cancer survivors undergoing endocrine therapy was 38.3% (F = 10.634, p < .001). ConclusionBreast cancer survivors should be supported to participate in economic activity, utilize rehabilitation and intervention programs to alleviate menopausal symptoms, and benefit from a social support network formed by the hospital, community, and government.

Work Productivity Among Younger Breast Cancer Survivors: The Impact of Behavioral Interventions for Depression

ObjectivesThe Pathways to Wellness randomized controlled trial found that 2 behavioral interventions, mindfulness awareness practices and survivorship education, reduced depressive symptoms in younger breast cancer survivors (BCSs) compared with wait-list control. This secondary analysis examines whether the interventions led to reduced loss of work productivity among younger BCSs and whether such reductions were mediated by reductions in depressive symptoms. MethodsThe Work Productivity and Activity Impairment scale was used to measure work productivity loss at 4 assessment time points. Correlates of productivity loss at enrollment were examined using multivariable linear regression. Differences in change over time in productivity loss between each intervention group and control were assessed using linear mixed models. Reduced depressive symptoms were tested as a mediator of reduced productivity loss. ResultsOf 247 trial participants, 199 were employed and included in the analyses. At enrollment, higher productivity loss was associated with chemotherapy receipt (P = .003), younger age (P = .021), more severe cognitive problems (P = .002), higher musculoskeletal pain severity (P = .002), more depressive symptoms (P = .016), and higher fatigue severity (P = .033). The mindfulness intervention led to significantly less productivity loss compared with control at all 3 postintervention assessment points (all P < .05), with about 54% of the effect mediated by reduction in depressive symptoms. Survivorship education was not associated with reduced loss of productivity. ConclusionsThese findings suggest that addressing depressive symptoms through behavioral interventions, such as mindfulness, may mitigate impacts on work productivity in younger BCSs.

Relationships between Attachment Style, Emotional Self-Disclosure, and Quality of Life among Young Breast Cancer Survivors: A Cross-Sectional Study

This investigation aims to explore relationships between adult attachment, emotional self-disclosure, and quality of life (QoL). The study sample completed the Chinese versions of the Experiences in Close Relationships Inventory, the Functional Assessment of Cancer Therapy-Breast Scale, and the Distress Disclosure Index between October 2021 and March 2022. The relationships between adult attachment, emotional self-disclosure, and QoL were investigated using a multiple mediation effects test and structural equation modeling. Attachment anxiety and avoidance were risk factors for young Chinese breast cancer survivors' emotional self-disclosure and QoL. Emotional self-disclosure mediates the association between attachment anxiety or avoidance and QoL. Assessing and easing attachment anxiety and avoidance may improve the emotional self-disclosure and QoL of young breast cancer survivors. This study confirms that adult attachment plays an important role in young breast cancer patients' adaptation to the disease and that high adult anxiety and avoidance levels can significantly reduce emotional self-disclosure and QoL in young breast cancer survivors. Identifying attachment patterns can help caregivers better understand patients' responses, adaptation, and treatment adherence to cancer, thereby helping caregivers develop targeted and personalized cancer care practice programs or psychotherapy interventions to improve patients' physical and mental health outcomes.

1866P Unmasking the extent of hidden sexual distress in young breast cancer survivors

1866P Unmasking the extent of hidden sexual distress in young breast cancer survivors

A hermeneutic phenomenological study on the disease experience among young women with breast cancer

ObjectiveWomen diagnosed with breast cancer under the age of 40 face distinctive physical and psychosocial challenges resulting from the disease's pathological features and the developmental aspects associated with their youth. This study aims to investigate the lived experience of breast cancer among this group of young women. MethodsParticipants were purposefully selected from online communities and chat rooms in South Korea. A total of 15 young women with breast cancer were included in this study, and data were gathered through three focus group interviews. The interviews were transcribed verbatim and analyzed using the hermeneutic phenomenology method. ResultsFour essential themes emerged based on four lifeworld existentials: lived body, lived time, lived space, and lived others. These four essential themes were: a wounded and sick body, life robbed of youth and elderly years, crossroads of growth discovered at life's extremes, and a steadfast companion on a solitary journey. ConclusionsYoung women with breast cancer face unique challenges due to the intersection of a severe illness and its impact during their formative years. This study offers valuable insights for crafting customized interventions that directly target the physical and psychosocial requirements of young breast cancer survivors, ultimately enhancing their quality of life.

Changes in amount and intensity of physical activity over time in breast cancer survivors.

Physical activity is associated with decreased breast cancer recurrence and mortality, as well as fewer treatment-related symptoms. Nevertheless, most breast cancer survivors do not meet physical activity guidelines. The purpose of this manuscript is to characterize physical activity trends over time in breast cancer survivors. Mayo Clinic Breast Disease Registry participants received surveys at baseline and at 1 and 4 years after diagnosis; breast cancer recurrence and/or metastatic disease were exclusion criteria. Participants were considered to be meeting guidelines if they self-reported at least 150 minutes of moderate-intensity (eg, fast walking) and/or strenuous (eg, jogging) physical activity per week. Statistical analyses include analysis of covariance methods, paired t tests, conditional logistic regression models, and McNemar tests of homogeneity. A total of 171 participants were included in the analysis. The amount of total physical activity decreased over time (P = .07). Mild-intensity physical activity (eg, easy walking) decreased most over time (P = .05). Among participants aged 18-49 years, mild-intensity (P = .05) and moderate-intensity (P = .02) physical activity decreased over time. Strenuous-intensity physical activity levels decreased over time among participants with a normal body mass index (P = .002) and with obesity (P = .01). We found a trend-level decrease in total physical activity over time, driven mostly by a decrease in mild-intensity physical activity. Young breast cancer survivors are especially likely to reduce their physical activity over time. Further research on implementing physical activity guidelines in clinical practice is warranted.

Survivorship Navigation for Young Women With Early-Stage Breast Cancer

BackgroundYoung women treated for breast cancer experience unique concerns in follow-up. We developed a program to direct young breast cancer survivors to a dedicated survivorship visit and evaluated their experience. Materials and MethodsEarly-stage breast cancer patients diagnosed under age 45 within 1 year of completing breast surgery, chemotherapy and/or radiation therapy were systematically referred for a survivorship visit. Patients completed a one-time, post-visit survey about their experience. ResultsSixty-nine out of 89 (78%) eligible patients attended a survivorship visit, and 40 of those 69 (58%) completed the post-visit survey. Most respondents learned about the survivorship clinic after completing treatment (30/40; 75%) and reported the survivorship visit occurred at an appropriate time in their follow-up care (26/40; 65%). Of the 34 respondents who reported receiving a treatment summary and survivorship care plan, 30 indicated it would be helpful when visiting their primary care provider (88.2%). Participants reported gaining valuable knowledge about cancer treatment (28/38; 73.7%), side effects (32/39; 82.1%), and cancer surveillance (30/40; 75%), and discussed emotional health (32/40; 80%), exercise (38/40; 95%), and ongoing cancer surveillance (32/37; 86.5%). Several reported intentions to make changes to their follow-up oncology care (8/20; 40%), exercise routines (16/30; 53.3%), and emotional health care (15/22; 68.2%). DiscussionSurvivorship visit navigation is feasible for young breast cancer patients. These visits can influence knowledge gained and intended future health plans and behaviors. Systematic approaches to survivorship care may improve the physical and mental health of cancer survivors. Future health care delivery research focused on survivorship is warranted.

Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer

PurposeWe examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients.MethodsWomen with stage I–III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women’s Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms).ResultsAt baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time.ConclusionsInsomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.