Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Br
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer? Angelena Crown, MD1, Shirin Muhsen, MD2, Emily C. Zabor, DrPH3, Varadan Sevilimedu, DrPH4, Joanne Kelvin, RN5, Shari B. Goldfarb, MD6, and Mary L. Gemignani, MD, MPH1 1
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon; 3Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; 4Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; 5Department of Medicine, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY; 6Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
ABSTRACT Background. The American Society of Clinical Oncology guidelines recommend early referral to reproductive endocrinology and infertility (REI) specialists for young women diagnosed with breast cancer. Current practice patterns demonstrate an increased utilization of neoadjuvant chemotherapy (NAC). We evaluated premenopausal women with breast cancer after consultation with a Fertility Nurse Specialist (FNS) and determine factors associated with referral to REI specialists. Methods. This retrospective review included all premenopausal women diagnosed at our institution with stage 0–III unilateral breast cancers between 2009 and 2015 who completed an FNS consultation. Clinicopathologic features and factors associated with referral to REI after FNS consultation were analyzed. Results. A total of 334 women were identified. Median age was 35 years (interquartile range 32–38). The majority of women were single (n = 198, 59.3%) and nulliparous (n = 239, 71.6%). REI referrals were common (n = 237, 71.0%). The Breast Surgery service was the most frequent referring service (n = 194, 58.1%), with significantly more
Ó Society of Surgical Oncology 2020 First Received: 11 February 2020 Accepted: 23 April 2020 M. L. Gemignani, MD, MPH e-mail: [email protected]
REI referrals compared to Breast Medicine and Genetics services (p = 0.002). Nulliparity was associated with REI referral (p \ 0.0001). Adjuvant chemotherapy (p = 0.003) was associated with pursuing REI referral, whereas NAC (p \ 0.001) was associated with declining REI referral. Conclusions. Most women elected to consult with an REI specialist, confirming strong interest in fertility preservation among premenopausal women with breast cancer. However, women receiving NAC more frequently declined referral to REI, suggesting that the need to start NAC may influence decisions regarding fertility preservation. With increasing utilization of NAC, our study supports the need for further counseling and education regarding fertility preservation for women undergoing NAC.
Breast cancer is the most commonly diagnosed malignancy in women of reproductive age.1 Alt
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