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Multicenter Study
. 2011 May;95(6):1932-6.
doi: 10.1016/j.fertnstert.2011.01.169. Epub 2011 Mar 3.

Determinants of access to fertility preservation in women with breast cancer

Sanghoon Lee  1 , Elke Heytens, Fred Moy, Sinan Ozkavukcu, Kutluk Oktay
Affiliations
Multicenter Study

Determinants of access to fertility preservation in women with breast cancer

Sanghoon Lee et al. Fertil Steril. 2011 May.

Abstract

Objective: To evaluate socioeconomic, demographic, and medical factors that influence the referral pattern-either before cancer treatment for fertility preservation (FP, early referral) or post-chemotherapy for assisted reproductive technology (PCART, delayed referral)-in women with breast cancer.

Design: Secondary analysis.

Setting: Academic medical centers.

Patient(s): Three hundred fourteen patients with breast cancer who were counseled for FP (n=218) or PCART (n=96) from June 1999 to July 2009.

Intervention(s): None.

Main outcome measure(s): Factors favoring early referrals.

Result(s): Mean age at diagnosis was higher in FP vs. PCART (35.3±4.5 years vs. 33.9±4.7 years). Ninety percent presented with cancer stage 1 or 2. From 2000 to 2009 the proportion of referrals for FP increased continually. In 2009, nearly all (95.5%) were for FP. The majority (63.8%) was referred from an academic center. Patients with a family history of breast cancer were more likely to consult for FP (75.2% vs. 64.3% without). There was no association with occupation, income, race, ethnicity, obstetric history, and prior infertility treatment. Only 22.9% of those counseled in PCART, compared with 45.0% in the FP group, proceeded with a procedure.

Conclusion(s): There has been an increasing trend within the last 10 years for early referral of breast cancer patients to FP. Factors favoring early referrals are older age, early-stage cancer, family history of breast cancer, and academic center involvement. Those seen before cancer treatment are more likely to receive an intervention.

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Figures

Figure 1
Figure 1
Flow of study participants
Figure 2
Figure 2
Proportion of referral for FP increased contiually from 2000 to 2009. FP: Fertility preservation (early referral) PCART: Post-chemotherapy assisted reproduction (delayed referral)
Figure 3
Figure 3
Proportion of referral for FP inversely associated with the stage of breast cancer. FP: Fertility preservation (early referral) PCART: Post-chemotherapy assisted reproduction (delayed referral)
See this image and copyright information in PMC

References

    1. Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, et al. American society of clinical oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24(18):2917–2931. - PubMed
    1. Oktay K. Fertility preservation: an emerging discipline in the care of young patients with cancer. Lancet Oncol. 2005;6(4):192–193. - PubMed
    1. Lee S, Ozkavukcu S, Heytens E, Moy F, Oktay K. Value of early referral to fertility preservation in women with breast cancer. J Clin Oncol. 2010;28(31):4683–4686. - PMC - PubMed
    1. Oktem O, Oktay K. Fertility preservation for breast cancer patients. Semin Reprod Med. 2009;27(6):486–492. - PubMed
    1. Azim AA, Rauch ER, Ravich M, Witkin S, Oktay K. Ovarian reserve is impaired in cancer patients with normal baseline FSH who previously received chemotherapy as determined by response to controlled ovarian stimulation and anti-mullerian hormone measurements: A controlled study. Fertil Steril. 2006;86(3):S123–S124. (Suppl 2)

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