Fertility preservation in women undergoing treatment for breast cancer in the UK: a questionnaire study

Abstract

Objective: Fertility preservation is an important survivorship issue for women treated for breast cancer. The aim of this work was to examine the referral practices of health care professionals who treat women with breast cancer in the United Kingdom, and to investigate their understanding and knowledge of the fertility preservation options available.

Method: An invitation to participate in a confidential, online questionnaire was e-mailed to surgeons, oncologists, and clinical nurse specialists who manage patients with breast cancer in the United Kingdom.

Results: n = 306 respondents. Factors which influenced whether fertility preservation options were discussed with a patient included the following: patient's age (78%), final tumor/nodes/metastasis status (37.9%); concern that fertility preservation would delay chemotherapy (37.3%); whether the patient had children (33.5%) or a partner (24.7%); estrogen receptor expression (22.6%), lack of knowledge regarding the available options (20.9%); and concern that fertility preservation would compromise the success of cancer treatment (19.8%). Twenty-seven percent did not know whether fertility preservation was available for their patients on the National Health Service. Nearly half (49.4%) of respondents said that gonadotropin-releasing hormone agonists were used for fertility preservation outside the setting of a clinical trial. Knowledge regarding the available options varied according to different members of the multidisciplinary team, with consultant oncologists better informed than consultant surgeons or clinical nurse specialists (p < .05).

Conclusions: Many health care professionals have incomplete knowledge regarding the local arrangements for fertility preservation for patients with breast cancer. This may result in patients receiving inadequate or conflicting information regarding fertility preservation.

Figure 1.

Respondent characteristics. A: Occupation. Figures indicate number of respondents. Clinical nurse specialists are key workers who are involved with breast cancer patients from the time of diagnosis onward. Research nurses are key workers for patients enrolled in clinical trails. Consultant = attending equivalent. SpR/SAS grades are approximately equivalent to that of resident. Clinical oncologist = radiation oncologist. B: The region where respondents worked (figures indicate number of respondents). Abbreviations: SAS, staff and associate specialist grade; SpR, registrar.

Figure 2.

“Who discusses fertility preservation with breast cancer patients? Tick all that apply. ” Figures indicate the percentage of respondents who reported that, for example, the CNS discussed fertility preservation with patients. Abbreviations: Clin Onc, clinical oncologist; CNS, clinical nurse specialist; GP, general practitioner; Med Onc, medical oncologist.

Figure 3.

Fertility options available locally. A: “Are GnRH agonists offered for fertility preservation?” B: “Does your local fertility preservation unit provide services for cancer patients on the NHS?” Abbreviations: GnRH, gonadotropin-releasing hormone; NHS, National Health Service; PCT, Primary Care Trust.