Factors Associated With the Discussion of Fertility Preservation in a Cohort of 1,357 Young Breast Cancer Patients Receiving Chemotherapy

Abstract

Purpose: Female 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 methods: We 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.

Results: The 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.

Conclusion: FP 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.

Keywords: breast cancer; chemotherapy; discussion; fertility preservation; oncofertility.

Figure 1

Factors associated with the likelihood of FP Discussion. (A) Age at BC diagnosis; (B): BMI; (C) Patient with children at the time of diagnosis; (D) Year of diagnosis; (E) Clinical stage (TNM); (F) Neoadjuvant chemotherapy; (G) MCA for fertility preservation discussion*. *The red ellipse represents the concentration of people who had no discussion about fertility preservation, whereas the blue ellipse represents the concentration of people who discussed fertility preservation with a physician.

Figure 2

Factors associated with fertility preservation Discussion. (A) Doctors’ specialty; (B) Doctors’ age; (C) Doctors’ sex; (D) Treatment Center; (E) MCA with FP discussion*. (E) The red ellipse represents the concentration of patients who did have discussion about fertility preservation, whereas the blue ellipse represents the concentration of patients who discussed fertility preservation with a physician.

Figure 3

Factors associated with fertility preservation procedures. (A) Age at diagnosis; (B) Children; (C) Neoadjuvant chemotherapy; (D) MCA for fertility preservation procedures*. *The red ellipse represents the concentration of patients who did not undergo fertility preservation procedures, whereas the blue ellipse represents the concentration of patients who underwent fertility preservation procedures.