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Carroll BR, Zheng Y, Ruddy KJ, Emmons KM, Partridge AH, Rosenberg SM. Satisfaction with Care and Attention to Age-Specific Concerns by Race and Ethnicity in a National Sample of Young Women with Breast Cancer. J Adolesc Young Adult Oncol 2024; 13:105-111. [PMID: 37594766 PMCID: PMC10877381 DOI: 10.1089/jayao.2023.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: In light of disparities in breast cancer care and outcomes, we explored whether attention to fertility, genetic, and emotional health concerns, as well as satisfaction with care, differs by race/ethnicity among young breast cancer patients. Methods: The Young and Strong Study was a cluster randomized trial of an intervention for patients and providers at 54 U.S. oncology practices enrolling women diagnosed with breast cancer at ≤45 years of age. Provider attention to fertility, genetics, and emotional health was evaluated by medical record review. The proportions of patients with attention to these concerns were compared by race/ethnicity (Hispanic, non-Hispanic Black [NHB], Asian, non-Hispanic White [NHW], or multiracial/other). Satisfaction with care was assessed with the Patient Satisfaction Questionnaire-18 (PSQ-18) at 3 months, with median scores for each of 7 PSQ-18 subscales (general satisfaction, interpersonal manner, communication, financial, time spent with doctor, accessibility, and technical quality) compared by race/ethnicity. Results: Among 465 patients, median age at diagnosis was 40; 6% were Hispanic, 11% NHB, 4% were Asian, 75% NHW, and 3% multiracial/other. Provider attention to genetics, emotional health, and fertility did not differ by race/ethnicity. Median PSQ-18 scores did not differ by race/ethnicity, with median subscale scores ranging from 3.0 to 4.5 across groups, indicating high levels of satisfaction. Conclusion: Satisfaction with care and provider attention to age-specific concerns were similar across racial/ethnic groups among young patients enrolled in an educational and supportive care intervention study. These data suggest that high-quality, equitable care is feasible. Further care delivery research is warranted in more diverse patient and practice settings. Clinical Trial Registration number: NCT01647607.
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Affiliation(s)
- Bridget Rose Carroll
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts, USA
| | - Yue Zheng
- Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ann H. Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shoshana M. Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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de Kermadec E, Zheng Y, Rosenberg S, Ruddy KJ, Ligibel JA, Emmons KM, Partridge AH. Fertility concerns and treatment decision-making among national sample of young women with breast cancer. Cancer Med 2024; 13:e6838. [PMID: 38131887 PMCID: PMC10807590 DOI: 10.1002/cam4.6838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Diagnosis of breast cancer in young women has been shown to affect their decision-making with regard to fertility and family planning. Limited data are available from populations across the U.S. regarding this issue; thus, we sought to describe fertility concerns and efforts to preserve fertility in a national clinical trial population of young breast cancer patients. METHODS The young and strong study was a cluster-randomized controlled trial testing an intervention program for young women with breast cancer. Patients were surveyed within 3 months after diagnosis and at 3, 6, and 12 months after. Surveys asked about sociodemographics, psychosocial domains, fertility concerns, and fertility preservation strategies. Univariable and multivariable models were used to investigate sociodemographic, clinical, and psychosocial predictors of fertility concerns. RESULTS Of 467 women from 54 clinical sites across the U.S. (14 academic, 40 community), 419 were evaluable regarding fertility concerns. Median age was 40 years (range 22-45), 11% were Black, 6% Hispanic, and 75% had children. Tumor stage was I (35%), II (51%), or III (14%); 82% received chemotherapy. At time of the treatment decision, 133 (32%) participants had fertility concerns, among whom 47% indicated this affected their treatment decisions. Sixty percent of participants reported having discussed fertility with their physician. Twenty percent of those with fertility concerns used fertility preservation strategies. History of difficulty becoming pregnant and younger age were associated with higher odds of fertility concerns in multivariable modeling. CONCLUSION Many young women with newly diagnosed breast cancer are concerned about fertility in a way that impacts their treatment decisions. Concerns were discussed, but few used fertility preservation strategies. These findings have implications for counseling young patients.
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Affiliation(s)
- Elisabeth de Kermadec
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Present address:
SanofiCambridgeMassachusettsUSA
| | - Yue Zheng
- Data ScienceDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Shoshana Rosenberg
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Present address:
Weill Cornell MedicineNew YorkNew YorkUSA
| | | | - Jennifer A. Ligibel
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Karen M. Emmons
- Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ann H. Partridge
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Pathak S, Vadaparampil ST, Sutter ME, Rice WS, McBride CM. Evaluating fertility preservation interventions for alignment with ASCO Guidelines for reproductive aged women undergoing cancer treatment: a systematic review. Support Care Cancer 2023; 31:689. [PMID: 37950073 PMCID: PMC10638151 DOI: 10.1007/s00520-023-08133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework. METHODS We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability. RESULTS Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders' views. All interventions were implemented in real-world contexts, and only three discussed sustainability. CONCLUSIONS This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.
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Affiliation(s)
- Sarita Pathak
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Megan E Sutter
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Whitney S Rice
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Lambertini M, Kim HJ, Poorvu P. Editorial: Breast Cancer in Young Women: Dedicated Research Efforts Are Needed. Front Oncol 2022; 12:913167. [PMID: 35719912 PMCID: PMC9198590 DOI: 10.3389/fonc.2022.913167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy,Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy,*Correspondence: Matteo Lambertini,
| | - Hee Jeong Kim
- Department of Surgery, College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philip Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston MA, United States
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Carmona C, Warner E. ASO Author Reflections: Referring Young Breast Cancer Patients for Fertility Preservation: Significant Progress but Still Room for Improvement. Ann Surg Oncol 2022; 29:3034-3035. [PMID: 34989939 DOI: 10.1245/s10434-021-11288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Carlos Carmona
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Ellen Warner
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
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Carmona CA, Yee S, Seminsky M, Glass K, Foong S, Lipson E, Baxter NN, Friedenreich CM, Metcalfe K, Isherwood S, Akbari MR, Narod S, Quan ML, Warner E. Surgeon and Patient Reports of Fertility Preservation Referral and Uptake in a Prospective, Pan-Canadian Study of Young Women with Breast Cancer. Ann Surg Oncol 2022; 29:3022-3033. [DOI: 10.1245/s10434-021-11254-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 01/23/2023]
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Sella T, Snow C, Freeman H, Poorvu PD, Rosenberg SM, Partridge AH. Young, Empowered and Strong: A Web-Based Education and Supportive Care Intervention for Young Women With Breast Cancer Across the Care Continuum. JCO Clin Cancer Inform 2021; 5:933-943. [PMID: 34473546 DOI: 10.1200/cci.21.00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic. METHODS Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome-based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview. RESULTS Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms. CONCLUSION YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.
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Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Craig Snow
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Philip D Poorvu
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Cook EE, Rosenberg SM, Ruddy KJ, Barry WT, Greaney M, Ligibel J, Sprunck-Harrild K, Holmes MD, Tamimi RM, Emmons KM, Partridge AH. Prospective evaluation of the impact of stress, anxiety, and depression on household income among young women with early breast cancer from the Young and Strong trial. BMC Public Health 2020; 20:1514. [PMID: 33023562 PMCID: PMC7541223 DOI: 10.1186/s12889-020-09562-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Young women with breast cancer tend to report lower quality of life and higher levels of stress than older women with breast cancer, and this may have implications for other psychosocial factors including finances. We sought to determine if stress, anxiety, and depression at diagnosis were associated with changes in household income over 12-months in young women with breast cancer in the United States. Methods This study was a prospective, longitudinal cohort study comprised of women enrolled in the Young and Strong trial. Of the 467 women aged 18–45 newly diagnosed with early-stage breast cancer enrolled in the Young and Strong trial from 2012 to 2013, 356 (76%) answered income questions. Change in household income from baseline to 12 months was assessed and women were categorized as having lost, gained, maintained the same household income <$100,000, or maintained household income ≥$100,000. Patient-reported stress, anxiety, and depression were assessed close to diagnosis at trial enrollment. Adjusted multinomial logistic regression models were used to compare women who lost, gained, or maintained household income ≥$100,000 to women who maintained the same household income <$100,000. Results Although most women maintained household income ≥$100,000 (37.1%) or the same household income <$100,000 (32.3%), 15.4% lost household income and 15.2% gained household income. Stress, anxiety, and depression were not associated with gaining or losing household income compared to women maintaining household incomes <$100,000. Women with household incomes <$50,000 had a higher risk of losing household income compared to women with household incomes ≥$50,000. Women who maintained household incomes ≥$100,000 were less likely to report financial or insurance problems. Among women who lost household income, 56% reported financial problems and 20% reported insurance problems at 12 months. Conclusions Baseline stress, anxiety, and depression were not associated with household income changes for young women with breast cancer. However, lower baseline household income was associated with losing household income. Some young survivors encounter financial and insurance problems in the first year after diagnosis, and further support for these women should be considered. Trial registration Clinicaltrials.gov, NCT01647607; date registered: July 23, 2012.
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Affiliation(s)
- Erin E Cook
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Current affiliation: Analysis Group, Inc., Boston, MA, USA
| | - Shoshana M Rosenberg
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | | | - William T Barry
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Jennifer Ligibel
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Kim Sprunck-Harrild
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | - Rulla M Tamimi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, Boston, MA, USA.
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Warner E, Glass K, Foong S, Sandwith E. Update on fertility preservation for younger women with breast cancer. CMAJ 2020; 192:E1003-E1009. [PMID: 32868272 PMCID: PMC7458684 DOI: 10.1503/cmaj.200245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ellen Warner
- Divisions of Medical Oncology (Warner) and Obstetrics/Gynecology (Glass), Sunnybrook Odette Cancer Centre; CReATe Fertility Centre (Glass); University of Toronto (Warner, Glass), Toronto, Ont.; Regional Fertility Program (Foong); University of Calgary (Foong, Sandwith), Calgary, Alta.
| | - Karen Glass
- Divisions of Medical Oncology (Warner) and Obstetrics/Gynecology (Glass), Sunnybrook Odette Cancer Centre; CReATe Fertility Centre (Glass); University of Toronto (Warner, Glass), Toronto, Ont.; Regional Fertility Program (Foong); University of Calgary (Foong, Sandwith), Calgary, Alta
| | - Shu Foong
- Divisions of Medical Oncology (Warner) and Obstetrics/Gynecology (Glass), Sunnybrook Odette Cancer Centre; CReATe Fertility Centre (Glass); University of Toronto (Warner, Glass), Toronto, Ont.; Regional Fertility Program (Foong); University of Calgary (Foong, Sandwith), Calgary, Alta
| | - Emily Sandwith
- Divisions of Medical Oncology (Warner) and Obstetrics/Gynecology (Glass), Sunnybrook Odette Cancer Centre; CReATe Fertility Centre (Glass); University of Toronto (Warner, Glass), Toronto, Ont.; Regional Fertility Program (Foong); University of Calgary (Foong, Sandwith), Calgary, Alta
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Warner E, Yee S, Seminsky M, Glass K, Foong S, Kennedy E, Narod S, Quan ML. Effect of a Knowledge-Translation Intervention on Breast Surgeons’ Oncofertility Attitudes and Practices. Ann Surg Oncol 2019; 27:1645-1652. [DOI: 10.1245/s10434-019-07972-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 12/14/2022]
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