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Loubersac S, Chaillot M, Reignier A, Lefebvre T, Dezellus A, Colombel A, Barriere P, Masson D, Freour T. Serum androgen dynamics in young women aged 18-40 treated with chemotherapy for breast cancer: an observational, multicentric, prospective study in France. HUM FERTIL 2024; 27:2350758. [PMID: 38957151 DOI: 10.1080/14647273.2024.2350758] [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: 04/26/2022] [Accepted: 04/24/2024] [Indexed: 07/04/2024]
Abstract
Although the deleterious impact of chemotherapy regimen used to treat women of reproductive age with breast cancer on ovarian reserve has been extensively studied, hardly anything has been reported on the effect of these protocols on theca cell function and ovarian androgen secretion. The aim of this prospective multicentric cohort study was to describe serum levels of total testosterone and androstenedione during chemotherapy and 24-month follow-up in 250 patients <40 years treated for breast cancer. Mean basal levels of androstenedione and total testosterone at diagnosis were 1.68 ng/mL and 0.20 ng/mL respectively. No correlation with age was found. Serum levels of androstenedione and total testosterone rapidly decreased after chemotherapy completion, before slowly increasing and almost returning to basal levels in all patients during 2-year follow-up. In conclusion our study demonstrates a chemotherapy-induced alteration of ovarian thecal function, resulting in a significant decrease in serum androgen levels. This alteration of theca cell function adds to the well-known alteration of granulosa cell function, resulting in a global, but partly transient, ovarian failure in young women treated for breast cancer. These data bring new insight into ovarian physiology and emphasize the need for pre and post-treatment ovarian follow-up. Trial registration: ClinicalTrial.gov identifier NCT01114464.
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Affiliation(s)
- S Loubersac
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
| | - M Chaillot
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
- Faculté de médecine, Université de Nantes, Nantes, France
| | - A Reignier
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
- Faculté de médecine, Université de Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Université de Nantes, Nantes, France
| | - T Lefebvre
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
- Faculté de médecine, Université de Nantes, Nantes, France
| | - A Dezellus
- Service d'oncologie, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - A Colombel
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
| | - P Barriere
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
- Faculté de médecine, Université de Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Université de Nantes, Nantes, France
| | - D Masson
- Faculté de médecine, Université de Nantes, Nantes, France
- Laboratoire de biochimie, CHU de Nantes, place Alexis-Ricordeau, Nantes, France
- INSERM UMR 913, rue Gaston Veil, Nantes, France
| | - T Freour
- Service de médecine et biologie du développement et de la reproduction, CHU de Nantes, Bd Jean Monnet, Nantes, France
- Faculté de médecine, Université de Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Université de Nantes, Nantes, France
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Helgadottir H, Matikas A, Fernebro J, Frödin JE, Ekman S, Rodriguez-Wallberg KA. Fertility and reproductive concerns related to the new generation of cancer drugs and the clinical implication for young individuals undergoing treatments for solid tumors. Eur J Cancer 2024; 202:114010. [PMID: 38520926 DOI: 10.1016/j.ejca.2024.114010] [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: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
The treatment landscape of solid tumors has changed markedly in the last years. Molecularly targeted treatments and immunotherapies have been implemented and have, in many cancers, lowered the risk of relapse and prolonged survival. Patients with tumors harboring specific targetable molecular alterations or mutations are often of a younger age, and hence future fertility and family building can be important concerns in this group. However, there are great uncertainties regarding the effect of the new drugs on reproductive functions, including fertility, pregnancy and lactation and how young patients with cancers, both women and men should be advised. The goal with this review is to gather the current knowledge regarding oncofertility and the different novel therapies, including immune checkpoint inhibitors, antibody-drug conjugates, small molecules and monoclonal antibody targeted therapies. The specific circumstances and reproductive concerns in different patient groups where novel treatments have been broadly introduced are also discussed, including those with melanoma, lung, breast, colorectal and gynecological cancers. It is clear, that more awareness is needed regarding potential drug toxicity on reproductive tissues, and it is of essence that individuals are informed based on current expertise and on available fertility preservation methods.
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Affiliation(s)
- Hildur Helgadottir
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Skin Cancer Centrum, Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Alexios Matikas
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Breast Center, Karolinska Comprehensive Cancer Center and Karolinska University Hospital, Stockholm, Sweden
| | - Josefin Fernebro
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Division of Gynecological Cancer, Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jan-Erik Frödin
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Division of Gastrointestinal Oncology, Department of Upper abdomen, Karolinska University Hospital, Sweden
| | - Simon Ekman
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction Karolinska University Hospital, Stockholm, Sweden
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Charpentier P, Cavalieri M, Desmoulins I, Coutant C. [Live birth rates after breast cancer among women who desired a child]. Bull Cancer 2024; 111:463-472. [PMID: 38580527 DOI: 10.1016/j.bulcan.2024.02.005] [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: 10/28/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION In France, the breast cancer is the most common cancer among women under the age of 40. From 38 to 70% of women have not fulfilled their parental plans at the time of diagnosis. The gonadotoxicity of the treatments and the follicular physiological decline linked to age can become an obstacle to this project. METHODS Among the patients, 386 were treated for breast cancer at the Centre Georges-François-Leclerc in Dijon between January 2011 and December 2018 were identified. 192 patients aged under 39 met the inclusion criteria. We excluded metastatic cancers, cancer in situ and pregnant patients at diagnosis. A total of 124 patients agreed to participate in the study. The included patients filled out a self-questionnaire. Data were collected from the patient's electronic medical. The primary endpoint of this study was the live birth rate. RESULT Among women who desired a child after breast cancer, the overall rate of live births was 36.2 % (21/58). Most achieved pregnancies were spontaneous (90.5 %). No factor was significantly associated with the absence of obtaining birth. Fertility was preserved by oocyte cryopreservation in 13.8 % of patients (17/124). The median time to conception in patients who received chemotherapy was 8 months [1.0-60.0] vs 2 months [1.0-7.0] in women who did not receive chemotherapy. DISCUSSION The non-negligible proportion of live births following spontaneous pregnancy after breast cancer allows us to be reassuring for patients. However, the emergence of new chemotherapy protocols whose consequences on long-term gonadotoxicity are still not well known requires further studies and prompts the promotion of fertility preservation as a precautionary measure.
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Affiliation(s)
- Pauline Charpentier
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU François-Mitterrand, Cote d'Or, Dijon, France.
| | - Mathilde Cavalieri
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU François-Mitterrand, Cote d'Or, Dijon, France
| | - Isabelle Desmoulins
- Centre Francois-Leclerc, 1, rue du Professeur-Marion, Cote d'Or, 21000 France
| | - Charles Coutant
- Centre Francois-Leclerc, 1, rue du Professeur-Marion, Cote d'Or, 21000 France
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Kipling LM, Shandley LM, Mertens AC, Spencer JB, Howards PP. The use of fertility treatments among reproductive-aged women after cancer. Fertil Steril 2023:S0015-0282(23)02079-4. [PMID: 38103881 DOI: 10.1016/j.fertnstert.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine whether female cancer survivors are more likely to pursue care for infertility after cancer than women without cancer. DESIGN Population-based cohort study involving detailed interviews regarding reproductive history. SETTING Not applicable. PATIENTS Female cancer survivors aged 22-45 years, who were at least 2 years after a cancer diagnosis between the ages of 20 and 35 years (n = 1,036), and age-matched comparison women with no cancer history (n = 1,026). EXPOSURE History of cancer vs. no history of cancer. MAIN OUTCOME MEASURE(S) Each cancer survivor was randomly matched to a comparison woman, who was assigned an artificial age at cancer diagnosis equal to that of her match. Matching was repeated 1,000 times. Outcomes of visiting a doctor for help becoming pregnant or undergoing fertility treatment were modeled using Cox proportional hazards regression, comparing survivors after a cancer diagnosis to age-matched comparison women, adjusted for race, income, residence, education, and parity. RESULTS Only 25.5% of cancer survivors reported meeting their desired family size before a cancer diagnosis. The median time from diagnosis to interview among survivors was 7 (interquartile range 5-11) years. Cancer survivors were more likely to report having no children (32.6%) at the interview compared with women with no cancer history (19.5%). Survivors were not more likely to visit a doctor for help becoming pregnant compared with women without a cancer history, matched on birth year and followed by the age at which cancer survivors received their diagnosis (hazard ratio [HR] 1.16, 95% simulation interval [SI] 0.78-1.74). Compared with cancer-free women, cancer survivors had similar probabilities of pursuing any treatment (adjusted HR [aHR] 0.88, 95% SI 0.46-1.56), using hormones or medications (aHR 0.86, 95% SI 0.46-1.63), or undergoing intrauterine insemination (aHR 1.26, 95% SI 0.40-5.88) to conceive. Cancer survivors were slightly more likely to pursue surgical interventions to become pregnant (HR 1.55, 95% SI 0.67-3.71). Of those who visited a doctor but declined to pursue fertility treatment, one-quarter of women reported declining treatment due to cost. CONCLUSION Cancer survivors did not use fertility treatments at higher rates than the general population. Further counseling and education surrounding fertility options are recommended for young adult female cancer patients after treatment is completed.
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Affiliation(s)
- Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Ann C Mertens
- Department of Pediatrics, Aflac Cancer Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Ahn J, Han J. The lived experiences of pregnancy planning after breast cancer in women of childbearing age: A phenomenological study. Asia Pac J Oncol Nurs 2023; 10:100276. [PMID: 37661963 PMCID: PMC10471927 DOI: 10.1016/j.apjon.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023] Open
Abstract
Objective This phenomenological study aimed to explore the lived experiences of planning for pregnancy after breast cancer in women of childbearing age. Methods The study comprised 15 women with breast cancer who were considering pregnancy and childbirth. Individual in-depth interviews were conducted between November 2022 and March 2023, and the verbatim transcripts were analyzed using Colaizzi's phenomenological method. Results Four theme clusters emerged: (1) deepening desires amidst hardships, (2) endless worries about an uncertain future, (3) unveiling the meaning of having a child, and (4) perpetual deliberations regarding unresolved dilemmas. Over time, the participants' longing for children intensified, despite the contradiction of their reduced fertility. They expressed concerns about the potential risks and challenges of pregnancy in breast cancer patients, but they attributed value to having a child as a means to restoring their health, reclaiming their ordinary lives, and providing motivation for a healthier future. The participants found making decisions regarding pregnancy to be difficult and were often influenced by others. Conclusions This study underscores the unique challenges faced by women with breast cancer who are making fertility-related decisions. The findings contribute to a better understanding of these challenges and offer valuable insights for the development of decision aids that support shared decision-making for pregnancy after breast cancer.
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Affiliation(s)
- Jeonghee Ahn
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeehee Han
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
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Abraham M, Lak MA, Gurz D, Nolasco FOM, Kondraju PK, Iqbal J. A Narrative Review of Breastfeeding and Its Correlation With Breast Cancer: Current Understanding and Outcomes. Cureus 2023; 15:e44081. [PMID: 37750138 PMCID: PMC10518059 DOI: 10.7759/cureus.44081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Breastfeeding has been extensively studied in relation to breast cancer risk. The results of the reviewed studies consistently show a decreased risk of breast cancer associated with breastfeeding, especially for 12 months or longer. This protective effect is attributed to hormonal, immunological, and physiological changes during lactation. Breastfeeding also appears to have a greater impact on reducing breast cancer risk in premenopausal women and specific breast cancer subtypes. Encouraging breastfeeding has dual benefits: benefiting infants and reducing breast cancer risk long-term. Healthcare professionals should provide evidence-based guidance on breastfeeding initiation, duration, and exclusivity, while public health policies should support breastfeeding by creating enabling environments. This review examines the existing literature and analyzes the correlation between breastfeeding and breast cancer risk.
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Affiliation(s)
- Merin Abraham
- Department of Internal Medicine, Kasturba Medical College, Manipal, IND
| | - Muhammad Ali Lak
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Danyel Gurz
- Department of Internal Medicine, Combined Military Hospital, Lahore, PAK
| | | | | | - Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
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7
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Pesce C. Donor Egg, Surrogacy, and Adoption for Breast Cancer Survivors. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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8
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Reproductive Outcomes in Young Breast Cancer Survivors Treated (15-39) in Ontario, Canada. Curr Oncol 2022; 29:8591-8599. [PMID: 36421330 PMCID: PMC9689574 DOI: 10.3390/curroncol29110677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
We conducted a population-based, retrospective, matched-cohort study to examine the impact of breast cancer diagnosis and treatment on fertility outcomes. Relative risks of infertility, childbirth, premature ovarian insufficiency (POI; age < 40) and early menopause (age < 45) were calculated using modified Poisson regression. Our primary cohort included young women (15-39) with early stage BC diagnosed 1995-2014. Five cancer-free patients were matched to each BC patient by birth year and census subdivision. The BC cohort was further divided by treatment with chemotherapy vs. no chemotherapy treatment. 3903 BC patients and 19,515 cancer-free women. BC patients treated with chemotherapy were at increased risk of infertility (RR 1.81; 95% CI 1.60-2.04), and POI (RR 6.25; 95% CI 5.15-7.58) and decreased childbirth (RR 0.85; 95% CI 0.75-0.96), compared to women without cancer. BC patients who did not receive chemotherapy were also at increased risk of infertility (RR 1.80 95% CI 1.48-2.18) and POI (RR 2.12 95% CI 1.37-3.28). All young BC survivors face an increased risk of diagnosed infertility and POI relative to women without cancer, independent of chemotherapy. These results emphasize the importance of pre-treatment fertility counselling for young women diagnosed with BC.
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Sparidaens EM, Beerendonk CCM, Fleischer K, Nelen WLDM, Braat DDM, Hermens RPMG. Exploration of fertility and early menopause related information needs and development of online information for young breast cancer survivors. BMC Womens Health 2022; 22:329. [PMID: 35922784 PMCID: PMC9351061 DOI: 10.1186/s12905-022-01901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately half of premenopausal women diagnosed with breast cancer desire to conceive after they finish treatment. Counseling about the risk of infertility prior to cancer treatment has been proven to improve quality of life after cancer treatment. As a result of this, guidelines focus on informing women on this topic prior to treatment. However, it is equally important to provide fertility related information after primary treatment has been completed, when the wish to conceive might become actual. Therefore, the aim of this study was to identify the fertility and early menopause related information needs of young breast cancer survivors and to design, develop and implement online information material with input of stakeholders. METHODS A phenomenological qualitative study consisting of four phases was performed: identification of information needs through semi-structured interviews from a professional perspective (1) and a patient perspective (2). Exploration of stakeholders perspective regarding development and implementation of online information material (3) and development and implementation of the information material (4). RESULTS Professionals indicated that there are no guidelines regarding the provision of fertility related information during cancer survivorship. Survivors reported unmet information needs. Women identified the following as most important information needs (a) fertility preservation options, (b) the risk of menopause or infertility, and (c) long term consequences of early menopause. A wide range of stakeholders involved in breast cancer care were interviewed. Based on their proposed design the information material was implemented on a nationwide website aiming at informing and supporting breast cancer patients. CONCLUSIONS Fertility and early menopause related information needs of young breast cancer survivors and their professionals were identified. Information material has been designed, developed and nationally implemented. This way, professionals in breast cancer care are provided with an information tool that helps them meet the information needs and preferences of their patients.
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Affiliation(s)
- Ellen Marie Sparidaens
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands.
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Kathrin Fleischer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
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Hours A, Toussaint A, De Castelbajac V, Sautter C, Borghese J, Frank S, Coussy F, Laas E, Grandal B, Dumas E, Daoud E, Guerin J, Balezeau T, Feron JG, Fourchotte V, Kirova Y, Lerebours F, Pierga JY, Guillot E, Santulli P, Grynberg M, Sonigo C, Reyrat E, Soibinet-Oudot P, Reyal F, Hamy AS. Factors Associated With the Discussion of Fertility Preservation in a Cohort of 1,357 Young Breast Cancer Patients Receiving Chemotherapy. Front Oncol 2021; 11:701620. [PMID: 34650912 PMCID: PMC8507557 DOI: 10.3389/fonc.2021.701620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Alice Hours
- Department of Surgery, Institut Curie, University Paris, Paris, France
| | - Aullene Toussaint
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Victoire De Castelbajac
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
- Sénopole Hôpital Saint Louis, Assistance Publique - Hôpitaux de Paris, University Paris, Paris, France
| | - Camille Sautter
- Department of Surgery, Institut Curie, University Paris, Paris, France
| | - Julie Borghese
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Sophie Frank
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Enora Laas
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Eric Daoud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | | | | | | | | | - Youlia Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - Florence Lerebours
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Jean-Yves Pierga
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Eugénie Guillot
- Department of Surgery, Institut Curie, University Paris, Paris, France
| | - Pietro Santulli
- Department of Obstetrics and Gynecology, Hôpital Cochin, University Paris, Paris, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart, France
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Emmanuel Reyrat
- Department of Data and Informatics, Unicancer, Paris, France
| | | | - Fabien Reyal
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Anne-Sophie Hamy
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
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Bajpai J, Majumdar A, Satwik R, Rohatgi N, Jain V, Gupta D, Agarwal R, Mittal S, Verma SK, Parikh PM, Aggarwal S. Practical consensus recommendations on fertility preservation in patients with breast cancer. South Asian J Cancer 2020; 7:110-114. [PMID: 29721475 PMCID: PMC5909286 DOI: 10.4103/sajc.sajc_113_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Majumdar
- Center of IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi, India
| | - R Satwik
- Center of IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi, India
| | - N Rohatgi
- Department of Medical Oncology, Max Saket Hospital, New Delhi, India
| | - V Jain
- Department of Gynaecology and Obstretics, Ludhiana Medicity Hospital, Ludhiana, Punjab, India
| | - D Gupta
- Department of Medical Oncology, Dharamshila Cancer Hospital, New Delhi, India
| | - R Agarwal
- Department of Surgical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | - S Mittal
- Department of Medical Oncology, Action Balajee Cancer Center, New Delhi, India
| | - S K Verma
- Department of Medical Oncology, Jolly Grant Himalayan Institute, Dehradoon, Uttarakhand, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institutes, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Gangaram Hospital, New Delhi, India
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12
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Moftakhar B, Vitek W, Huston A. Impact of Breast Cancer Systemic Therapies on Fertility. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Crown A, Muhsen S, Zabor EC, Sevilimedu V, Kelvin J, Goldfarb SB, Gemignani ML. Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer? Ann Surg Oncol 2020; 27:4740-4749. [PMID: 32767225 PMCID: PMC7554118 DOI: 10.1245/s10434-020-08883-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/23/2020] [Indexed: 01/04/2023]
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 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.
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Affiliation(s)
- Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirin Muhsen
- Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon
| | - Emily C Zabor
- Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne Kelvin
- Department of Medicine, Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shari B Goldfarb
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Primary and Secondary Markers of Doxorubicin-Induced Female Infertility and the Alleviative Properties of Quercetin and Vitamin E in a Rat Model. Reprod Toxicol 2020; 96:316-326. [PMID: 32810592 DOI: 10.1016/j.reprotox.2020.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022]
Abstract
The incidence of cancer has recently risen among the women at the reproductive age. Therefore, exposure to doxorubicin (DOX) chemotherapy has become a cause of reproductive toxicity followed by secondary destructive effects. The present study aimed to evaluate the effects of quercetin (QCT) and vitamin.E (Vit.E) on doxorubicin-induced toxicity in the ovary and uterus, and the secondary bone-related effects in a rat model. Animals were divided into six groups including control normal saline/corn oil (CON), QCT at 20 mg/Kg, Vit.E at 200 mg/Kg, DOX at accumulative 15 mg/Kg, DOX/QCT, and DOX/Vit.E. After 21 days of treatment, the alterations were analyzed in histoarchitecture, apoptosis, hormones secretion, the gene expression of aromatase and estrogen α-receptor (ER-α) in the uterine and ovarian tissues, and serum levels of bone-related factors. The results demonstrated the ameliorative effects of QCT and Vit.E on doxorubicin caused altered ovarian histology, increased apoptosis, decreased ovarian aromatase and ER-α gene expression (p-value<0.05), decreased estrogen and progesterone levels, decreased ALP (p-value<0.001), and increased osteocalcin (p-value<0.05). The findings suggested that the studied antioxidants administration could be a promising fertility preservation strategy in DOX-treated females.
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15
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Cairncross ZF, Nelson G, Shack L, Metcalfe A. Validation in Alberta of an administrative data algorithm to identify cancer recurrence. ACTA ACUST UNITED AC 2020; 27:e343-e346. [PMID: 32669943 DOI: 10.3747/co.27.5861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Readily available population-based data about cancer recurrence would improve surveillance and research for women of reproductive age. Methods We randomly selected 200 women from the Alberta Cancer Registry who had received a cancer diagnosis and who ever had a pregnancy between 2003 and 2012. Administrative data were obtained and linked. Several definitions of recurrence were assessed using various minimum lengths of time between the initial diagnosis date and subsequent diagnoses or treatments, or both. Chart review was used as a "gold standard" definition of recurrence. Results Chart review identified recurrences in 26 women. The definition that best captured "recurrence" was 2 or more cancer diagnosis codes 10 or more months from the diagnosis date [sensitivity: 80.8%; 95% confidence interval (ci): 60.7% to 93.5%; specificity: 81.0%; 95% ci: 74.4% to 86.6%; positive predictive value: 38.9%; 95% ci: 25.9% to 53.1%; negative predictive value: 96.6%; 95% ci: 92.2% to 98.9%; kappa = 0.42; 95% ci: 0.28 to 0.57]. Conclusions Recurrence in reproductive-aged women can be captured with moderate validity using administrative data, but should be interpreted with caution.
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Affiliation(s)
- Z F Cairncross
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
| | - G Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
| | - L Shack
- Cancer Research and Analytics, CancerControl Alberta, Alberta Health Services, Calgary, AB
| | - A Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
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16
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Speller B, Metcalfe K, Kennedy ED, Facey M, Greenblatt E, Scheer AS, Warner E, Joy AA, Wright FC, Baxter NN. The "Begin Exploring Fertility Options, Risks and Expectations" (BEFORE) decision aid: development and alpha testing of a fertility tool for premenopausal breast cancer patients. BMC Med Inform Decis Mak 2019; 19:203. [PMID: 31660965 PMCID: PMC6819618 DOI: 10.1186/s12911-019-0912-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 09/09/2019] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Premenopausal breast cancer patients are at risk of treatment-related infertility. Many patients do not receive sufficient fertility information before treatment. As such, our team developed and alpha tested the Begin Exploring Fertility Options, Risks, and Expectations decision aid (BEFORE DA). METHODS The BEFORE DA development process was guided by the International Patient Decision Aids Standards and the Ottawa Decision Support Framework. Our team used integrated knowledge translation by collaborating with multiple stakeholders throughout the development process including breast cancer survivors, multi-disciplinary health care providers (HCPs), advocates, and cancer organization representatives. Based on previously conducted literature reviews and a needs assessment by our team - we developed a paper prototype. The paper prototype was finalized at an engagement meeting with stakeholders and created into a graphically designed paper and mirrored online decision aid. Alpha testing was conducted with new and previously engaged stakeholders through a questionnaire, telephone interviews, or focus group. Iterative reviews followed each step in the development process to ensure a wide range of stakeholder input. RESULTS Our team developed an 18-page paper prototype containing information deemed valuable by stakeholders for fertility decision-making. The engagement meeting brought together 28 stakeholders to finalize the prototype. Alpha testing of the paper and online BEFORE DA occurred with 17 participants. Participants found the BEFORE DA usable, acceptable, and most provided enthusiastic support for its use with premenopausal breast cancer patients facing a fertility decision. Participants also identified areas for improvement including clarifying content/messages and modifying the design/photos. The final BEFORE DA is a 32-page paper and mirrored online decision aid ( https://fertilityaid.rethinkbreastcancer.com ). The BEFORE DA includes information on fertility, fertility options before/after treatment, values clarification, question list, next steps, glossary and reference list, and tailored information on the cost of fertility preservation and additional resources by geographic location. CONCLUSION The BEFORE DA, designed in collaboration with stakeholders, is a new tool for premenopausal breast cancer patients and HCPs to assist with fertility discussions and decision-making. The BEFORE DA helps to fill the information gap as it is a tool that HCPs can refer patients to for supplementary information surrounding fertility.
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Affiliation(s)
- Brittany Speller
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Erin D Kennedy
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Mount Sinai Health System, Toronto, Canada
| | - Marcia Facey
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Ellen Greenblatt
- Mount Sinai Fertility, Department of Obstetrics and Gynecology, Sinai Health System, Toronto, Ontario, Canada
| | - Adena S Scheer
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Ellen Warner
- Department of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anil Abraham Joy
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Frances C Wright
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Lee MH, Kim YA, Hong JH, Jung SY, Lee S, Kong SY, Park B, Lee ES. Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study. Cancer Res Treat 2019; 52:426-437. [PMID: 31476846 PMCID: PMC7176946 DOI: 10.4143/crt.2018.382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose The purpose of this study was to determine the rate and outcomes of pregnancies subsequent to breast cancer in Korea, and the effect of such pregnancies on the prognosis of women who survived breast cancer and subsequently conceived. Materials and Methods We followed a total of 31,761 Korean women 45 years of age or younger who were treated for primary breast cancer from 2002 to 2010. We also included follow-up surveys that were conducted through December 2011. We identified recurrence and mortality from breast cancer using data linked to the Korea National Health Insurance database. We used propensity score matching of the study cohort to analyze the risks of recurrence and mortality from breast cancer depending on pregnancy. Results Within our sample, 992 women (3.1%) became pregnant after receiving treatment for breast cancer. Of those, 622 (67.5%) successfully delivered; the remaining 370 (32.5%) failed to deliver. After propensity score matching, we found that the women who became pregnant after breast cancer did not have a different risk of recurrence (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.434 to 0.584) and death (HR, 0.520; 95% CI, 0.397 to 0.681), compared with those who did not conceive after breast cancer treatment. Conclusion Our study is the first to report outcomes for Korean women who survived breast cancer and subsequently conceived. Women who survived breast cancer and subsequently became pregnant did not show a poorer survival outcome, compared with those who did not become pregnant.
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Affiliation(s)
- Moo Hyun Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Division of Breast and Thyroid, Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Hyuk Hong
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, Center for Diagnostic Oncology, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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18
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Grossesse après cancer du sein : revue de la littérature. Presse Med 2019; 48:376-383. [DOI: 10.1016/j.lpm.2019.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 02/14/2017] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
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19
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Gálvez-Hernández CL, Ortega Mondragón A, Villarreal-Garza C, Ramos del Río B. Mujeres Jóvenes con Cáncer de Mama: Necesidades de Apoyo en Atención y Resiliencia. PSICOONCOLOGIA 2018. [DOI: 10.5209/psic.61436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antecedentes: las mujeres menores de 40 años con cáncer de mama (CaMa) presentan características bio-psico-sociales únicas que ameritan ser atendidas y estudiadas. Objetivo: evaluara) la percepción de necesidades de apoyo en la atención (NAT) insatisfechas y nivel de resiliencia,b) la diferencia de NAT entre pacientes en tratamiento y sobrevivientes y c) la relación entre NAT y resiliencia, y su asociación con variables clínicas y sociodemográficas, respectivamente. Método: se estudiaron transversalmente a 150 mujeres jóvenes con CaMa en tratamiento y sobrevivientes, con una encuesta de NAT y una de resiliencia mexicanas. Resultados: la mediana de edad de las participantes fue de 36 años. Las necesidades menos satisfechas fueron las de sistema de salud e información. El grupo de tratamiento presentó más NAT comparado con las sobrevivientes (p=0,005). Se encontró que cuanto más NAT insatisfechas (globales, psicológicas, cuidado y apoyo, e información), menores valores en los dominios de resiliencia (p<0,005) en ambos grupos y por separado. Conclusiones: las condiciones externas (infraestructura, servicios de salud proporcionados y apoyo en seguridad social), habilidades propias (auto-confianza, estructura y organización) y/o recursos de apoyo externo (social y familiar) pudieron contribuir a que las pacientes percibieran pocas NAT insatisfechas. Los resultados resaltan la relevancia clínica de implementar intervenciones basadas en resiliencia.
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20
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Lopresti M, Rizack T, Dizon DS. Sexuality, fertility and pregnancy following breast cancer treatment. Gland Surg 2018; 7:404-410. [PMID: 30175056 DOI: 10.21037/gs.2018.01.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For women facing a new diagnosis of breast cancer, treatments can result in changes to intimate issues, including sexual health. For women of reproductive age, other significant concerns include the potential impact on fertility and the safety of pregnancy after treatment. These issues are important to acknowledge and to address, as they can impact on quality of life, not only for the patient, but may impact relationships, both present and future. In this paper we review sexual health after cancer, the importance of proactively addressing fertility, and important issues related to pregnancy following breast cancer.
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Affiliation(s)
- Mary Lopresti
- Lifespan Cancer Institute, Providence, RI, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tina Rizack
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Don S Dizon
- Lifespan Cancer Institute, Providence, RI, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
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21
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Vriens IJH, De Bie AJR, Aarts MJB, de Boer M, van Hellemond IEG, Roijen JHE, van Golde RJT, Voogd AC, Tjan-Heijnen VCG. The correlation of age with chemotherapy-induced ovarian function failure in breast cancer patients. Oncotarget 2017; 8:11372-11379. [PMID: 28076330 PMCID: PMC5355271 DOI: 10.18632/oncotarget.14532] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/26/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the incidence of chemotherapy-induced ovarian function failure (COFF) based on estradiol and follicle stimulating hormone (FSH) monitoring in premenopausal women with hormone-receptor positive breast cancer treated with second and third generation (neo-)adjuvant chemotherapy. RESULTS We identified 115 eligible women. Two years after start of chemotherapy, COFF was significantly more often present in women ≥ 40 years (85.6%) as compared to women < 40 years (8.7%). Only age was significantly associated with COFF two years after start of chemotherapy (HR 12.26; 95% CI 5.21-28.86). In 50% of the patients, premenopausal hormone levels were the first or only evidence of ovarian function recovery (OFR). MATERIALS AND METHODS We included all premenopausal women with hormone-receptor positive breast cancer treated with anthracycline-based chemotherapy, with or without taxanes, in our university hospital in the Netherlands in the years 2005-2013. Patients were 3-monthly monitored for ovarian function. Cox proportional hazards model was used to determine the predictive impact of various parameters on the occurrence of COFF. CONCLUSIONS After second- or third generation (neo-)adjuvant chemotherapy, COFF was still present in 8.7% of patients < 40 years after two years. FSH and estradiol monitoring may be relevant for those in whom ovarian function suppression is considered an additional effective endocrine treatment.
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Affiliation(s)
- Ingeborg J H Vriens
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ashley J R De Bie
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maaike de Boer
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Irene E G van Hellemond
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joyce H E Roijen
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron J T van Golde
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Adri C Voogd
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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22
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Rosenberg SM, Gelber S, Gelber RD, Krop E, Korde LA, Pagani O, Partridge AH. Oncology Physicians' Perspectives on Practices and Barriers to Fertility Preservation and the Feasibility of a Prospective Study of Pregnancy After Breast Cancer. J Adolesc Young Adult Oncol 2017; 6:429-434. [PMID: 28686476 PMCID: PMC5649410 DOI: 10.1089/jayao.2017.0031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer) is a prospective clinical trial assessing safety and pregnancy outcomes in premenopausal hormone receptor-positive breast cancer survivors (age ≤42) who interrupt endocrine therapy (ET) to attempt pregnancy. We sought to assess interest in this study and perspectives on fertility preservation (FP) among United States medical oncologists who had previously enrolled women at their institutions on select premenopausal endocrine studies. METHODS From August 2015 to December 2015, 301 investigators were invited to complete a web-based survey on behalf of their institution. We assessed FP practices and attitudes, barriers to discussing FP, and willingness to open/enroll women on POSITIVE. RESULTS Of 93 respondents (31%), most were affiliated with an National Cancer Institute (NCI)-designated comprehensive cancer center (44%). Almost all said they usually or always discussed the issue of future fertility with patients (98%) and referred patients with fertility questions to specialists (97%). Over half of respondents cited discomfort with recommending women to stop ET, as well as perceived patient concern regarding ET interruption, as factors seen as influencing POSITIVE enrollment; however, 84% were willing to recommend trial participation for selected patients. CONCLUSIONS Most providers reported discussing fertility with their young patients, indicating awareness of FP guidelines for cancer patients. While most oncologists said that they would be willing to recommend POSITIVE, many also expressed discomfort in endorsing women to stop ET temporarily, underscoring the need for prospective data regarding the safety of ET interruption. High willingness to recommend POSITIVE suggests the potential for successful accrual to this study, which addresses a critical issue for young breast cancer survivors.
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Affiliation(s)
| | - Shari Gelber
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, Massachusetts
| | - Richard D. Gelber
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Boston, Massachusetts
| | - Ethan Krop
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, Massachusetts
| | - Larissa A. Korde
- Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Olivia Pagani
- Institute of Oncology and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - Ann H. Partridge
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, Massachusetts
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Roberts SC, Knight A, Whitcomb BW, Gorman JR, Dietz AC, Irene Su H. Validity of self-reported fertility-threatening cancer treatments in female young adult cancer survivors. J Cancer Surviv 2017; 11:517-523. [PMID: 28265843 PMCID: PMC5501745 DOI: 10.1007/s11764-017-0610-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Detailed cancer treatment information is important to fertility and pregnancy care of female young adult cancer survivors. Accuracy of self-report of treatments that impact fertility and pregnancy is unknown. This study assessed agreement between self-report and medical records on receipt of fertility-threatening treatments. METHODS A national cohort study of female young adult cancer survivors reported cancer treatments via Web-based questionnaires. Primary cancer treatment records were abstracted. Self-reported exposure to fertility-threatening therapies (alkylating chemotherapy, stem cell transplant, pelvic radiation, hysterectomy, and/or oophorectomy) was compared to medical records. Logistic regression models estimated odds ratios (OR) for characteristics associated with inaccurate self-report of fertility-threatening therapies. RESULTS The study included 101 survivors (mean age 28.2, SD 6.3). Lymphoma (33%), breast cancer (26%), and gynecologic cancers (10%) were the most common cancers. Accuracy of self-report was 68% for alkylating chemotherapy and 92-97% for radiation, surgery, and transplant. Significant proportions of survivors who were treated with transplant (8/13, 62%), alkylating chemotherapy (18/43, 42%), pelvic radiation (4/13, 31%), or hysterectomy and/or oophorectomy (3/13, 23%) did not report undergoing these therapies. In adjusted analysis, age ≤ 25 at diagnosis (OR 3.4, 95% CI 1.3-8.7) and recurrence (OR 6.0, 95% CI 1.5-24.4) were related to inaccurate self-report. CONCLUSIONS Female young adult cancer survivors have limited recall of fertility-threatening cancer treatment exposures. Reproductive health providers and researchers who need this information may require primary medical records or treatment summaries. IMPLICATIONS FOR CANCER SURVIVORS Additional patient education regarding treatment-related reproductive risks is needed to facilitate patient engagement in survivorship. Obtaining a cancer treatment summary will help survivors communicate their prior treatment exposures to reproductive healthcare providers.
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Affiliation(s)
- Samantha C Roberts
- Department of Reproductive Medicine and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-090, USA
| | - Amber Knight
- Department of Reproductive Medicine and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-090, USA
| | - Brian W Whitcomb
- Division of Biostatistics and Epidemiology, University of Massachusetts Amherst, 408 Arnold House, 715 North Pleasant Street , University of Massachusetts, Amherst, MA, 01003-9304, USA
| | - Jessica R Gorman
- School of Social and Behavioral Health Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331, USA
| | - Andrew C Dietz
- Department of Pediatrics Division of Hematology/Oncology/BMT, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - H Irene Su
- Department of Reproductive Medicine and Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-090, USA.
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Nogueira LP, Alessio R, Mantuano A, Sena G, de Almeida CE, Tromba G, Almeida AP, Salata C, Colaço MVG, Braz D, Barroso RC. Synchrotron microtomography to evaluate effects of different polychemotherapy drugs on cortical bone structure. Int J Radiat Biol 2017; 93:726-733. [DOI: 10.1080/09553002.2017.1304591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Liebert P. Nogueira
- Physics Institute, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Rita Alessio
- Nuclear Engineering Program, COPPE/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Mantuano
- Physics Institute, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Gabriela Sena
- Nuclear Engineering Program, COPPE/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos E. de Almeida
- Radiological Sciences Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Camila Salata
- CNEN, National Nuclear Energy Commission, Rio de Janeiro, Brazil
| | - Marcos V. G. Colaço
- Physics Institute, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Delson Braz
- Nuclear Engineering Program, COPPE/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Regina C. Barroso
- Physics Institute, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Vu JV, Llarena NC, Estevez SL, Moravek MB, Jeruss JS. Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients. J Surg Oncol 2016; 115:116-121. [PMID: 27966219 DOI: 10.1002/jso.24418] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. METHODS An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007-2012, after program initiation. The study included women <45, stages 0-III, diagnosed before (n = 278) and after (n = 515) program initiation. RESULTS Demographics for the cohorts were similar. Fertility discussions (P < 0.0001), patients interested in maintaining fertility at diagnosis (P = 0.0041), referrals to reproductive endocrinologists (P < 0.0001), appointments (P < 0.0001), and fertility preservation procedures (P < 0.0183) increased significantly after programmatic implementation. CONCLUSIONS An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. J. Surg. Oncol. 2017;115:116-121. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Natalia C Llarena
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Jacqueline S Jeruss
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Guerreiro DD, Lima LFD, Rodrigues GQ, Carvalho ADA, Castro SV, Campello CC, Pessoa CDÓ, Gadelha CRF, Figueiredo JRD, Bordignon V, Rodrigues APR. In situ cultured preantral follicles is a useful model to evaluate the effect of anticancer drugs on caprine folliculogenesis. Microsc Res Tech 2016; 79:773-81. [PMID: 27311936 DOI: 10.1002/jemt.22697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
Despite the increase in the incidence of cancer, the number of women who survive cancer treatment is growing. However, one of the principal results of chemotherapy is premature ovarian failure (POF). The aim of this study was to use the in situ culture preantral follicles as an in vitro model to evaluate the toxicity of two anticancer drugs, doxorubicin (DXR) and paclitaxel (PTX), on the integrity and development of ovarian follicles. Fragments of the ovarian cortex of goats were cultured in vitro for 1 or 7 days in α-MEM(+) supplemented with different concentrations of DXR (0.003, 0.03, or 0.3 µg/mL) and PTX (0.001, 0.01, or 0.1 µg/mL). Analyses were performed before and after culture to evaluate tissue integrity by classical histology, apoptosis by TUNEL assay, DNA laddering kit and the detection of activated caspase 3, and DNA damage by the immune detection of phosphorylated histone H2A.x (H2AXph139). Both DXR and PTX reduced the number of morphologically normal primordial and developing follicles. Positive staining for TUNEL and active caspase 3 was detected in all the samples (P < 0.05). Therefore, we propose the in situ culture of caprine preantral follicles as a useful experimental model for assessing the toxic effects of the chemotherapeutic agents on ovarian folliculogenesis. Microsc. Res. Tech. 79:773-781, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Denise Damasceno Guerreiro
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Laritza Ferreira de Lima
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Giovanna Quintino Rodrigues
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Adeline de Andrade Carvalho
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Simone Vieira Castro
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Cláudio Cabral Campello
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Cláudia do Ó Pessoa
- Department Pharmacology, Federal University of Ceará, Fortaleza, CE, 60430-270, Brazil
| | | | - José Ricardo de Figueiredo
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
| | - Vilceu Bordignon
- Department of Animal Science, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Ana Paula Ribeiro Rodrigues
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocyte and Preantral Follicles (LAMOFOPA), State University of Ceará, Avenue Parajana 1700, Fortaleza, CE, 60740-000, Brazil
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MORAES ALANCNDE, ANDRADE CHERLEYBV, SALATA CAMILA, NASCIMENTO ANALR, RAMOS ISALIRAP, GOLDENBERG REGINACS, CARVALHO JORGEJ, MACHADO ANACS. A combination of stereological methods, biochemistry and electron microscopy for the investigation of drug treatment effects in experimental animals. J Microsc 2015; 261:267-76. [DOI: 10.1111/jmi.12329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 09/11/2015] [Indexed: 01/01/2023]
Affiliation(s)
- ALAN CN DE MORAES
- Laboratório de Pesquisas em Células-Tronco, Departamento de Histologia e Embriologia; Instituto de Biologia Roberto Alcântara Gomes; UERJ Rio de Janeiro RJ Brazil
| | - CHERLEY BV ANDRADE
- Laboratório de Cardiologia Celular e Molecular, Instituto de Biofísica Carlos Chagas Filho; Centro de Ciências da Saúde; UFRJ Rio de Janeiro Brazil
| | - CAMILA SALATA
- Laboratório de Ciências Radiológicas, Departamento de Biofísica e Biometria; Instituto de Biologia Roberto Alcântara Gomes; UERJ Rio de Janeiro RJ Brazil
| | - ANA LR NASCIMENTO
- Laboratório de Ultraestutura e Biologia Tecidual, Departamento de Histologia e Embriologia; Instituto de Biologia Roberto Alcântara Gomes; UERJ Rio de Janeiro RJ Brazil
| | - ISALIRA P RAMOS
- Laboratório de Cardiologia Celular e Molecular, Instituto de Biofísica Carlos Chagas Filho; Centro de Ciências da Saúde; UFRJ Rio de Janeiro Brazil
| | - REGINA CS GOLDENBERG
- Laboratório de Cardiologia Celular e Molecular, Instituto de Biofísica Carlos Chagas Filho; Centro de Ciências da Saúde; UFRJ Rio de Janeiro Brazil
| | - JORGE J CARVALHO
- Laboratório de Ultraestutura e Biologia Tecidual, Departamento de Histologia e Embriologia; Instituto de Biologia Roberto Alcântara Gomes; UERJ Rio de Janeiro RJ Brazil
| | - ANA CS MACHADO
- Laboratório de Pesquisas em Células-Tronco, Departamento de Histologia e Embriologia; Instituto de Biologia Roberto Alcântara Gomes; UERJ Rio de Janeiro RJ Brazil
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Association of tamoxifen use and ovarian function in patients with invasive or pre-invasive breast cancer. Breast Cancer Res Treat 2015. [PMID: 26208485 DOI: 10.1007/s10549-015-3511-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The impact of long-term tamoxifen therapy on ovarian function is not known. Understanding these effects will help reproductive-aged patients who desire future pregnancy make more informed decisions regarding their treatment. This is a retrospective cohort study in patients identified through the UCSF Cancer Registry and SPORE database. We enrolled women with a history of ductal carcinoma in situ (DCIS) or early stage invasive breast cancer who were premenopausal at diagnosis and did not receive chemotherapy. Menstrual histories were obtained through electronic and paper surveys. We compared the age of menopause onset and menstrual pattern changes between women who received tamoxifen (TAM) and those who did not receive tamoxifen (control). Neither group received chemotherapy. 250 subjects were included in this study (125 TAM, 125 control). Mean age of menopause onset was 51.0 for both the groups and was not associated with duration of tamoxifen use or the age at tamoxifen initiation. Menstrual pattern changes, including amenorrhea, were more frequent in the TAM group than control group (any change: 48% TAM vs. 15 % control, p < 0.001; amenorrhea: 22% TAM vs. 3% control, p < 0.001). Older age was associated with an increased risk of developing amenorrhea within 6 months of starting tamoxifen (HR 1.32, p < 0.001). Menstrual pattern changes are common in premenopausal women taking tamoxifen. Tamoxifen use in the absence of chemotherapy is not associated with an earlier age onset of menopause in patients with DCIS or invasive breast cancer and is unlikely to significantly accelerate ovarian aging.
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Luo M, Zeng J, Li F, He L, Li T. Safety of pregnancy after surgical treatment for breast cancer: a meta-analysis. Int J Gynecol Cancer 2015; 24:1366-72. [PMID: 25188887 DOI: 10.1097/igc.0000000000000242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Because of the rising trend of delayed pregnancies, more and more women remain nulliparous at the diagnosis of breast cancer, and approximately 71% of them desire to conceive after breast cancer treatment. Advances in breast cancer screening have made early diagnosis of breast cancer possible, and many patients have the opportunity to be treated by surgery. In this study, we conducted a meta-analysis to evaluate the effect of pregnancy on patient survival and prognosis after surgical treatment for breast cancer. METHODS An electronic search was performed in MEDLINE (PubMed), EMBASE, and Web of Science to identify potentially eligible studies published before August 2013. Both fixed-effect and random-effect models were used to calculate the pooled relative risk (PRR). The Q test and I(2) statistics were used to assess the heterogeneity among the studies. RESULTS A total of 5 studies were included in our meta-analysis. Five hundred fifty-four patients who become pregnant after surgical treatment for breast cancer were compared with a control group of 2354 patients for overall survival (OS). Our analysis demonstrated that pregnancy after surgical treatment for breast cancer had a significant beneficial effect on OS (PRR, 0.78; 95% confidence interval, 0.64-0.95). The disease-free survival outcome also favored patients in the pregnancy group (PRR, 0.87; 95% confidence interval, 0.71-1.08). CONCLUSIONS This meta-analysis indicates that pregnancy after surgical treatment does not increase the risk of breast cancer recurrence and may actually improve OS.
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Affiliation(s)
- Ming Luo
- Department of Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Chirol A, Debled M, Fournier M, Papaxanthos A, Hoppe S, Brouste V, Conri V, Bonnefoi H, Von Théobald P, Mathoulin S, Hocké C, Tunon de Lara C. [Oncofertility and breast cancer: Where have we come from, where are we going?]. Bull Cancer 2015; 102:489-96. [PMID: 25991386 DOI: 10.1016/j.bulcan.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Focusing on the current context of national and international recommendations, techniques development to evaluate and preserve fertility and patients' claims, this study aims to make a survey about the management of patients' breast cancer regarding oncofertility. METHODS Retrospective and analytic study of medical practices at Bergonié Institute of health professionals (medical oncologists, surgical oncologists, nurses) dedicated to the care of non-disseminated breast cancer patients younger than 37, needing medical treatment. RESULTS The number of participants was 230. The most interested practitioners in fertility theme are those of multidisciplinary consultation and surgeons (P<0.001), with an increasing interest during last years (P<0.05). The information about hypofertilizing risks of treatments are delivered most of the time by oncologists (57.7%). The motherhood project is expressed by 11 patients (4.9%) before treatment, only 4 of them receive information on the risks and 49 patients (21.7%) during follow-up. Only 24 patients (48% of the 49) are encouraged for motherhood. CONCLUSION To satisfy patients' requests, several improvements have to be made regarding the patients' information, the health professionals' awareness and care coordination.
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Affiliation(s)
- Aurélie Chirol
- Institut de lutte contre le cancer, institut Bergonié, service de chirurgie, Bordeaux, France; Université de Bordeaux, Bordeaux, France; Université de la Réunion, France
| | - Marc Debled
- Institut de lutte contre le cancer, institut Bergonié, service d'oncologie médicale, Bordeaux, France
| | - Marion Fournier
- Institut de lutte contre le cancer, institut Bergonié, service de chirurgie, Bordeaux, France
| | - Aline Papaxanthos
- CHU Pellegrin, service de biologie de la reproduction, Bordeaux, France
| | - Stéphanie Hoppe
- Institut de lutte contre le cancer, institut Bergonié, service de biostatistiques, Bordeaux, France
| | - Véronique Brouste
- Institut de lutte contre le cancer, institut Bergonié, service de biostatistiques, Bordeaux, France
| | - Vanessa Conri
- CHU Pellegrin, service de gynécologie et reproduction, Bordeaux, France
| | - Hervé Bonnefoi
- Institut de lutte contre le cancer, institut Bergonié, service d'oncologie médicale, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - Peter Von Théobald
- CHU Felix-Guyon, service de gynécologie, 97400 Saint-Denis, Réunion; Université de la Réunion, France
| | - Simone Mathoulin
- Institut de lutte contre le cancer, institut Bergonié, service de biostatistiques, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - Claude Hocké
- CHU Pellegrin, service de gynécologie et reproduction, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - Christine Tunon de Lara
- Institut de lutte contre le cancer, institut Bergonié, service de chirurgie, Bordeaux, France.
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Raphael J, Trudeau ME, Chan K. Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature. ACTA ACUST UNITED AC 2015; 22:S8-S18. [PMID: 25848342 DOI: 10.3747/co.22.2338] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND An increasing number of young women are delaying childbearing; hence, more are diagnosed with breast cancer (bca) before having a family. No clear recommendations are currently available for counselling such a population on the safety of carrying a pregnancy during bca or becoming pregnant after treatment for bca. METHODS Using a Web-based search of PubMed we reviewed the recent literature about bca and pregnancy. Our objective was to report outcomes for patients diagnosed with bca during pregnancy, comparing them with outcomes for non-pregnant women, and to evaluate prognosis in women diagnosed with and treated for bca who subsequently became pregnant. RESULTS "Pregnancy and bca" should be divided into two entities. Pregnancy-associated bca tends to be more aggressive and advanced in stage at diagnosis than bca in control groups; hence, it has a poorer prognosis. With respect to pregnancy after bca, there is, despite the bias in reported studies and meta-analyses, no clear evidence for a different or worse disease outcome in bca patients who become pregnant after treatment compared with those who do not. CONCLUSIONS Pregnancy-associated bca should be treated as aggressively as and according to the standards applicable in nonpregnant women; pregnancy after bca does not jeopardize outcome. The guidelines addressing risks connected to pregnancy and bca lack a high level of evidence for better counselling young women about pregnancy considerations and preventing unnecessary abortions. Ideally, evidence from large prospective randomized trials would set better guidelines, and yet the complexity of such studies limits their feasibility.
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Affiliation(s)
- J Raphael
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - M E Trudeau
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - K Chan
- Medical Oncology Department, Sunnybrook Odette Cancer Centre, Toronto, ON
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Cho J, Jung SY, Lee JE, Shim EJ, Kim NH, Kim Z, Sohn G, Youn HJ, Kim KS, Kim H, Lee JW, Lee MH. A review of breast cancer survivorship issues from survivors' perspectives. J Breast Cancer 2014; 17:189-99. [PMID: 25320616 PMCID: PMC4197348 DOI: 10.4048/jbc.2014.17.3.189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
Despite the fact that more breast cancer survivors are currently enjoying longer lifespans, there remains limited knowledge about the factors and issues that are of greatest significance for these survivors, particularly from their perspectives. This review was based on the concept that the topics addressed should focus on the perspectives of current survivors and should be extended to future modalities, which physicians will be able to use to gain a better understanding of the hidden needs of these patients. We intended to choose and review dimensions other than the pathology and the disease process that could have been overlooked during treatment. The eight topics upon which we focused included: delay of treatment and survival outcome; sexual well-being; concerns about childbearing; tailored follow-up; presence of a family history of breast cancer; diet and physical activity for survivors and their families; qualitative approach toward understanding of breast cancer survivorship, and; mobile health care for breast cancer survivors. Through this review, we aimed to examine the present clinical basis of the central issues noted from the survivors' perspectives and suggest a direction for future survivorship-related research.
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Affiliation(s)
- Jihyoung Cho
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Sookmyung Women's University, Seoul, Korea
| | - Eun-Jung Shim
- Department of Psychology, Pusan National University School of Medicine, Busan, Korea
| | - Nam Hyoung Kim
- Department of Advertising and Branding, Kaywon University of Art and Design, Uiwang, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Guiyun Sohn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Ku Sang Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hanna Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
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Juozaitytė E, Aleknavičius E, Jančiauskienė R, Česas A, Pipirienė-Želvienė T, Liutkauskienė S, Krasauskienė A, Vencevičienė L. Guidelines for diagnostics and treatment of aromatase inhibitor-induced bone loss in women with breast cancer. Medicina (B Aires) 2014; 50:197-203. [DOI: 10.1016/j.medici.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 09/15/2014] [Indexed: 11/15/2022] Open
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Dillon KE, Sammel MD, Ginsberg JP, Lechtenberg L, Prewitt M, Gracia CR. Pregnancy after cancer: results from a prospective cohort study of cancer survivors. Pediatr Blood Cancer 2013; 60:2001-6. [PMID: 24038829 PMCID: PMC4457373 DOI: 10.1002/pbc.24701] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/24/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Future fertility is an important concern for many cancer survivors. Cancer therapies have been shown to adversely impact reproductive function. However, it is difficult to predict the extent to which reproductive dysfunction will occur. The purpose of this study was to compare measures of ovarian reserve (MOR) and pregnancy rates in young female cancer survivors and similar-aged controls. PROCEDURES A prospective cohort study was conducted in a university-hospital setting. Participants were followed annually for a mean 25 months to assess reproductive history, the incidence of pregnancy, and MOR (serum follicle-stimulating hormone, luteinizing hormone, estradiol, inhibin B, anti-mullerian hormone (AMH), antral follicle counts and mean ovarian volume). RESULTS Eighty-four female survivors (average age 26, and 14 years post-treatment) and 98 similar-aged controls that were sexually active with men were included. At baseline, 27/84 survivors and 42/98 controls reported a prior pregnancy. Adjusted models showed that anti-mullerian hormone (AMH) and antral follicle count (AFC) were impaired in survivors with a prior pregnancy compared to controls with a prior pregnancy (P < 0.01, P = 0.03). During follow-up in 56 survivors and 74 controls, 19 pregnancies occurred in survivors and 18 in controls. Comparison of MOR between survivors who became pregnant and controls who became pregnant revealed that AMH and AFC were impaired in survivors (P < 0.05). Compared to survivors who did not become pregnant, survivors who did were older (P < 0.01) and more likely to be cohabitating (P < 0.01), but had similar MOR and exposure to alkylators (P = 0.34). CONCLUSIONS Survivors achieved pregnancy at a rate similar to controls despite impaired MOR.
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Affiliation(s)
- Katherine E Dillon
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Dahhan T, Balkenende E, van Wely M, Linn S, Goddijn M. Tamoxifen or letrozole versus standard methods for women with estrogen-receptor positive breast cancer undergoing oocyte or embryo cryopreservation in assisted reproduction. Cochrane Database Syst Rev 2013; 2013:CD010240. [PMID: 24213953 PMCID: PMC11228698 DOI: 10.1002/14651858.cd010240.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cryopreservation of oocytes or embryos preceded by controlled ovarian stimulation (COS) can increase the chance of future pregnancy in women with breast cancer who risk therapy-induced ovarian failure. In women with estrogen-receptor (ER) positive breast cancer, alternative COS protocols with tamoxifen or letrozole are being used to theoretically inhibit breast cancer growth during COS. OBJECTIVES To assess the effects of tamoxifen or letrozole, in addition to standard COS protocols, on the breast cancer-free interval in premenopausal women with ER positive breast cancer who undergo COS for embryo or oocyte cryopreservation. SEARCH METHODS We searched the Ovid Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, and EBSCOhost CINAHL. We applied no limitations in year of publication or language. In addition, we searched trial registers for ongoing and registered trials, conference abstracts, and sources of grey literature. The search was conducted in January 2013. SELECTION CRITERIA Randomised trials comparing different COS protocols in women with breast cancer were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently scanned the titles, abstracts, or both sections according to Cochrane guidelines. If data to include were provided, data extraction would have been independently performed by two review authors by using forms designed according to Cochrane guidelines. MAIN RESULTS No randomised controlled trials were found that met the inclusion criteria. AUTHORS' CONCLUSIONS COS schedules with the additional use of tamoxifen or letrozole are commonly chosen as an alternative regimen in young women with ER positive breast cancer who undergo COS for oocyte or embryo cryopreservation. No randomised controlled trials support the idea that these alternative COS schedules are superior to standard COS.
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Affiliation(s)
- Taghride Dahhan
- Academic Medical Center University of AmsterdamCenter for Reproductive Medicine, Department of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Eva Balkenende
- Academic Medical Centre, University of AmsterdamDepartment of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1100 DD
| | - Madelon van Wely
- Academic Medical Center, University of AmsterdamCenter for Reproductive Medicine, Department of Obstetrics and GynaecologyCenter Meibergdreef 9AmsterdamNetherlands1105 AZ
| | - Sabine Linn
- Antoni van Leeuwenhoek Hospital ‐ Netherlands Cancer InstituteDepartment of Medical OncologyPlesmanlaan 121AmsterdamNetherlands1066 CX
| | - Mariëtte Goddijn
- Academic Medical Center University of AmsterdamCenter for Reproductive Medicine, Department of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1105 AZ
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Corney RH, Swinglehurst AJ. Young childless women with breast cancer in the UK: a qualitative study of their fertility-related experiences, options, and the information given by health professionals. Psychooncology 2013; 23:20-6. [DOI: 10.1002/pon.3365] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/04/2013] [Accepted: 07/04/2013] [Indexed: 11/10/2022]
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Torino F, Barnabei A, De Vecchis L, Sini V, Schittulli F, Marchetti P, Corsello SM. Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer. Crit Rev Oncol Hematol 2013; 89:27-42. [PMID: 23953684 DOI: 10.1016/j.critrevonc.2013.07.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/16/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022] Open
Abstract
Cytotoxic chemotherapy may variably affect ovarian function depending on age and ovarian reserve at diagnosis, type of chemotherapy and use of tamoxifen. Ascertaining whether a premenopausal patient with endocrine-responsive early breast cancer and chemotherapy-induced amenorrhea has reached menopause is essential not only in order to provide accurate information on residual fertility, but also to appropriately prescribe endocrine therapy. Indeed, aromatase inhibitors are contraindicated in women with residual ovarian reserve. However, the diagnosis of menopause in patients with chemotherapy-induced amenorrhea is challenging, since clinical features, follicle-stimulating hormone and estradiol levels may be inaccurate to this aim. Recent studies demonstrated that the anti-müllerian hormone may improve the assessment of ovarian reserve residual to chemotherapy in women with early breast cancer. Herein, we review the incidence of amenorrhea and menopause induced by cytotoxic chemotherapy in women affected by early breast cancer and the suggested mechanisms that sustain these side-effects. Furthermore, it has been scrutinized the potential of new markers of ovarian reserve that may facilitate the selection of appropriate endocrine treatment for premenopausal women who develop amenorrhea following adjuvant chemotherapy for early breast cancer.
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Affiliation(s)
- Francesco Torino
- Department of Systems Medicine, Chair of Medical Oncology, Tor Vergata University of Rome, Italy
| | - Agnese Barnabei
- Endocrinology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Liana De Vecchis
- Department of Systems Medicine, Chair of Medical Oncology, Tor Vergata University of Rome, Italy
| | - Valentina Sini
- Surgical and Medical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, "Sapienza" University of Rome, Italy
| | | | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Medical Oncology Division, Sant'Andrea Hospital, "Sapienza" University of Rome and IDI-IRCCS, Rome, Italy
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Rosenberg SM, Partridge AH. Premature menopause in young breast cancer: effects on quality of life and treatment interventions. J Thorac Dis 2013; 5 Suppl 1:S55-61. [PMID: 23819028 DOI: 10.3978/j.issn.2072-1439.2013.06.20] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/19/2013] [Indexed: 12/14/2022]
Abstract
Many young women are at increased risk for premature menopause following adjuvant treatment for breast cancer. These women must deal with consequences of menopause, including loss of fertility and physiologic symptoms such as night sweats, hot flashes, vaginal dryness, and weight gain. These symptoms can be particularly distressing for young women and can adversely affect both health-related and psychosocial quality of life (QOL). While there are a wide range of pharmacologic and non-pharmacologic interventions available to help with these symptoms and in turn, improve QOL, there is little data available about the use and efficacy of these interventions in younger women who become menopausal as a result of their breast cancer treatment. Future studies should focus on this vulnerable population, with the goal of identifying effective strategies to relieve symptoms and improve quality of life in young breast cancer survivors.
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Affiliation(s)
- Shoshana M Rosenberg
- Dana-Farber Cancer Institute, Boston, MA, USA; ; Harvard School of Public Health, Boston, MA, USA
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Seror V, Cortaredona S, Bouhnik AD, Meresse M, Cluze C, Viens P, Rey D, Peretti-Watel P. Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery. Psychooncology 2013; 22:2546-56. [PMID: 23749441 DOI: 10.1002/pon.3316] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/26/2013] [Accepted: 04/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). METHODS A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. RESULTS The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. CONCLUSIONS Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making.
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Affiliation(s)
- Valérie Seror
- INSERM, UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM), Marseille, France; Aix-Marseille University, UMR_S912, IRD, Marseille, France
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Palumbo MO, Kavan P, Miller WH, Panasci L, Assouline S, Johnson N, Cohen V, Patenaude F, Pollak M, Jagoe RT, Batist G. Systemic cancer therapy: achievements and challenges that lie ahead. Front Pharmacol 2013; 4:57. [PMID: 23675348 PMCID: PMC3646247 DOI: 10.3389/fphar.2013.00057] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022] Open
Abstract
In the last half of the century, advances in the systemic therapy of cancer, including chemotherapy, hormonal therapy, targeted therapy, and immunotherapy have been responsible for improvements in cancer related mortality in developed countries even as the population continues to age. Although such advancements have yet to benefit all cancer types, systemic therapies have led to an improvement in overall survival in both the adjuvant and metastatic setting for many cancers. With the pressure to make therapies available as soon as possible, the side-effects of systemic therapies, in particular long-term side-effects are not very well characterized and understood. Increasingly, a number of cancer types are requiring long-term and even lifelong systemic therapy. This is true for both younger and older patients with cancer and has important implications for each subset. Younger patients have an overall greater expected life-span, and as a result may suffer a greater variety of treatment related complications in the long-term, whereas older patients may develop earlier side-effects as a result of their frailty. Because the incidence of cancer in the world will increase over the next several decades and there will be more people living with cancer, it is important to have an understanding of the potential side-effects of new systemic therapies. As an introductory article, in this review series, we begin by describing some of the major advances made in systemic cancer therapy along with some of their known side-effects and we also make an attempt to describe the future of systemic cancer therapy.
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Affiliation(s)
- Michael O Palumbo
- Department of Medicine and Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University Montreal, QC, Canada
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41
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Margulies AL, Uzan C. Grossesse après cancer du sein. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baxter NN, Sutradhar R, DelGuidice ME, Forbes S, Paszat LF, Wilton AS, Urbach D, Rabeneck L. A population-based study of rates of childbirth in recurrence-free female young adult survivors of non-gynecologic malignancies. BMC Cancer 2013; 13:30. [PMID: 23343211 PMCID: PMC3605316 DOI: 10.1186/1471-2407-13-30] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 01/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background Fertility is an important issue for long-term survivors of malignancies developing during reproductive years. We designed a population-based study to investigate childbirth in female young adult survivors of non-gynecologic malignancies. Methods Women 20–34 years diagnosed with non-gynecologic malignancies in Ontario from 1992–1999 who lived at least 5 years recurrence-free were identified using the Ontario Cancer Registry and age matched to 5 randomly selected cancer-free women. Childbirth was determined through hospital discharge data. Time-to-childbirth was compared between survivors and controls using Cox proportional hazard regression for all subjects and stratified by prior childbirth and disease site. Results 3,285 survivors and 15,118 control women had a median of 12 years observation. 1,194 survivors and 6,049 controls experienced childbirth to the end of observation (March 2011). Overall, survivors experienced a longer time to childbirth than controls (HR 0.92, 95% CI 0.87-0.98), however this was limited to survivors with prediagnosis childbirth (HR 0.76, 95% CI 0.66-0.86). Survivors with no prediagnosis childbirth experienced a similar time to childbirth (HR 1.00, 95% CI 0.93-1.08) as control women. Differences between survivors and controls varied by type of malignancy; notably for those with prediagnosis childbirth, survivors of breast cancer (HR 0.45, 95% CI 0.29-0.68) and Hodgkin Disease (HR 0.57, 95% CI 0.36-0.91) had lower rates of postdiagnosis childbirth than controls. Conclusions Long-term female young adult survivors of malignancies are less likely than controls to have childbirth after diagnosis; the overall effect is small and is influenced by prediagnosis childbirth and malignancy type.
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Affiliation(s)
- Nancy N Baxter
- Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, 30 Bond Street 16CC-40, Toronto, ON M5B 1W8, Canada.
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Czaplicki KL. Two lives intertwined: pregnancy-associated breast cancer. Clin J Oncol Nurs 2012; 16:E183-9. [PMID: 23022945 DOI: 10.1188/12.cjon.e183-e189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of concurrent breast cancer and pregnancy (also known as pregnancy-associated breast cancer [PABC]) may increase as women delay child bearing. Because of the physiologic changes associated with pregnancy, diagnosis often is delayed, lending to poorer prognostic factors on presentation. Therefore, the clinical challenge in managing PABC involves controlling the cancer while maximizing survival outcomes for the expectant mother without compromising the health and safety of the fetus. Collaboration and communication between multidisciplinary team members are crucial. Education is key in providing a general overview of available diagnostic modalities, endorsing the multidisciplinary approach to care and treatment for the mother and fetus, and identifying the oncology nursing role specific to this patient population. Women with PABC must be kept informed of all aspects of care to ensure active participation in the decision-making process, as they are not only concerned for their own well-being but also that of their unborn child. Anxiety levels often run high and steady communication offers a modicum of control to this already-stressed patient population.
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Christinat A, Pagani O. Fertility after breast cancer. Maturitas 2012; 73:191-6. [PMID: 23020991 DOI: 10.1016/j.maturitas.2012.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/12/2012] [Indexed: 12/13/2022]
Abstract
Breast cancer is the most common tumor in childbearing women. In the last decades, considerable improvement in breast cancer-related death has been achieved with adjuvant therapies (chemotherapy, endocrine and targeted therapies, radiotherapy) but at cost of significant long-term sequels, including infertility. Reproductive issues are of great importance to young women, in particular for those who did not complete their families before breast cancer diagnosis: patients should be adequately informed at the time of diagnosis about the risk of infertility and the available methods for fertility preservation. This review will focus on incidence and impact of infertility secondary to breast cancer treatment, the available options for ovarian function preservation, including embryo and oocyte cryopreservation, ovarian tissue cryopreservation, and ovarian suppression with gonadotropin-releasing hormone agonists. We will also discuss the optimal time of subsequent pregnancy, the potential risks for the mother and the fetus, and the impact of therapies on breastfeeding.
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Abstract
Because of the heterogeneity in the definition of chemotherapy-induced amenorrhea (CIA) there are distinct differences in the literature with regard to its incidence as well as its dependence on various influencing factors. The occurrence of CIA varies greatly depending on the applied chemotherapy. The pathogenesis of CIA is especially based on a reduction of ovarian reserves. Various sonographic and biochemical factors can be used to exclude or confirm CIA. This is particularly important when an endocrine therapy with tamoxifen is not possible and the use of aromatase inhibitors is under consideration. CIA and especially the frequently thereby resulting early menopause can lead to pronounced restrictions in the quality of life of the affected patients, not least due to the resulting infertility. On the other hand, various studies have shown that CIA may have a positive prognostic significance. Thus, the identification of measures to prevent CIA (for example, through the use of GnRH analogues) is of particular importance.
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Affiliation(s)
- C Liedtke
- Gynecology and Obstetrics, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster
| | - L Kiesel
- Gynecology and Obstetrics, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster
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Margulies AL, Berveiller P, Mir O, Uzan C, Chabbert-Buffet N, Rouzier R. Grossesse après cancer du sein : mise à jour des connaissances en 2012. ACTA ACUST UNITED AC 2012; 41:418-26. [DOI: 10.1016/j.jgyn.2012.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/30/2022]
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Reduced pretreatment ovarian reserve in premenopausal female patients with Hodgkin lymphoma or non-Hodgkin-lymphoma—evaluation by using antimüllerian hormone and retrieved oocytes. Fertil Steril 2012; 98:141-4. [DOI: 10.1016/j.fertnstert.2012.04.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/29/2012] [Accepted: 04/13/2012] [Indexed: 11/17/2022]
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Torino F, Barnabei A, De Vecchis L, Appetecchia M, Strigari L, Corsello SM. Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer. Endocr Relat Cancer 2012; 19:R21-33. [PMID: 22241718 DOI: 10.1530/erc-11-0199] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cytotoxic anticancer treatment may induce amenorrhea or menopause to a variable extent. These side effects may not only impair or impede fertility but also cause sexual dysfunction, bone loss, and menopausal symptoms, with a strikingly negative effect on quality of life in many women. Aromatase inhibitors (AIs) are a recommended adjuvant endocrine treatment option in postmenopausal patients affected by early breast cancer (EBC) but are contraindicated in premenopausal women and in those with residual ovarian function. Women over 40 years of age with chemotherapy-induced amenorrhea (CIA) and routine hormonal levels consistent with menopause may receive an AI as adjuvant endocrine treatment. For these women, the tools available to identify menopause do not appear to be completely reliable. This review focused on the pathophysiology of ovarian toxicity induced by cytotoxic agents and on potentially useful methods to diagnose chemotherapy-induced menopause in patients treated with adjuvant chemotherapy for endocrine-responsive EBC. Moreover, practical approaches are proposed to distinguish true menopausal women, who would benefit from AIs, from those with transient or persistent CIA.
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Affiliation(s)
- Francesco Torino
- Department of Internal Medicine, Chair of Medical Oncology, University of Rome Tor Vergata, Rome, Italy
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Lawrenz B, Henes M, Neunhoeffer E, Fehm T, Huebner S, Kanz L, Marini P, Mayer F. Pregnancy after successful cancer treatment: what needs to be considered? ACTA ACUST UNITED AC 2012; 35:128-32. [PMID: 22414979 DOI: 10.1159/000336830] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Over the last decade, advances in oncology led to improved treatment results and increasing numbers of long-term cancer survivors. Fulfilling the desire to have children is important for many patients after cancer treatment. Consequently, oncologists, gynecologists and obstetricians are seeing more patients who wish to conceive after treatment. The necessary prerequisites that should be considered when supporting a planned pregnancy after cancer treatment are discussed in this article. The possible consequences of chemotherapy and radiotherapy on the course of pregnancy and the health of the offspring, as well as the interactions between cancer and pregnancy, are reviewed with the focus on childhood cancer, malignant lymphomas, and breast cancer. Despite chemo- or radiotherapy, neither the teratogenic risk nor the risk of adventitious cancers appears to be increased for the offspring of cancer survivors. However, there is a slightly higher risk of miscarriage after chemotherapy. In case of radiation to the uterus, there is a higher risk of premature birth, intrauterine growth retardation, and increased perinatal mortality. The effect is more pronounced after prepubertal radiation than for postpubertal radiation. The former cancer patient's desire to conceive can nevertheless be supported, given that pregnancy and birth are closely monitored.
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50
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Partridge AH. Ovarian suppression for prevention of premature menopause and infertility: empty promise or effective therapy? J Clin Oncol 2012; 30:479-81. [PMID: 22231046 DOI: 10.1200/jco.2011.37.9883] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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