Original articleDoes a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral?
Section snippets
Background
An important concern for young women with early-stage breast cancer is future fertility [1]. Many women will require adjuvant systemic chemotherapy [2], which often has a detrimental effect on fertility [1]. While adjuvant tamoxifen is not toxic to the ovary, the need to take this drug for several years, during which time pregnancy is contraindicated [3], results in further fertility reduction due to the normal effects of aging. With increasing numbers of women having children at later ages,
Study design
A comparative cohort study comprising a retrospective chart review and prospective survey was undertaken, with OCC forming the experimental group, and Princess Margaret Cancer Centre (PM), which does not have a dedicated program for younger women, forming the control group. Electronic patient records (EPR) were retrospectively reviewed at both sites. The same cohort of women was prospectively sent surveys to corroborate information identified in EPR. Both cancer centers are academic, tertiary
Patient characteristics
Eight-one patients were identified at both OCC and PM. Baseline characteristics are listed in Table 1. Overall the cohorts were well matched with the exception of a greater proportion of nulliparous women at PM compared to OCC. Within these cohorts, 47 and 49 women at OCC and PM returned surveys, for a response rate of 58% and 60% respectively. Survey respondents were similar to the larger groups with respect to demographic variables.
Fertility discussions
Chart reviews identified that for 63 (78%) women at OCC and
Discussion
Our study demonstrates that implementation of a dedicated program for young cancer patients with a nurse navigator is associated with a higher probability of fertility discussion and FP referrals for young breast cancer patients based on patient surveys, but does not appear to increase documentation rates.
The higher FP referral rate at OCC is particularly striking, as the patients from that institution were less likely to be nulliparous at the time of diagnosis. The survey finding that 96% of
Conflict of interest statement
The authors have no conflicts of interest to declare.
Acknowledgments
This work was supported by internal departmental funds from Princess Margaret Cancer Centre. Institutional Research Ethics Board approval from the Sunnybrook Odette Cancer Centre and the Princess Margaret Cancer Centre in Toronto, Ontario, Canada was obtained prior to study commencement.
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