Journal Article
. 2017 Jul; 6(3):429-434.
doi: 10.1089/jayao.2017.0031.

Oncology Physicians' Perspectives on Practices and Barriers to Fertility Preservation and the Feasibility of a Prospective Study of Pregnancy After Breast Cancer

Shoshana M Rosenberg 1 Shari Gelber 2 Richard D Gelber 2 Ethan Krop 1 Larissa A Korde 3 Olivia Pagani 4 Ann H Partridge 1 
Affiliations
  • PMID: 28686476
  •     24 References
  •     10 citations

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.

Keywords: breast cancer; endocrine therapy; fertility; pregnancy.

Adjuvant exemestane with ovarian suppression in premenopausal breast cancer.
Olivia Pagani, Meredith M Regan, +32 authors, International Breast Cancer Study Group.
N Engl J Med, 2014 Jun 03; 371(2). PMID: 24881463    Free PMC article.
Highly Cited.
Pregnancy after breast cancer: Are young patients willing to participate in clinical studies?
Olivia Pagani, Monica Ruggeri, +20 authors, Ann H Partridge.
Breast, 2015 Feb 11; 24(3). PMID: 25662412
Fertility (male and female) and menopause.
Kathryn J Ruddy, Ann H Partridge.
J Clin Oncol, 2012 Sep 26; 30(30). PMID: 23008319
Review.
Effect of medical oncologists' attitudes on accrual to clinical trials in a community setting.
Carol P Somkin, Lynn Ackerson, +4 authors, Louis Fehrenbacher.
J Oncol Pract, 2013 Oct 24; 9(6). PMID: 24151327    Free PMC article.
Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study.
Hatem A Azim, Niels Kroman, +12 authors, Fedro A Peccatori.
J Clin Oncol, 2012 Nov 22; 31(1). PMID: 23169515    Free PMC article.
Value of early referral to fertility preservation in young women with breast cancer.
Sanghoon Lee, Sinan Ozkavukcu, +2 authors, Kutluk Oktay.
J Clin Oncol, 2010 Sep 30; 28(31). PMID: 20876425    Free PMC article.
Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update.
Alison W Loren, Pamela B Mangu, +7 authors, American Society of Clinical Oncology.
J Clin Oncol, 2013 May 30; 31(19). PMID: 23715580    Free PMC article.
Highly Cited. Systematic Review.
Impact of Fertility Concerns on Tamoxifen Initiation and Persistence.
Natalia C Llarena, Samantha L Estevez, Susan L Tucker, Jacqueline S Jeruss.
J Natl Cancer Inst, 2015 Aug 27; 107(10). PMID: 26307641    Free PMC article.
American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.
Stephanie J Lee, Leslie R Schover, +7 authors, American Society of Clinical Oncology.
J Clin Oncol, 2006 May 03; 24(18). PMID: 16651642
Highly Cited. Systematic Review.
Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer.
Joseph M Letourneau, Erin E Ebbel, +6 authors, Mitchell P Rosen.
Cancer, 2011 Sep 03; 118(6). PMID: 21887678    Free PMC article.
Highly Cited.
Fertility Preservation for the Young Breast Cancer Patient.
Shari B Goldfarb, Sabrina A Kamer, +6 authors, Mary L Gemignani.
Ann Surg Oncol, 2016 Jan 23; 23(5). PMID: 26790670    Free PMC article.
Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer.
B Thewes, B Meiser, +7 authors, M L Friedlander.
J Clin Oncol, 2005 Jul 30; 23(22). PMID: 16051957
Young breast cancer survivors: their perspectives on treatment decisions and fertility concerns.
Jessica R Gorman, Paula M Usita, Lisa Madlensky, John P Pierce.
Cancer Nurs, 2010 Aug 11; 34(1). PMID: 20697269    Free PMC article.
Safety of pregnancy following breast cancer diagnosis: a meta-analysis of 14 studies.
Hatem A Azim, Luigi Santoro, +4 authors, Fedro A Peccatori.
Eur J Cancer, 2010 Oct 15; 47(1). PMID: 20943370
Review.
Adjuvant ovarian suppression in premenopausal breast cancer.
Prudence A Francis, Meredith M Regan, +28 authors, International Breast Cancer Study Group.
N Engl J Med, 2014 Dec 17; 372(5). PMID: 25495490    Free PMC article.
Highly Cited.
Health care provider surveys in the United States, 2000-2010: a review.
Caroline C McLeod, Carrie N Klabunde, Gordon B Willis, Debra Stark.
Eval Health Prof, 2013 Feb 05; 36(1). PMID: 23378504
Review.
Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update.
Harold J Burstein, Sarah Temin, +10 authors, Jennifer J Griggs.
J Clin Oncol, 2014 May 29; 32(21). PMID: 24868023    Free PMC article.
Highly Cited.
Physician referral for fertility preservation in oncology patients: a national study of practice behaviors.
Gwendolyn P Quinn, Susan T Vadaparampil, +5 authors, Terrance L Albrecht.
J Clin Oncol, 2009 Oct 15; 27(35). PMID: 19826115
Highly Cited.
Web-based survey of fertility issues in young women with breast cancer.
Ann H Partridge, Shari Gelber, +7 authors, Eric P Winer.
J Clin Oncol, 2004 Oct 16; 22(20). PMID: 15483028
Highly Cited.
Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: A population-based study.
Margarett Shnorhavorian, Linda C Harlan, +11 authors, AYA HOPE Study Collaborative Group.
Cancer, 2015 Jul 28; 121(19). PMID: 26214755    Free PMC article.
Fertility and adjuvant treatment in young women with breast cancer.
Ann H Partridge, Kathryn J Ruddy.
Breast, 2007 Sep 07; 16 Suppl 2. PMID: 17804236
Review.
Prospective study of fertility concerns and preservation strategies in young women with breast cancer.
Kathryn J Ruddy, Shari I Gelber, +6 authors, Ann H Partridge.
J Clin Oncol, 2014 Feb 26; 32(11). PMID: 24567428    Free PMC article.
Highly Cited.
Young adult female cancer survivors' unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation.
Catherine Benedict, Bridgette Thom, +4 authors, Joanne F Kelvin.
Cancer, 2016 May 24; 122(13). PMID: 27213483    Free PMC article.
Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns.
Jessica R Gorman, Vanessa L Malcarne, +2 authors, John P Pierce.
Breast Cancer Res Treat, 2010 Feb 05; 123(2). PMID: 20130979    Free PMC article.
Exogenous reproductive hormone use in breast cancer survivors and previvors.
Ines Vaz-Luis, Ann H Partridge.
Nat Rev Clin Oncol, 2018 Jan 24; 15(4). PMID: 29358778
Review.
Fertility preservation in breast cancer with case-based examples for guidance.
Mary E Hampe, Alice S Rhoton-Vlasak.
J Assist Reprod Genet, 2020 Feb 03; 37(3). PMID: 32008180    Free PMC article.
Review.
Issues with Fertility in Young Women with Breast Cancer.
Nicole Christian, Mary L Gemignani.
Curr Oncol Rep, 2019 May 18; 21(7). PMID: 31098718
Review.
COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management.
Carlo Alviggi, Sandro C Esteves, +30 authors, POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) group.
Reprod Biol Endocrinol, 2020 May 15; 18(1). PMID: 32404170    Free PMC article.
Estimation of historical control rate for a single arm de-escalation study - Application to the POSITIVE trial.
Zhuoxin Sun, Samuel M Niman, +9 authors, POSITIVE Steering Committee.
Breast, 2020 Jun 15; 53. PMID: 32535486    Free PMC article.
Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer?
Angelena Crown, Shirin Muhsen, +4 authors, Mary L Gemignani.
Ann Surg Oncol, 2020 Aug 09; 27(12). PMID: 32767225    Free PMC article.
Discussing motherhood when the oncological prognosis is dire: ethical considerations for physicians.
Alma Linkeviciute, Barbara Buonomo, +2 authors, Fedro A Peccatori.
ESMO Open, 2020 Nov 12; 5(6). PMID: 33172958    Free PMC article.
Review.
Evidenced-based practice of decision-making process in oncofertility care among registered nurses: A qualitative study.
Ching-Ting Lien, Sheng-Miauh Huang, Yi Hua Chen, Wen-Ting Cheng.
Nurs Open, 2021 Feb 12; 8(2). PMID: 33570287    Free PMC article.
The Effect of Subsequent Pregnancy on Prognosis in Young Breast Cancer Patients (≤35 Years Old) According to Hormone Receptor Status.
Yang Li, Yuhan Zhang, +3 authors, Hong Liu.
Cancer Manag Res, 2021 Feb 25; 13. PMID: 33623430    Free PMC article.
Survey of professionals on breast cancer, fertility preservation and pregnancy in Argentina.
Alejandra García, Gabriela Candás, +11 authors, Juan Luis Uriburu.
Ecancermedicalscience, 2021 Mar 30; 15. PMID: 33777176    Free PMC article.