Physician Perspectives on Fertility Preservation Discussions with Premenopausal Breast Cancer Patients: Results from a Multihospital Health Care System
Ten percent of new breast cancer diagnoses occur in premenopausal women, and oncologic therapies may compromise fertility. Thus, fertility preservation discussions (FPDs) and referral to fertility specialists are imperative prior to initiation of therapy. A previous retrospective chart review showed 45% FPD rates at our institution. The aim of this study is to investigate physician perspectives and limitations regarding FPD.
An electronic survey was distributed to 30 surgical, medical, and radiation oncologists across ten regional hospitals. Questions addressed provider demographics, and barriers to and facilitators of FPD.
The survey response rate was 63.3%. Only 31.6% of physicians reported “always” documenting FPD. Respondents opined that the physician prescribing systemic therapy was the most appropriate person to provide FPD. Patient age, treatment with chemotherapy, and patient desire for FPD were more likely to increase FPD (p < 0.0001, p < 0.05, and p < 0.0001, respectively). The majority of physicians (84.2%) expressed intent to increase FPD rates.
Fertility preservation is an integral aspect of breast cancer care, requiring thorough discussion and clear documentation. This study identified that physicians believe the medical oncologist is the most appropriate person to have FPDs with patients and that empowering patients to bring up fertility concerns may improve rates of FPDs. Education of physicians and patients about fertility preservation techniques is likely to improve FPDs.
M.C.M., A.J.B., and E.V.T. assisted with study design, data interpretation, and article creation. M.H., L.M.B. and S.S.T. assisted with study and survey design. R.T. assisted with article preparation. All authors gave final approval.
- 1.National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: Female breast cancer, percent of new cases by age group: Female breast cancer - SEER 18 2011–2015, all races, females.Google Scholar
- 3.Matthews T, Hamilton B. Mean age of mothers is on the rise: United States, 2000–2014. (2016). https://www.cdc.gov/nchs/data/databriefs/db232.pdf. Accessed 17 Feb 2019.
- 5.Genetic/familial high-risk assessment: Breast and ovarian. www.nccn.org. Updated 2019. Accessed 23 May 19.
- 6.Bartholomew AJ, Haslinger ML, Masciello MC, Bozzuto LM, Tisapali EV. Fertility preservation discussions in premenopausal breast cancer patients. Abstract presented at: 13th annual meeting of the academic surgical congress; January 2018; Jacksonville, FL. Abstract 69.03.Google Scholar
- 8.Rosenberg SM, Gelber S, Gelber RD, et al. 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. https://doi.org/10.1089/jayao.2017.003.
- 11.Oncofertility Consortium. Save my fertility: an online fertility preservation toolkit for patients and their providers. The Oncofertility Consortium - Northwestern University. (2015). www.savemyfertility.org. Accessed 20 Feb 2019.
- 12.The American Cancer Society medical and editorial content team. Preserving fertility in women with cancer. American Cancer Society. 2017.Google Scholar
- 13.National Comprehensive Cancer Network, (NCCN). Cancer and fertility. Available: https://www.nccn.org/patients/resources/life_with_cancer/fertility.aspx.Accessed 20 Feb 2019.
- 14.Fertility preservation and reproduction in patients facing gonadotoxic therapies: an ethics committee opinion. Fertil Steril. 2018;110(3):380–386. https://www.sciencedirect.com/science/article/pii/S0015028218304357. https://doi.org/10.1016/j.fertnstert.2018.05.034.
- 16.American Society for Reproductive Medicine. Fertility Preservation for Cancer Patients. Reproductive Facts. https://www.reproductivefacts.org/resources/educational-videos/videos/full-length-videos/videos/fertility-preservation-for-cancer-patients/. (2015). Accessed 31 Mar 2019.
- 17.American Society for Reproductive Medicine (2015). Fertility Preservation for Cancer Patients video. YouTube. https://youtu.be/Ii2xFMNlYM8. Published September 14, 2015. Accessed 31 Mar 2019.