Download Fertility concerns among young women with breast cancer

Session
Fertility and
Pregnancy
13-10-2006
Specific questions
•
•
•
•
•
Risk of premature ovarian failure
Ability to become pregnant
Safety of pregnancy
Influence of BC treatment on offspring
Contraception options
Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005
FL-BBM 2006
2
Fertility concerns among
young women
with breast cancer
Fabienne Liebens MD
Breast Unit- CHU Saint Pierre
Brussels
Fertility concerns among women
with breast cancer
• Why do we need to address this issue?
• To what extent are women with BC
concerned by their fertility?
• How do health professionals communicate
about this matter?
• Guidelines?
FL-BBM 2006
4
Why do we need to address this issue?
Fertility concerns among women with breast cancer
• The incidence of breast cancer has
increased by 0.5% per year over the past
decade, whereas the death rate
decreased by 1.4% per year during the
same period. (Ghafoor A, CA Cancer J Clin 2003).
• 25% of breast cancer cases occur before
the age of menopause,
– 15% occur under the age of 45.
FL-BBM 2006
5
Why do we need to address this issue?
Fertility concerns among women with breast cancer
In Belgium per year
• 30-34 yrs: 125 cases
• 35-39 yrs: 250 cases
• 40-44 yrs: 500 cases
FL-BBM 2006
6
Why do we need to address this issue?
Fertility concerns among women with breast cancer
• Polyagent chemotherapy
– Risk of menopause range
from 13% to 98%
• Variability related to
– Definitions of menopause
– Patient (age) and treatment
characteristics
– Follow up duration
Sonmezer, M. et al. Oncologist 2006;11:422-434
FL-BBM 2006
7
Why do we need to address this issue?
Fertility concerns among women with breast cancer
• There have been
recent advances in
the field of fertility
preservation.
Donnez J et al, 2004
FL-BBM 2006
8
Fertility concerns among women
with breast cancer
• Why do we need to address this issue?
• To what extent are women with BC
concerned by their fertility?
• How do health professionals communicate
about this matter?
• Guidelines?
FL-BBM 2006
9
Web-Based Survey of Fertility Issues in
Young Women With Breast Cancer
•Premenopausal
•Age < = 40
years at the time
of breast cancer
diagnosis.
FL-BBM 2006
Partridge, A. H. et al. J Clin Oncol; 22:4174-4183
2004
10
Web-Based Survey of Fertility Issues in
Young Women With Breast Cancer
• Concerned about becoming
infertile: 57%
– most common among women
who had a desire for future
children regardless of their
age or stage of disease,
• Infertility influenced their
decisions about treatment:
29%
FL-BBM 2006
Partridge, A. H. et al. J Clin Oncol; 22:4174-4183
2004
11
Web-Based Survey of Fertility Issues in
Young Women With Breast Cancer
• Discussion fertility issues: 72%
– 17% discussed these issues with fertility
specialists.
• Satisfaction after discussing the issue:
51%
• Fertility concerns had not been adequately
addressed: 26%
FL-BBM 2006
Partridge, A. H. et al. J Clin Oncol; 22:4174-4183
2004
12
Perceived percentage likelihood of menopause with
therapy among young women with breast cancer
Web-Based Survey of Fertility Issues in Young Women With Breast Cancer
FL-BBM 2006
Partridge, A. H. et al. J Clin Oncol; 22:4174-4183
2004
13
Fertility- Related Information Needs of
Younger Women With Early BC.
May change over time
p <.001
FL-BBM 20062005
Thewes, B. et al. J Clin Oncol; 23:5155-5165
14
Top 10 questions about fertility
Fertility- and Menopause-Related Information Needs of Younger Women With
Early BC.
What should I be doing about contraception?
106
(47.1%)
Am I currently fertile?
94
(41.8%)
Am I going to be able to become pregnant after treatment?
94
(41.8%)
If I become infertile, does it happen immediately?
52
(23.3%)
What are the statistics about my chances of becoming
pregnant?
63
(28.4%)
Would a future pregnancy influence my prognosis (my
chances of a recurrence)?
58
(26%)
Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005
FL-BBM 2006
15
Fertility- Related Information Needs of
Younger Women With Early BC.
Which women were significantly more likely to
rate fertility-related information as extremely
important?
– Younger women,
– Women with plans for childbearing at
diagnosis,
– Women with no children at diagnosis,
– Women who were single.
FL-BBM 20062005
Thewes, B. et al. J Clin Oncol; 23:5155-5165
16
FL-BBM 2006
17
Fertility concerns among women
with breast cancer
• Why do we need to address this issue?
• To what extent are women with BC
concerned by their fertility?
• How do health professionals
communicate about this matter?
• Guidelines?
FL-BBM 2006
18
Discussions Regarding Reproductive
Health for Young Women With Breast
Cancer Undergoing Chemotherapy
• Communication between health
professionals and patients
•Questionnaire interview
•N: 166
•Age < = 45
•Stage I-III
•Before chemotherapy
Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773
FL-BBM 2006
19
Discussions Regarding Reproductive
Health for Young Women With Breast
Cancer Undergoing Chemotherapy
• The median number of
physicians: 4
• All women: oncologist and
surgeon
• More than half: radiation
oncologist,
obstetrician/gynecologist, or
primary care physician.
Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773
FL-BBM 2006
20
Issue discussed
Discussions Regarding Reproductive Health for Young Women With
Breast Cancer Undergoing Chemotherapy
• The possibility of early
menopause: 68%.
• Fertility: 34%.
• Side effects of treatment:
98%.
Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773
FL-BBM 2006
21
Physician discussing side effects by
specialty
Discussions Regarding Reproductive Health for Young Women With
Breast Cancer Undergoing Chemotherapy
Type of Medical Provider
(%)
Medical
Impact
Discussed
Menopause
Fertility
Side effects
Impact on
normal
activities
Percent of All Physicians Discussing
Side Effects, by Specialty
n = number of women reporting seeing that physician
regarding breast cancer.
Surgeon
(n = 144)
Medical
Oncologist
(n = 144)
68.2
34.1
98.5
90.0
61.1
28.5
96.5
84.0
All
Physicians
Family
Practice
(n = 80)
OB/GYN
(n =
144)
Radiation
Oncologist (n
= 83)
24.3
9.0
37.5
41.7
7.2
6.0
44.6
28.9
6.3
2.5
15.0
6.3
13.1
4.8
7.1
2.3
(n =
84)
Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773
FL-BBM 2006
22
Are guidelines available?
FL-BBM 2006
23
ASCO GUIDELINES 2006
Lee, S. J. et al. J Clin Oncol; 24:2917-2931 2006
FL-BBM 2006
24
EUROPA DONNA Working Group for
Young Women with Breast Cancer
Concerns and Priorities
• Raising awareness of breast cancer in young women
amongst gynaecologists and other doctors, through
training
• Being informed about side effects of treatment, such as
hormonal therapy and symptoms of early menopause
• Having access to information about clinical trials, their
results and how to participate in them
• Understanding the fertility issues, the possibilities of
becoming a mother in the future
• Knowing the prospects for adoption and being
eligible as a breast cancer survivor
FL-BBM 2006
25
Conclusion
Fertility concerns among women with breast cancer
• The available evidence suggests that fertility
preservation is of great importance to many
young women diagnosed with breast cancer
• Infertility resulting from cancer treatment may be
associated with psychosocial distress
• Clinicians should not assume that women who
are younger or have better prognoses are more
interested in exploring fertility issues.
FL-BBM 2006
26
Conclusion
Fertility concerns among women with breast cancer
• It may be impossible for physicians to know how
important fertility preservation is to their patients unless
they ask
– about plans for childbearing
– about preferred amount of information when
discussing fertility
• Clinicians should provide information about the impact of
adjuvant treatment on fertility status in a timely fashion
before treatment begins, so that women can explore
fertility-preserving options.
• Participation in clinical trials in centers with the
necessary expertise should be encouraged.
FL-BBM 2006
27
…Fighting Breast Cancer is giving Hope.
Europa Donna Belgium
FL-BBM 2006
28
Top 10 questions about fertility
Fertility- and Menopause-Related Information Needs of Younger Women With
Early BC.
What should I be doing about contraception?
106 (47.1%)
Am I currently fertile?
94 (41.8%)
Am I going to be able to become pregnant after treatment?
94 (41.8%)
What are the risks or benefits of having a child after breast cancer?
41 (18.3%)
How long after treatment can I check whether I'm still fertile?
38 (17%)
What has happened to other breast cancer survivors who have
decided to have children?
42 (18.7%)
Are there any health concerns for children I might have in the future
as a result of my treatment?
30 (13.3%)
If I become infertile, does it happen immediately?
52 (23.3%)
What are the statistics about my chances of becoming
pregnant?
63 (28.4%)
Would a future pregnancy influence my prognosis (my chances of a
recurrence)?
58 (26%)
FL-BBM 20062005
Thewes, B. et al. J Clin Oncol; 23:5155-5165
29