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Session Fertility and Pregnancy

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.

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Session Fertility and Pregnancy

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  1. Session Fertility andPregnancy 13-10-2006

  2. 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

  3. Fertility concerns among young women with breast cancer Fabienne Liebens MD Breast Unit- CHU Saint Pierre Brussels

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Perceived percentage likelihood of menopause with therapy among young women with breast cancerWeb-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

  14. Fertility- Related Information Needs of Younger Women With Early BC. May change over time p <.001 FL-BBM 2006 Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005

  15. Top 10 questions about fertilityFertility- and Menopause-Related Information Needs of Younger Women With Early BC. Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005 FL-BBM 2006

  16. Fertility- Related Information Needs of Younger Women With Early BC. • Younger women, • Women with plans for childbearing at diagnosis, • Women with no children at diagnosis, • Women who were single. Which women were significantly more likely to rate fertility-related information as extremely important? FL-BBM 2006 Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005

  17. FL-BBM 2006

  18. 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

  19. 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

  20. 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

  21. Issue discussedDiscussions 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

  22. Type of Medical Provider (%) Medical Impact Discussed All Physicians (n = 144) Medical Oncologist (n = 144) Surgeon (n = 144) Radiation Oncologist (n = 83) Family Practice (n = 80) OB/GYN (n = 84) Menopause 68.2 61.1 24.3 7.2 6.3 13.1 Fertility 34.1 28.5 9.0 6.0 2.5 4.8 Side effects 98.5 96.5 37.5 44.6 15.0 7.1 Impact on normal activities 90.0 84.0 41.7 28.9 6.3 2.3 Physician discussing side effects by specialtyDiscussions Regarding Reproductive Health for Young Women With Breast Cancer Undergoing Chemotherapy Percent of All Physicians Discussing Side Effects, by Specialty n = number of women reporting seeing that physician regarding breast cancer. Duffy CM, Journal of Clinical Oncology, Vol 23, No 4, 2005: pp. 766-773 FL-BBM 2006

  23. Are guidelines available? FL-BBM 2006

  24. ASCO GUIDELINES 2006 Lee, S. J. et al. J Clin Oncol; 24:2917-2931 2006 FL-BBM 2006

  25. EUROPA DONNA Working Group for Young Women with Breast CancerConcerns 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

  26. ConclusionFertility 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

  27. ConclusionFertility 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

  28. …Fighting Breast Cancer is giving Hope. Europa Donna Belgium FL-BBM 2006

  29. Top 10 questions about fertilityFertility- and Menopause-Related Information Needs of Younger Women With Early BC. FL-BBM 2006 Thewes, B. et al. J Clin Oncol; 23:5155-5165 2005

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