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Perception and needs of reproductive specialists with regard to fertility preservation of young breast cancer patients

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Treatment-related infertility is one of the important quality-of-life issues in young breast cancer (YBC) patients. Although existing guidelines recommend supporting fertility preservation (FP) of YBC, the perceptions of reproductive specialists (RS) has not been evaluated. We investigated the perceptions and needs of RS with regard to FP of YBC patients.

Methods

A cross-sectional survey was sent to 423 certified RS registered to the Japan Society for Reproductive Medicine to self-evaluate their perceptions and needs regarding FP in YBC patients.

Results

Two hundred RS (47 %) responded to the survey. 99 % responded that RS should be engaged in FP of YBC patients. 88 % responded that they would like to treat YBC patients, while 46 % responded that cancer treatment is more important than childbirth, even when the patient is recurrence-free 5 years after primary treatment. Respondents affiliated to private clinics were more likely to accept both fertilized and unfertilized egg preservation than those affiliated with academic or general hospitals. 70 % responded that they were anxious about treating breast cancer patients: concerns regarding a greater or unknown risk of recurrence (66 %), insufficient knowledge about breast cancer (47 %), and lack of a patient’s spouse/partner (24 %) were identified as major barriers in supporting FP for YBC patients.

Conclusions

RS recognize the need for FP in YBC patients and are willing to participate in their care. Affiliation of RS was related to a positive attitude to egg preservation. Various concerns regarding FP among RS indicate the need for evidence that supports the safety of FP, inter-disciplinary communication, and practice guidelines.

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Acknowledgments

We thank Ms. Masayo Kawamura for her support in data collection and Dr. Richard Theriault of University of Texas, M. D. Anderson Cancer Center for his generous help in editing and reviewing this manuscript. This study was supported by a Health Labor Sciences Research Grant of the Ministry of Health, Labor and Welfare (H21-021) and Third Term Comprehensive 10-year Strategy for Cancer Control (H24-Sanjigan-Ippan-010). The results of this study were partly presented at the 35th Annual San Antonio Breast Cancer Symposium.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Breast and Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Chikako Shimizu & Yasuhiro Fujiwara

  2. Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan

    Tomoyasu Kato

  3. Breast and Endocrine Surgery Division, Department of Surgical Oncology, Toranomon Hospital, Tokyo, Japan

    Nobuko Tamura

  4. Breast and Endocrine Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaragi, Japan

    Hiroko Bando

  5. Asada Ladies Clinic, Nagoya, Japan

    Yoshimasa Asada

  6. Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan

    Yuri Mizota & Seiichiro Yamamoto

Authors
  1. Chikako Shimizu
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  2. Tomoyasu Kato
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  3. Nobuko Tamura
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  4. Hiroko Bando
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  5. Yoshimasa Asada
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  6. Yuri Mizota
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  7. Seiichiro Yamamoto
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  8. Yasuhiro Fujiwara
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Corresponding author

Correspondence to Chikako Shimizu.

Appendix

Appendix

This is an English translation of the survey (the original version is in Japanese).

Section A: demographic, medical training, and practice information

  1. 1.

    How old are you?

  2. 2.

    What is your gender?

  3. 3.

    Do you have a partner/spouse?

  4. 4.

    Do you have any children?

  5. 5.

    What kind of institution are you affiliated to?

  6. 6.

    How large is your institution?

  7. 7.

    Do you have a breast oncology unit in your institution?

  8. 8.

    How many years have you served as a clinician?

  9. 9.

    How many years have you specialised in reproductive medicine?

  10. 10.

    Have you ever specialised in cancer management?

  11. 11.

    Do you have any cancer patients among your family or close friends?

Section B: attitude to fertility preservation of young women with breast cancer

  1. 1.

    I think that RS should be engaged in FP of breast cancer patients.

  2. 2.

    I think that it is difficult for cancer patients to pursue FP because of the risk of dying from cancer.

  3. 3.

    I am concerned about hereditary breast cancer when treating breast cancer patients.

  4. 4.

    I think that patients are concerned about hereditary transmission of cancer to their offspring.

  5. 5.

    I think that cancer treatment is more important even if the patient has been disease free for 5 years since the initial diagnosis.

Section C: interpretation of available evidence regarding fertility issues in breast cancer patients

  1. 1.

    I think that pregnancy after cancer increases the risk of recurrence and progression of breast cancer.

  2. 2.

    I think that cancer chemotherapy increases risk of miscarriage or teratism during subsequent pregnancy.

  3. 3.

    I think that luteinizing-hormone releasing-hormone agonists are useful for ovarian protection during chemotherapy.

  4. 4.

    I think that ovulation stimulation using letrozole will have an influence on breast cancer.

Section D: practice behavior with infertile women without cancer

  1. 1.

    I talk about the potential risk of development of cancer to my patients.

  2. 2.

    How many patients a week do you take care of in a typical week?

  3. 3.

    How many egg retrievals do you perform in a typical week?

  4. 4.

    How many fertilized egg preservations do you perform in a typical week?

  5. 5.

    How many unfertilized egg preservations do you perform in a typical week?

  6. 6.

    What kind of ovulation methods would you use for ovulation induction? Circle “Yes, I use it.” or “No, I don’t use it.” for each ovulation stimulation method listed.

Section E: practice behavior with women with breast cancer

  1. 1.

    Have you had any clinical experience of treating breast cancer patients? If yes, how many patients have you treated in the past 2 years (2010–2011).

  2. 2.

    I would like to accept breast cancer patients as my clients.

  3. 3.

    What kind of ovulation methods would you use for ovulation induction in breast cancer patients? Circle “Yes, I use it.” or “No, I don’t use it.” for each ovulation stimulation method listed.

  4. 4.

    I think that the method of ovulation induction should be modified in breast cancer patients.

  5. 5.

    Can you accept married breast cancer patients for fertilized egg preservation in your affiliating institution?

  6. 6.

    Can you accept unmarried breast cancer patients for unfertilized egg preservation in your affiliating institution?

  7. 7.

    I feel anxiety or barriers to treating FP of breast cancer patients.

  8. 8.

    Please circle the items that give you cause for anxiety or barriers. Multiple selections are allowed.

Section F: the needs for developing a system to support FP in breast cancer patients from a reproductive specialist’s perspective

  1. 1.

    We are planning to develop a program to support YBC patients who wish for future fertility. Please describe, using your expertise, your opinion on what kind of information or system is necessary to build such a program.

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Shimizu, C., Kato, T., Tamura, N. et al. Perception and needs of reproductive specialists with regard to fertility preservation of young breast cancer patients. Int J Clin Oncol 20, 82–89 (2015). https://doi.org/10.1007/s10147-014-0676-4

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  • DOI: https://doi.org/10.1007/s10147-014-0676-4

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