Fertility Concerns May Affect Breast Cancer Patients’ Treatment Decisions Over their Cancer Care Journey

For young women with breast cancer, concerns about how certain treatments may affect their fertility might play a significant role in treatment-related decisions, according to a study.

Fertility concerns not only affected whether women would initiate certain treatments, but it may also play a role in whether they continue treatment over time, emphasizing the need for patients’ cancer care teams to have conversations about what the patient’s goals are.

“Young women with breast cancer face unique challenges, including issues surrounding fertility,” said lead study author Tal Sella, MD, of the Dana-Farber Cancer Institute, in a press release. “For many premenopausal women with hormone receptor-positive breast cancer, long-term endocrine therapy [which blocks hormones that feed the cancer’s growth] may prevent patients from having children while treatment is under way. In this study, we explored the degree to which fertility concerns affect patients’ decisions about receiving such therapy.”

Dr. Sella and fellow researchers surveyed 643 women aged 40 years or younger with hormone receptor-positive, stage I to III breast cancer. The women were asked about fertility concerns, as well as preferences for and use of endocrine therapy (ET).

A third of women said fertility concerns affected their decisions surrounding ET treatment. The only factor that seemed to be associated with this concern was parity at the time they were diagnosed. Women who had never given birth as well as women with only one child were much more likely than those who had at least two children to say they had concerns about fertility.

Fertility concerns affected women even after they decided on treatment, as those who had concerns had higher noninitaition/nonpersistance than those for whom fertility was not a concern (40% vs 20%; P<0.0001).

Overall, 7% of the women with fertility concerns about ET opted not to initiate the treatment, and over five years, a third of these women were nonpersistent with treatment. Of the 85 women who either did not initiate or remain persistent, two-thirds had at least one pregnancy or pregnancy attempt, and at the last follow-up available over five years, 15 of these women had resumed ET.

The study was published in Cancer.

“Concern about fertility is a contributor to adjuvant ET decisions among a substantial proportion of young breast cancer survivors. Ensuring family planning is addressed in the setting of ET recommendations should be a priority throughout the cancer care continuum,” the researchers concluded.