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A survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients
compatible with achieving pregnancy. This could be considered as a positive indication of potential fertility and advocates storing frozen semen prior to treatment. Supported by: None. P-689 QUALITY OF INFORMATION GIVEN TO YOUNG BREAST CANCER PATIENTS ABOUT FERTILITYAND SEXUALITY AFTER TREATMENT. P. Barriere, C. Menez, D. Allaoua, R. Pioud, J.-M. Classe, P.-F. Dupre. Medecine de la Reproduction, CHU, Nantes, Loire-Atlantique, France, Metropolitan; Chirurgie, Institut Regional du Cancer, Nantes, Loire-Atlantique, France, Metropolitan; Institut de Cancerologie et d’hematologie, CHU, Brest, Bretagne, France, Metropolitan. OBJECTIVE: Quality of information about fertility and sexuality was evaluated in a population of young women with a history of breast cancer. DESIGN: Questionnaire – prospective study – cohort study – long-term follow-up. MATERIALS AND METHODS: Two hundred and sixty-nine women younger than 42 years were repertoried with a diagnosis of breast cancer between 1990 and 2000. A paper-questionnaire was adressed to the 169 survivors. Quality of information received and wish about fertility and sexuality was evaluated. Each questionnaire had a reply-paid envelope and an anonymity code to correlate the answers with clinical caracteristics of the patients. RESULTS: An high response rate to the survey was observed at 71.6%, confirming interest of patients for these topics. Eighteen percent of women reported discussing fertility and pregnancy concerns with their doctors. When women were childless, the percentage of patients informed increases to only 28%. Thirty-eight percent of women desire more information about fertility after breast cancer when considered all the population. When childless, this request increases to 65% of women. Sexual dysfunction after treatment was evaluated on an analogic visual scale at 4.7 3.1 (scale from 0 to 10). This impairing of sexuality was not different whatever the treatment (conservative or non-conservative surgery, use an protocol of chemotherapy, use of Tamoxifen).
P-691
TABLE. Impairing of sexuality
Treatment Surgery Conservative vs. non conservative surgery Tumorectomie vs. Mastectomie avec reconstruction Mastectomy with reconstructive surgery vs. Chemotherapy With chemotherapy vs. Tamoxifen With tamoxifen vs.
Impairing of sexuality P 4.5 3.1 vs. 5 3 0.2 4.5 3.1 vs. 5 3 0.5 5 3 vs. 5 3
0.4
5 3 vs. 3.9 2.9 0.16 5.6 3.3 vs. 4.4 3 0.2
Fifty-nine percent of women asked from more information about sexuality (68% when childless). CONCLUSIONS: Breast cancer treatment induces amenorrhea resulting from premature ovarian failure. Young patients desire information about sexuality and fertility, especially when childless. This information is insufficient according to patients. Counseling all women regarding the impact of treatment on their reproductive health is essential from both ethical and legal standpoint. Fertility and sexuality must be discussing before and during treatment and preferably by fertility specialist. Supported by: None. P-690 A SURVEY OF ONCOLOGISTS REGARDING TREATMENTRELATED INFERTILITY AND FERTILITY PRESERVATION IN FEMALE CANCER PATIENTS. E. Forman, M. Behera, C. K. Anders, P. C. Leppert. Obstetrics & Gynecology, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC. OBJECTIVE: Improved cancer therapies and delayed childbearing have led to a rising number of female cancer survivors interested in fertility pres-
S336
Abstracts
ervation. The American Society for Reproductive Medicine recommends that oncologists routinely discuss options for fertility preservation. Although surveys have addressed oncologists’ attitudes regarding sperm banking in male cancer patients, this is the first survey of oncologists, to our knowledge, focusing on female patients. The goal of this study is to assess oncologists’ knowledge and practices related to fertility preservation in female patients. DESIGN: A 19-item survey was emailed to 91 oncologists, excluding gynecologic oncologists, at Duke University. MATERIALS AND METHODS: A survey was designed and data was collected using www.surveymonkey.com. E-mail addresses were obtained from faculty listings. RESULTS: There was a 40% response rate (36/91). The majority of oncologists (61%) usually discuss the impact treatment will have on fertility. Common reasons for not discussing the impact included poor prognosis (53%) and need for immediate therapy (24%). Nearly half (44%) never refer women to reproductive specialists. Only 15% routinely refer. The most common reason for not referring was patient disinterest in preserving fertility (39%). Most oncologists were aware of techniques such as IVF with embryo cryopreservation (97%), oocyte cryopreservation (97%), ovarian tissue cryopreservation (85%) and ovarian suppression with GnRH agonists (85%). Most (72%) knew that alkylating agents are considered the most gonadotoxic class of chemotherapeutics. All agreed that oncologists have a responsibility to inform patients that treatments may permanently impair fertility. Respondents who attended an educational Grand Rounds on ‘‘Fertility Among Cancer Survivors’’ (11/35) were more likely to consider a patient’s desire for future fertility when planning her treatment (46% vs. 36% of those who did not attend). More than half (54%) were willing to consider a less aggressive regimen to preserve fertility, compared with 29% of those who did not attend. CONCLUSIONS: Infertility is a common concern of female cancer patients. Most oncologists recognize the importance of discussing infertility risks with patients. In practice, however, many do not discuss fertility preservation due to the emergent need to start therapy. Increasing awareness through educational events may influence current practice patterns and increase collaboration between reproductive endocrinologists and oncologists. Supported by: None.
THE WISH FOR PREGNANCY AFTER BREAST CANCER, RESULTS OF A FRENCH SURVEY ON YOUNG BREAST CANCER PATIENTS. P. Barriere, C. Menez, D. Allaoua, F. Dravet, J.-M. Classe, P.-F. Dupre. Medecine de la Reproduction, CHU, Nantes, Loire-Atlantique, France, Metropolitan; Chirurgie, Institut Regional du Cancer Nantes-Atlantique, Nantes, Loire-Atlantique, France, Metropolitan; Institut de Cancerologie et d’Hematologie, CHU, Brest, Loire-Atlantique, France, Metropolitan. OBJECTIVE: The aim of the study was to evaluate the wish for pregnancy in a population of young women with history of breast cancer. DESIGN: Prospective study. Cohort study. Long-term follow-up. MATERIALS AND METHODS: Between 1990 and 2000, 269 women younger than 42 years were repertoried with a diagnosis of breast cancer. A questionnaire about fertility, motherhood and gynecologic symptoms was send to the 169 survivors. Each questionnaire had a reply-paid envelope and an anonyme code to correlate the answers with clinical characteristics of the patients. RESULTS: The response rate to the survey was 72%. The mean age at diagnosis was 37 years old. Participating patients presented with 14% in-situ carcinoma and 86% infiltrating carcinoma. Before cancer, the patients had a mean of 1,7 children and 73% had at least 1 child. After treatment, 25 patients (18%) want a pregnancy . This motherhood was not amplified by childless but enhances to 44% when women aged %30 years. In our study, 5 women gave birth after breast cancer (concerning only 20% of patients willing to conceive). Four reasons were given in favor of chilbirth: wish to have siblings for the existing children (32%), nurturance (32%), giving meaning to life (32%), normative behavior (36%). Four reasons were given against childbirth: risk of breast cancer recurrence (30%), premature ovarian failure (POF) after treatment (21%), advice against pregnancy by physicians (18%), number of children achieved (67%). Patients received chemotherapy (78%) with anthracycline for 98% of treatments. After treatment, 49% declared amenorrhea. It was definitive for 48,5%. The number of patients with amenorrhea increases with age (36% when <35 years old; 51,8% when R40 years old). CONCLUSIONS: Wish for pregnancy after breast cancer is high, especially when women are younger than 30 years old. Only a minority of women gave birth after treatment. The motherhood is altered by POF resulting from chemotherapy. Recovery of cycles after amenorrhea, frequently associated with POF, could not be taken in account to reassure patient about their
Vol. 88, Suppl 1, September 2007
P-691
TABLE. Impairing of sexuality
Treatment Surgery Conservative vs. non conservative surgery Tumorectomie vs. Mastectomie avec reconstruction Mastectomy with reconstructive surgery vs. Chemotherapy With chemotherapy vs. Tamoxifen With tamoxifen vs.
Impairing of sexuality P 4.5 3.1 vs. 5 3 0.2 4.5 3.1 vs. 5 3 0.5 5 3 vs. 5 3
0.4
5 3 vs. 3.9 2.9 0.16 5.6 3.3 vs. 4.4 3 0.2
Fifty-nine percent of women asked from more information about sexuality (68% when childless). CONCLUSIONS: Breast cancer treatment induces amenorrhea resulting from premature ovarian failure. Young patients desire information about sexuality and fertility, especially when childless. This information is insufficient according to patients. Counseling all women regarding the impact of treatment on their reproductive health is essential from both ethical and legal standpoint. Fertility and sexuality must be discussing before and during treatment and preferably by fertility specialist. Supported by: None. P-690 A SURVEY OF ONCOLOGISTS REGARDING TREATMENTRELATED INFERTILITY AND FERTILITY PRESERVATION IN FEMALE CANCER PATIENTS. E. Forman, M. Behera, C. K. Anders, P. C. Leppert. Obstetrics & Gynecology, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC. OBJECTIVE: Improved cancer therapies and delayed childbearing have led to a rising number of female cancer survivors interested in fertility pres-
S336
Abstracts
ervation. The American Society for Reproductive Medicine recommends that oncologists routinely discuss options for fertility preservation. Although surveys have addressed oncologists’ attitudes regarding sperm banking in male cancer patients, this is the first survey of oncologists, to our knowledge, focusing on female patients. The goal of this study is to assess oncologists’ knowledge and practices related to fertility preservation in female patients. DESIGN: A 19-item survey was emailed to 91 oncologists, excluding gynecologic oncologists, at Duke University. MATERIALS AND METHODS: A survey was designed and data was collected using www.surveymonkey.com. E-mail addresses were obtained from faculty listings. RESULTS: There was a 40% response rate (36/91). The majority of oncologists (61%) usually discuss the impact treatment will have on fertility. Common reasons for not discussing the impact included poor prognosis (53%) and need for immediate therapy (24%). Nearly half (44%) never refer women to reproductive specialists. Only 15% routinely refer. The most common reason for not referring was patient disinterest in preserving fertility (39%). Most oncologists were aware of techniques such as IVF with embryo cryopreservation (97%), oocyte cryopreservation (97%), ovarian tissue cryopreservation (85%) and ovarian suppression with GnRH agonists (85%). Most (72%) knew that alkylating agents are considered the most gonadotoxic class of chemotherapeutics. All agreed that oncologists have a responsibility to inform patients that treatments may permanently impair fertility. Respondents who attended an educational Grand Rounds on ‘‘Fertility Among Cancer Survivors’’ (11/35) were more likely to consider a patient’s desire for future fertility when planning her treatment (46% vs. 36% of those who did not attend). More than half (54%) were willing to consider a less aggressive regimen to preserve fertility, compared with 29% of those who did not attend. CONCLUSIONS: Infertility is a common concern of female cancer patients. Most oncologists recognize the importance of discussing infertility risks with patients. In practice, however, many do not discuss fertility preservation due to the emergent need to start therapy. Increasing awareness through educational events may influence current practice patterns and increase collaboration between reproductive endocrinologists and oncologists. Supported by: None.
THE WISH FOR PREGNANCY AFTER BREAST CANCER, RESULTS OF A FRENCH SURVEY ON YOUNG BREAST CANCER PATIENTS. P. Barriere, C. Menez, D. Allaoua, F. Dravet, J.-M. Classe, P.-F. Dupre. Medecine de la Reproduction, CHU, Nantes, Loire-Atlantique, France, Metropolitan; Chirurgie, Institut Regional du Cancer Nantes-Atlantique, Nantes, Loire-Atlantique, France, Metropolitan; Institut de Cancerologie et d’Hematologie, CHU, Brest, Loire-Atlantique, France, Metropolitan. OBJECTIVE: The aim of the study was to evaluate the wish for pregnancy in a population of young women with history of breast cancer. DESIGN: Prospective study. Cohort study. Long-term follow-up. MATERIALS AND METHODS: Between 1990 and 2000, 269 women younger than 42 years were repertoried with a diagnosis of breast cancer. A questionnaire about fertility, motherhood and gynecologic symptoms was send to the 169 survivors. Each questionnaire had a reply-paid envelope and an anonyme code to correlate the answers with clinical characteristics of the patients. RESULTS: The response rate to the survey was 72%. The mean age at diagnosis was 37 years old. Participating patients presented with 14% in-situ carcinoma and 86% infiltrating carcinoma. Before cancer, the patients had a mean of 1,7 children and 73% had at least 1 child. After treatment, 25 patients (18%) want a pregnancy . This motherhood was not amplified by childless but enhances to 44% when women aged %30 years. In our study, 5 women gave birth after breast cancer (concerning only 20% of patients willing to conceive). Four reasons were given in favor of chilbirth: wish to have siblings for the existing children (32%), nurturance (32%), giving meaning to life (32%), normative behavior (36%). Four reasons were given against childbirth: risk of breast cancer recurrence (30%), premature ovarian failure (POF) after treatment (21%), advice against pregnancy by physicians (18%), number of children achieved (67%). Patients received chemotherapy (78%) with anthracycline for 98% of treatments. After treatment, 49% declared amenorrhea. It was definitive for 48,5%. The number of patients with amenorrhea increases with age (36% when <35 years old; 51,8% when R40 years old). CONCLUSIONS: Wish for pregnancy after breast cancer is high, especially when women are younger than 30 years old. Only a minority of women gave birth after treatment. The motherhood is altered by POF resulting from chemotherapy. Recovery of cycles after amenorrhea, frequently associated with POF, could not be taken in account to reassure patient about their
Vol. 88, Suppl 1, September 2007