Abstract P6-11-09: Physician knowledge and attitudes towards fertility preservation in Mexican young breast cancer patients

Abstract

Background: In Mexico, approximately 30% of young women with breast cancer (YWBC) are childless and >40% express concern about infertility risk secondary to cytotoxic treatment. However, only 30% of patients recall being disclosed by their physician of such risk. The aim of this study was to characterize and analyze the caregivers' behavior, attitudes and knowledge towards fertility preservation in YWBC in a limited resource setting, such as Mexico. Materials and Methods: A 20-item survey was designed and validated by an expert panel, which was answered by participants of the annual meeting of the Mexican Society of Oncology 2016, as well as by physicians affiliated to the same association via web. Pearson chi-square tests were used to assess factors associated with the likelihood of disclosure of infertility risk, discussion about methods of fertility preservation and referral to a reproductive health specialist. Results: The participants' demographic characteristics are displayed in Table 1 and are associated with the main areas of interest in Table 2. Characteristics%Age ≤40y56>40y44Gender Male69Female31Specialty Medical36Surgical53Other12Clinical Practice Public26Private9Both65Knowledge safety subsequent pregnancy Fair64Not fair36Knowledge safety ovulation inductors Fair38Not fair62Knowledge safety GnRH analogues Fair37Not fair63 Inform about infertility riskInform about preservation strategiesRefer to a specialist %p%p%pAge ≤40y56.5 46.2 54.9 >40y44.5.8653.8.00845.1.72Gender Male67.6 73.1 65.4 Female32.4.7226.9.14934.5.24Specialty Medical30.2 31.1 28.4 Surgical57.7 57.7 60.5 Other12.1.579.2.4211.1.18Clinical practice Public19.8 12.6 19.8 Private19.8 21.0 15.4 Both60.4.0266.4.00264.8.51Sense of responsibility Low-Middle8.8 5.0 8.0 High91.2<.00195.5<.00192.0<.001Inform about infertility risk Always--94.1 64.8 Not always--5.9<.00135.2.013 The caregivers' most influential factor in all areas was their self-reported sense of responsibility on disclosing patients about infertility risk. Those physicians that inform patients about infertility risk are statistically more likely to discuss fertility preservation strategies and to refer to a reproductive health specialist. As for the main barriers for fertility preservation, costs were the most frequently mentioned (29.6%), followed by lack of specialists (11.2%), and patient's prognosis according to clinical stage (11.2%). Conclusions: This represents the first Latinamerican study evaluating the YWBC's caregivers' attitudes and practices towards fertility preservation, as well as their general knowledge concerning oncofertility issues. The fact that only one third of the enquired physicians were aware of the safety of ovulation inductors and use of GnRH analogues in YWBC is striking, which may translate into worse survivorship care. Furthermore, physicians reported that access barriers were the most prevalent factors that hindered appropriate referral. Health-care providers play a major role in the timely detection of the patient's interest in future offspring, thus it is crucial to promote knowledge about this relevant topic and endorse policies that can provide universal access to assisted reproductive technologies. Citation Format: Villarreal-Garza CM, Barragan-Carrillo R, Bargallo-Rocha JE, Peña-Curiel O, Martinez-Cannon BA, Platas A, Torres J, Mohar A, Rivera S, Garcia-Valdovino VJ, Garcia-Leon GA, Castro-Sanchez A. Physician knowledge and attitudes towards fertility preservation in Mexican young breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-09.

Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico

“…First, not all Mexican physicians discuss reproductive issues with YWBC, and a substantial proportion wrongly believe that GnRHa are detrimental to their prognosis. 14 Second, GnRHa are seldom covered by public insurances and most patients either lack the resources to afford them or are forced to choose between cryopreserving or receiving GnRHa because of financial constraints. Support from the Mexican public healthcare system through coverage of GnRHa for FP purposes among YWBC, following the examples of countries such as Italy, Sweden, and Israel, 25,30,31 would aid considerably in addressing this need.…”

“…11 However, adherence to these recommendations is often suboptimal in limited-resource countries such as Mexico, presumably because of physicians' lack of knowledge regarding the safety of preservation methods and pregnancy after BC, financial hindrances, scarcity of specialists, and lack of partnerships with reproductive units. [12][13][14] Moreover, in resource-constrained settings such as Mexico, cancer control efforts are mainly focused on providing medical treatment, generally bypassing the survivorship aspects of care. 15 Additionally, preservation strategies are seldom covered by private or governmental healthcare insurances and are unaffordable for most underserved populations.…”