Breast cancer: an update on treatment-related infertility

Silvestris, Erica; Dellino, Miriam; Cafforio, Paola; Paradiso, Angelo; Cormio, Gennaro; D’Oronzo, Stella

doi:10.1007/s00432-020-03136-7

Cited by 29 publications

(17 citation statements)

References 78 publications

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“…A comprehensive analysis of the SOFT results revealed that OFS combined with GnRHa has a similar effect to OA but with clear advantages for premenopausal women [14,30,39]. First, GnRHa has reversible effects and can be discontinued if the patient experiences intolerable symptoms.…”

Section: Introductionmentioning

confidence: 99%

Major depressive symptoms in breast cancer patients with ovarian function suppression: a cross-sectional study comparing ovarian ablation and gonadotropin-releasing hormone agonists

Jiang

Cai

et al. 2021

BMC Psychiatry

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Background Ovarian function suppression (OFS) is indicated in premenopausal women with early or metastasis breast cancer, which may be achieved with similar effect by gonadotropin-releasing hormone agonists (GnRHa) or ovarian ablation (OA). We examined whether there were differences in major depressive symptoms outcomes and its associated factors between gonadotropin-releasing hormone agonists (GnRHa) and ovarian ablation (OA) in premenopausal breast cancer patients. Methods Premenopausal breast cancer patients from seven hospitals who received OFS participated in the study between June 2019 and June 2020. The correlated variable was the type of ovarian suppression, categorized as either OA (n = 174) or GnRHa (n = 389). Major depressive symptoms was evaluated using the Patient Health Questionnaire (PHQ-9), and the Female Sexual Function Index questionnaire was used to assess sexual function. Results A total of 563 patients completed the surveys. The mean PHQ-9 sum score was slightly lower in the GnRHa cohort than in the OA cohort (11.4 ± 5.7 vs. 12.8 ± 5.8, P = 0.079). There were significantly fewer patients with major depressive symptoms (PHQ-9 ≥ 15) in the GnRHa cohort (31.1% vs. 40.2%, Exp (B)=1.805, P=0.004). Further, breast-conserving surgery and sexual dysfunction were negatively correlated with major depressive symptoms [mastectomy vs. breast-conserving: Exp (B) = 0.461, P <0.001;[sexual dysfunction vs. normal: Exp (B) = 0.512, P = 0.001]. Conclusions This is the first study to demonstrate that GnRHa results in more favorable depressive symptoms outcomes than OA. Moreover, most patients preferred alternatives to their OFS treatment. These findings can contribute to improving and alleviating the adverse effects of OFS.

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Section: Introductionmentioning

confidence: 99%

Major depressive symptoms in breast cancer patients with ovarian function suppression: a cross-sectional study comparing ovarian ablation and gonadotropin-releasing hormone agonists

Jiang

Cai

et al. 2021

BMC Psychiatry

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“… 1 Decreased ovarian follicle reserve occurs in more than one-third of patients after breast cancer treatment resulting in permanent infertility. 2 In long-term female survivors of pediatric hema tologic malignancies 26.7% experienced premature ovarian insufficiency and face infertility after cancer treatment. 3 The situation is similar with other cancers; cancer therapy is the cause of premature ovarian failure in 25% of women with this diagnosis.…”

Section: Introductionmentioning

confidence: 99%

In vitro maturation of immature oocytes for fertility preservation in cancer patients compared to control patients with fertility problems in an in vitro fertilization program

Virant‐Klun

Bedenk

Jančar

2021

Radiology and Oncology

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Background The aim of this study was to determine whether in vitro maturation (IVM) of immature oocytes after controlled hormonal stimulation of the ovaries could be important in cancer patients to improve their chances of conception in the future. Patients and methods After ovarian stimulation in cancer patients, the number of oocytes and their quality and maturity were compared to control patients with fertility problems in the in vitro fertilization (IVF) program. In both groups of patients, immature oocytes at the developmental stage of germinal vesicle were matured in vitro and the proportion of oocytes that matured in vitro was compared between groups. In a subset of women with fertility problems, intracytoplasmic sperm injection (ICSI) was performed on IVM oocytes to assess their ability to be fertilized and develop into an embryo compared to vivo matured oocytes in the same cycles and consider the procedure in cancer patients. Results In patients with different cancers, the disease did not affect the number and quality of retrieved oocytes. In cancer patients, there was even a significantly lower proportion of immature oocytes than in patients with fertility problems (30.0% vs. 43.6%; P < 0.05). However, in patients with cancer, fewer oocytes per patient matured in vitro than in patients with fertility problems (1.39 ± 1.04 vs. 2.48 ± 1.83; P < 0.05). After ICSI, the proportions of fertilized oocytes and fertilized oocytes developing into an embryo did not differ between oocytes matured in vitro and in vivo in the same cycles. Conclusions Oocyte IVM is proving to be a reliable procedure for resolving immature oocytes after controlled ovarian stimulation in cancer patients.

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“…More important for clinicians and patients were to understand the state of ovarian function and protect their ovarian function. Ovarian function suppression is being widely utilized as endocrine therapy to reduce estrogen release in premenopausal early and metastatic breast cancer patients [16,17] or as ovarian protector in premenopausal early breast cancer patients prior to adjuvant chemotherapy [18].…”

Section: Introductionmentioning

confidence: 99%

Depression, Sexual dysfunction and Quality of Life Among Breast Cancer Patients with Ovarian Function Suppression: A Cross Sectional Study between Ovarian Ablation Verse GnRH Agonists

Jiang

Cai

et al. 2020

Preprint

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Background: Ovarian function suppression is being widely utilized as endocrine therapy to reduce estrogen release in premenopausal breast cancer patients and was achieved either by medical treatment with bilateral oophorectomy, irradiation, or the Gonadotropin releasing hormone (GnRH) agonist. This study aimed to examine whether GnRHa differed from ovarian ablation on depression, sexual dysfunction and quality of life.Methods: The premenopausal breast cancer patients who received ovarian function suppression were enrolled from seven hospital between June 2019 and June 2020. Our independent variable was the type of ovarian suppression, categorized as Ovarian Ablation (OA cohort, n=174) and medical GnRH agonist (GnRHa cohort, n=389). The self-administered questionnaire (OFS-Q5) was developed and used in this study aimed to assess the depression (PHQ-9), sexual dysfunction (FSFI) and quality of life (EORTC QLQ-BR23).Results: In this cross-sectional study, 563 patients with ovarian function suppression completed surveys were collected. The mean sum score of the PHQ-9 tend to be slight decrease in GnRHa cohort than that in ovarian ablation (OA) cohort (11.4 ±5.7 vs. 12.8 ±5.8, OR=1.910, P=0.079). Patients with major depression (PHQ-9≧15) was indicated significantly fewer in GnRHa cohort (31.1% vs 40.2%, P=0.025). The more surprising correlation is less patients with sexual dysfunction (61.5%, FSFI< 23) in OA cohort, a remarkable increase in GnRHa cohort (72.2%, P = 0.011). The ratio of sexual dysfunction remained lower for ovarian ablation women in long-term ovarian suppression (duration of ovarian suppression > 2 years: OA vs GnRHa, OR=1.555, P=0.037). No significantly difference for most subscales of QLQ-BR23 between two cohorts was evident.Conclusions: Our current investigation demonstrate here for the first time that medical GnRHa resulted in favour depression, worse sexual function than those with ovarian ablation, with similar quality of life. This new understanding should help to improve and alleviate adverse effect in patients with diverse ovarian function suppression.

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Breast cancer: an update on treatment-related infertility

Cited by 29 publications

References 78 publications

Major depressive symptoms in breast cancer patients with ovarian function suppression: a cross-sectional study comparing ovarian ablation and gonadotropin-releasing hormone agonists

Major depressive symptoms in breast cancer patients with ovarian function suppression: a cross-sectional study comparing ovarian ablation and gonadotropin-releasing hormone agonists

In vitro maturation of immature oocytes for fertility preservation in cancer patients compared to control patients with fertility problems in an in vitro fertilization program

Depression, Sexual dysfunction and Quality of Life Among Breast Cancer Patients with Ovarian Function Suppression: A Cross Sectional Study between Ovarian Ablation Verse GnRH Agonists

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