Fertility and Reproductive Considerations in Premenopausal Patients with Breast Cancer

Lee, M. Catherine; Gray, Jhanelle E.; Han, Hyo S.; Plosker, Shayne

doi:10.1177/107327481001700304

Cited by 36 publications

(20 citation statements)

References 65 publications

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“…Because the survival rate of women with BC is increasing,44 consideration of QOL of these patients in terms of emotional well-being, physical functioning, psychosocial well-being, socioeconomic concerns, and behavioral outcomes becomes important. Younger women with BC may have particular concerns about infertility and premature menopause, which are not an issue for postmenopausal women with BC 45,46. Weight gain and physical inactivity as a result of BC therapy might also be a problem resulting in negative body image, decreased libido, and comorbidity associated with obesity 46.…”

Section: Considerations For Payersmentioning

confidence: 99%

Considerations for payers in managing hormone receptor-positive advanced breast cancer

Chitre

Reimers²

2014

CEOR

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Breast cancer (BC) is the second most common cause of death in women. In 2010, the direct cost associated with BC care in the US was $16.5 billion, the highest among all cancers. By the year 2020, at the current rates of incidence and survival, the cost is projected to increase to approximately $20 billion. Although endocrine therapies to manage hormone receptor-positive (HR+) BC are highly effective, endocrine resistance results in disease progression. Increased understanding of endocrine resistance and the mechanisms of disease progression has led to development and subsequent approval of novel targeted treatments, resulting in the expansion of the therapeutic armamentarium to combat HR+ BC. Clear guidelines based on the safety and efficacy of treatment options exist; however, the optimal sequence of therapy is unknown, and providers, payers, and other key players in the health care system are tasked with identifying cost-effective and evidence-based treatment strategies that will improve patient outcomes and, in time, help curb the staggering increase in cost associated with BC care. Safety and efficacy are key considerations, but there is also a need to consider the impact of a given therapy on patient quality of life, treatment adherence, and productivity. To minimize cost associated with overall management, cost-effectiveness, and financial burden that the therapy can impose on patients, caregivers and managed care plans are also important considerations. To help evaluate and identify the optimal choice of therapy for patients with HR+ advanced BC, the available data on endocrine therapies and novel agents are discussed, specifically with respect to the safety, efficacy, financial impact on patients and the managed care plan, impact on quality of life and productivity of patients, and improvement in patient medication adherence.

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Section: Considerations For Payersmentioning

confidence: 99%

Considerations for payers in managing hormone receptor-positive advanced breast cancer

Chitre

Reimers²

2014

CEOR

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“…10 Evidence from the medical and psychological literature examining aspects of fertility, pregnancy and decision-making following a cancer diagnosis have identified a range of factors which may hinder decisionmaking for this patient population. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The barriers identified are diverse including financial concerns (especially in those countries where fertility preservation is not covered by insurance), fear associated with aggravating a hormone-sensitive cancer or a future pregnancy (in terms of a cancer recurrence and/or implications for the health of a future child) and lack of referral to fertility services (eg, due to reasons such as the oncologist prioritising cancer survival).…”

Section: Introductionmentioning

confidence: 99%

Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol

et al. 2017

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IntroductionWomen diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services while undergoing treatment of their cancer with oncology services. Oncologists identify a need for resources enabling them to support women's fertility preservation decisions more effectively; women report wanting more specialist information to make these decisions. The overall aim of the ‘Cancer, Fertility and Me’ study is to develop and evaluate a new evidence-based patient decision aid (PtDA) for women with any cancer considering fertility preservation to address this unmet need.Methods and analysisThis is a prospective mixed-method observational study including women of reproductive age (16 years +) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire, UK. The research involves three stages. In stage 1, the aim is to develop the PtDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information. In stage 2, the aim is to assess the face validity of the PtDA. Feedback on its content and format will be ascertained using questionnaires and interviews with patients, user groups and key stakeholders. Finally, in stage 3 the acceptability of using this resource when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated. This will involve a quantitative and qualitative evaluation of the PtDA in clinical practice. Measures chosen include using count data of the PtDAs administered in clinics and accessed online, decisional and patient-reported outcome measures and qualitative feedback. Quantitative data will be analysed using descriptive statistics, paired sample t-tests and CIs; interviews will be analysed using thematic analysis.Ethics and disseminationResearch Ethics Committee approval (Ref: 16/EM/0122) and Health Research Authority approval (Ref: 194751) has been granted. Findings will be published in open access peer-reviewed journals, presented at conferences for academic and health professional audiences, with feedback to health professionals and program managers. The Cancer, Fertility and Me patient decision aid (PtDA) will be disseminated via a diverse range of open-access media, study and charity websites, professional organisations and academic sources. External endorsement will be sought from the International Patient Decision Aid Standards (IPDAS) Collaboration inventory of PtDAs and other relevant professional organisations, for example, the British Fertility Society.Trial registration numberNCT02753296; pre-results.

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“…This may cause an ethical dilemma for the physician that may be best resolved by addressing the topic of fertility directly with the patient. It is known that up to 1 in 7 patients would be prepared to take compromises in oncological certainty into account if it meant being able to have children later on [14]. At the same time, it is also known that as the patientʼs awareness of the significance of and options for preserving fertility increases, so does the frequency of educating the patients about this and in turn, the use of fertilitypreserving measures [15].…”

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confidence: 99%

Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility – Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours

Findeklee

Lotz

Hoffmann

et al. 2016

Geburtshilfe Frauenheilkd

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Borderline ovarian tumours are semimalignant tumours occurring unilaterally or bilaterally with a peak incidence among women of reproductive age. Since the affected women often wish to preserve fertility, particular precautions must be taken when counselling the patient and obtaining consent prior to planning an individual treatment. Options for preserving fertility include an organ-sparing surgical procedure and cryopreservation of oocytes and/or ovarian tissue. In this article, we report on a 25-year-old patient with a bilateral seromucinous borderline tumour who desired all fertility-preserving options. In order to perform the procedure without delay, we opted to perform luteal phase stimulation prior to oocyte retrieval. We conclude by discussing the current literature on the state of fertility preservation in the treatment of borderline ovarian tumours.

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Fertility and Reproductive Considerations in Premenopausal Patients with Breast Cancer

Cited by 36 publications

References 65 publications

Considerations for payers in managing hormone receptor-positive advanced breast cancer

Considerations for payers in managing hormone receptor-positive advanced breast cancer

Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol

Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility – Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours

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