PYNK : Breast Cancer Program for Young Women

Abstract

Consider this scenario: A 35-year-old recently married woman is referred to a surgeon because of a growing breast lump. After a core biopsy shows cancer, she undergoes mastectomy for a 6-cm invasive lobular cancer that has spread to 8 axillary nodes. By the time she sees the medical oncologist, she is told that it is too late for a fertility consultation, and she receives a course of chemotherapy. At clinic appointments, she seems depressed and admits that her husband has been less supportive than she had hoped. After tamoxifen is started, treatment-related sexuality problems and the probability of infertility contribute to increasing strain on the couple’s relationship. Their marriage ends two years after the woman’s diagnosis. Six years after her diagnosis, this woman has completed all treatment, is disease-free, and is feeling extremely well physically. However, she is upset about being postmenopausal, and she is having difficulty adopting a child as a single woman with a history of breast cancer. Could this woman and her husband have been offered additional personalized interventions that might have helped them better cope with the breast cancer diagnosis and the effects of treatment? Compared with their older counterparts, young women with breast cancer often have greater and more complex supportive care needs. The present article describes the goals, achievements, and future plans of a specialized interdisciplinary program—the first of its kind in Canada—for women 40 years of age and younger newly diagnosed with breast cancer. The program was created to optimize the complex clinical care and support needs of this population, to promote research specifically targeting issues unique to young women, and to educate the public and health care professionals about early detection of breast cancer in young women and about the special needs of those women after their diagnosis.

Formal Evaluation of PYNK: Breast Cancer Program for Young Women—The Patient Perspective

“…The program also encourages patients to participate in research studies focusing on younger women with breast cancer, a population greatly underrepresented in most breast cancer studies. Details of the services offered by pynk were described in detail in a previous issue of this journal 4 , but are summarized here.…”

“…The breast cancer incidence in young women varies with ethnicity and increases with lower socioeconomic status 3 . Although 88% of young breast cancer patients now survive more than 5 years 1 , this particular age group suffers more than older women both physiologically (from more-aggressive local and systemic treatment, and premature ovarian failure) and psychologically (from body image changes, relationship distress, marital strain, childcare issues, and alienation from healthy peers) 4,5 . Moreover, survival is lower in this population than in their older counterparts.…”

Oncofertility considerations in adolescents and young adults given a diagnosis of melanoma: Fertility risk of Food and Drug Administration–approved systemic therapies

“…31 Several institutions have successfully implemented programs to support female fertility preservation as well. 32,33 …”

Abstract P1-11-10: Young women with breast cancer: Needs and experiences

“…Some cancer programs in the US and in Canada have developed breast cancer programs specifically geared for YWBC with success including the Program for YWBC at the Dana-Farber Cancer Institute in Boston, MA and the PYNK program at Sunnybrook hospital in Toronto, ON (Partridge, Ruddy, Kennedy, & Winer, 2012). A key component to both programs is the utilization of a "nurse navigator" who assists patients with referrals to fertility specialists, genetic counseling, plastic surgery and other informational materials and supportive care services throughout treatment and follow-up (Ali & Warner, 2013). Each patient is also automatically referred to a social worker who provides an initial consultation to determine the supportive care needs and depending on the needs of the situation, may refer the patient to other mental health specialists .…”