Factors Associated With the Discussion of Fertility Preservation in a Cohort of 1,357 Young Breast Cancer Patients Receiving Chemotherapy

Alice Hours; Aullene Toussaint; Victoire De Castelbajac; Camille Sautter; Julie Borghese; Sophie Frank; Florence Coussy; Enora Laas; Beatriz Grandal; Elise Dumas; Eric Daoud; Julien Guerin; Thomas Balezeau; Jean-Guillaume Feron; Virginie Fourchotte; Youlia Kirova; Florence Lerebours; Jean-Yves Pierga; Eugénie Guillot; Pietro Santulli; Michael Grynberg; Charlotte Sonigo; Emmanuel Reyrat; Pauline Soibinet-Oudot; Fabien Reyal; Anne-Sophie Hamy

doi:10.3389/fonc.2021.701620

Factors Associated With the Discussion of Fertility Preservation in a Cohort of 1,357 Young Breast Cancer Patients Receiving Chemotherapy

Front Oncol. 2021 Sep 28:11:701620. doi: 10.3389/fonc.2021.701620. eCollection 2021.

Authors

Alice Hours¹, Aullene Toussaint^{1

2

3}, Victoire De Castelbajac^{2

4}, Camille Sautter¹, Julie Borghese³, Sophie Frank², Florence Coussy², Enora Laas^{1

2}, Beatriz Grandal³, Elise Dumas³, Eric Daoud³, Julien Guerin⁵, Thomas Balezeau⁵, Jean-Guillaume Feron¹, Virginie Fourchotte¹, Youlia Kirova⁶, Florence Lerebours³, Jean-Yves Pierga³, Eugénie Guillot¹, Pietro Santulli⁷, Michael Grynberg^{8

9}, Charlotte Sonigo⁸, Emmanuel Reyrat¹⁰, Pauline Soibinet-Oudot¹¹, Fabien Reyal^{1

3}, Anne-Sophie Hamy^{1

2

3}

Affiliations

¹ Department of Surgery, Institut Curie, University Paris, Paris, France.
² Department of Medical Oncology, Institut Curie, University Paris, Paris, France.
³ Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France.
⁴ Sénopole Hôpital Saint Louis, Assistance Publique - Hôpitaux de Paris, University Paris, Paris, France.
⁵ Data Factory, Institut Curie, Paris, France.
⁶ Department of Radiation Therapy, Institut Curie, Paris, France.
⁷ Department of Obstetrics and Gynecology, Hôpital Cochin, University Paris, Paris, France.
⁸ Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart, France.
⁹ Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France.
¹⁰ Department of Data and Informatics, Unicancer, Paris, France.
¹¹ Department of Medical Oncology, Godinot Institute, Reims, France.

Abstract

Purpose: Female breast cancer (BC) patients exposed to gonadotoxic chemotherapy are at risk of future infertility. There is evidence of disparities in the discussion of fertility preservation for these patients. The aim of the study was to identify factors influencing the discussion of fertility preservation (FP).

Material and methods: We analyzed consecutive BC patients treated by chemotherapy at Institut Curie from 2011-2017 and aged 18-43 years at BC diagnosis. The discussion of FP was classified in a binary manner (discussion/no discussion), based on mentions present in the patient's electronic health record (EHR) before the initiation of chemotherapy. The associations between FP discussion and the characteristics of patients/tumors and healthcare practitioners were investigated by logistic regression analysis.

Results: The median age of the 1357 patients included in the cohort was 38.7 years, and median tumor size was 30.3 mm. The distribution of BC subtypes was as follows: 702 luminal BCs (58%), 241 triple-negative breast cancers (TNBCs) (20%), 193 HER2⁺/HR⁺ (16%) and 81 HER2⁺/HR^- (6%). All patients received chemotherapy in a neoadjuvant (n=611, 45%) or adjuvant (n= 744, 55%) setting. A discussion of FP was mentioned for 447 patients (33%). Earlier age at diagnosis (discussion: 34.4 years versus no discussion: 40.5 years), nulliparity (discussion: 62% versus no discussion: 38%), and year of BC diagnosis were the patient characteristics significantly associated with the mention of FP discussion. Surgeons and female physicians were the most likely to mention FP during the consultation before the initiation of chemotherapy (discussion: 22% and 21%, respectively). The likelihood of FP discussion increased significantly over time, from 15% in 2011 to 45% in 2017. After multivariate analysis, FP discussion was significantly associated with younger age, number of children before BC diagnosis, physicians' gender and physicians' specialty.

Conclusion: FP discussion rates are low and are influenced by patient and physician characteristics. There is therefore room for improvement in the promotion and systematization of FP discussion.

Keywords: breast cancer; chemotherapy; discussion; fertility preservation; oncofertility.

Copyright © 2021 Hours, Toussaint, De Castelbajac, Sautter, Borghese, Frank, Coussy, Laas, Grandal, Dumas, Daoud, Guerin, Balezeau, Feron, Fourchotte, Kirova, Lerebours, Pierga, Guillot, Santulli, Grynberg, Sonigo, Reyrat, Soibinet-Oudot, Reyal and Hamy.