Abstract P3-12-06: Fertility concerns and their impact on hormonal therapy decisions in young breast cancer survivors
Authors: Poorvu PD , Ruddy KJ , Gelber SI , Tamimi RM , Peppercorn J , Schapira L , Borges VF , Come SE , Partridge AH , Rosenberg SM 
Published: February 2018

Background: Fertility is a critical issue for young breast cancer (BC) survivors and can be diminished by adjuvant chemotherapy or by age-related decline in ovarian reserve over time. Little is known about how fertility concerns affect decision-making and persistence with endocrine therapy (ET) given the standard 5-10 year duration of therapy during which pregnancy is contraindicated.

Methods: As part of a multi-center, prospective cohort study enrolling women with newly diagnosed (dx) BC at age ≤40 years between 2006-2016, we identified participants with HR+, Stage I-III BC, without documented recurrence and with at least 3 years of follow-up. Participants completed serial surveys that include questions about socio-demographics, fertility issues and outcomes, treatment, and decision-making. ET use and pregnancy outcomes were evaluated up to 5 years post-dx (mean follow-up: 4.4 years). We used t-tests and chi-square tests to evaluate differences between women who indicated at least once in the first 2 years following diagnosis that fertility concerns affected their ET decisions and those who did not, and multi-variable logistic regression to identify factors independently associated (p≤0.05) with indicating ET decisions were affected by fertility concerns.

Results: Among 479 women included in this analysis, 33% (156/479) indicated that fertility concerns affected their decision regarding hormonal therapy – by choosing to defer treatment, stop early, or indicating that they may stop early or interrupt at a future time. Among these women, 44% (67/156) did not initiate or stopped ET (at least temporarily) vs. 21% (68/323) among women who did not indicate that fertility concerns affected their decision (p&lt;0.0001). Among the 67 women with fertility concerns who did not initiate/discontinued ET, 29 (43%) subsequently reported a pregnancy within 5 years of dx. Women who were younger at dx, not partnered, nulliparous, and those who had a pre-treatment discussion about fertility with a provider were more likely to indicate that fertility concerns affected their ET decision (Table). In multi-variable analyses, only no or low parity remained significant: no children at diagnosis vs. ≥2 OR 9.86, 95% CI: 5.19-18.75, 1 child at diagnosis vs. ≥2: OR 6.28, 95% CI: 3.18-12.39.

Conclusion: Concern about fertility is a contributor to ET decisions among a significant number of young women with HR+ BC. Ongoing research, including the POSITIVE trial (NCT 02308085), an international study that is exploring the safety and feasibility of interrupting ET for pregnancy after HR+ BC, will provide much needed evidence that will help inform and guide both patients and providers as they make fertility and treatment decisions.

Table Fertility concerns affected decisionFertility concerns did not affect decisionpAge at dx - mean (SD)34.0 (3.8)36.3 (3.8)&lt;0.0001Stage  0.17172 (46)128 (40) 269 (44)146 (45) 315 (10)49 (15) Chemo  0.41Yes112 (73)247 (77) No41 (27)75 (23) Radiation  0.96Yes98 (64)205 (64) No56 (36)116 (36) Partnered  &lt;0.0001Yes106 (69)272 (84) No48 (31)50 (16) Children pre-diagnosis  &lt;0.0001094 (64)73 (23) 131 (21)43 (14) &gt; 2 children22 (15)197 (63) Pre-treatment fertility discussion  0.0003Yes127 (88)225 (73) No17 (12)84 (27) 

Citation Format: Poorvu PD, Ruddy KJ, Gelber SI, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Partridge AH, Rosenberg SM. Fertility concerns and their impact on hormonal therapy decisions in young breast cancer survivors [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 P3-12-06.