Abstract P6-12-01: Attitudes and practice of breast surgeons towards referring young women with breast cancer (YWBC) for fertility preservation (FP)
Authors: Warner E , Yee S , Glass K , Kennedy E , Foong S , Seminsky M 
Published: May 2016

Background: Despite ASCO guidelines (2006, 2013) recommending that young cancer patients be offered referral for FP as soon as possible after diagnosis, the literature consistently shows suboptimal referral rates for YWBC. Surgeons are in a unique position to initiate early FP referral. Surgeon & Patient Oncofertility Knowledge Enhancement (SPOKE) is one of 5 components of the pan-Canadian RUBY research program for YWBC. SPOKE aims to improve breast surgeon FP knowledge and referral rates. The lead surgeon from each of the RUBY sites was previously interviewed about FP. The goal of the current survey was to assess the baseline oncofertility attitudes and practice of the non-lead breast surgeons at those sites.

Methods: An online survey taking approximately 10 minutes to complete was developed specifically for this study. In February 2015, an email invitation with a hyperlink to the anonymous survey was sent to all 86 surgeons identified by the 23 lead surgeons. Repeated reminders were sent by the research assistant over 3 months and a final request was sent by the PI. Participants received a $25 gift certificate.

Results: A total of 55/86 (64%) surgeons with an average of 15 years' surgical practice completed the survey. 53% were male, 56% were under age 50, and 93% worked at a cancer centre or university-affiliated hospital. Thirty respondents (55%) indicated that more than half of their practice was breast cancer. Twenty (36%) never or rarely initiated a fertility discussion, and 23 (42%) never or rarely discussed FP options with their YWBC. Twenty-two respondents (40%) stated it was the duty of the medical oncology rather than the surgical team to initiate fertility discussions. Only a minority were quite or very familiar with egg freezing (n=10, 19%) and embryo freezing (n=11, 20%), while only 7 (13%) felt comfortable discussing egg or embryo freezing with their patients. Twenty-four (44%) did not know a FP centre in their area to which they could refer. Compared to surgeons who assumed responsibility for fertility discussion, surgeons who did not think FP referral was their clinical responsibility were less familiar with egg freezing (21% vs. 63%, p&lt;.001) and embryo freezing (32% vs. 73%, p&lt;.01), and were less likely to know where to send FP referrals (31% vs. 85%, p&lt;.05). The most common patient factors that surgeons stated would deter them from FP referral were: poor prognosis, need to start chemotherapy urgently, and already having children. A quarter of surgeons said they would be less likely to refer a highly anxious YWBC for FP.

Conclusions: Many Canadian breast surgeons are unaware of the importance of early FP referral and nearly half surveyed did not consider FP referral to be their mandate. A majority of these surgeons lack sufficient oncofertility knowledge to feel comfortable mentioning FP options to their patients, and have not created a protocol for FP referral by the surgical team. In the next phases of the SPOKE study, a knowledge translation intervention will be developed and its effectiveness tested.

Support: Canadian Breast Cancer Foundation & Canadian Institute of Health Research (OBW139590).

Citation Format: Warner E, Yee S, Glass K, Kennedy E, Foong S, Seminsky M. Attitudes and practice of breast surgeons towards referring young women with breast cancer (YWBC) for fertility preservation (FP). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-01.