Factors associated with treatment delay in women with primary breast cancer who were referred to reproductive specialists

PurposeCancer treatment delay due to fertility preservation procedures is a barrier for patients with breast cancer who wish to preserve their fertility. This study aimed to describe the associations between fertility preservation and treatment delay in patients with breast cancer with reproductive concerns and assess the factors related to treatment delay.MethodsPatients with primary breast cancer who visited the reproductive unit at our institution before cancer treatment between 2007 and 2015 were enrolled. The treatment delay cut-off was defined as follows: time to chemotherapy (TTC) >8 weeks for patients intending to receive neoadjuvant chemotherapy, TTC >12 weeks for patients intending to receive adjuvant chemotherapy, time to endocrine therapy (TTE) >12 weeks for patients intending to receive endocrine therapy without radiation therapy and TTE >20 weeks for patients intending to receive endocrine therapy after radiation therapy. Multivariable models were constructed to examine the factors of treatment delay.ResultsOverall, 212 patients met the inclusion criteria. Using the defined cut-offs, treatment delay was noted in 18% of the patients. Endocrine therapy was related to treatment delay (OR 4.49, 95% CI 1.02 to 19.7; p=0.05), but fertility preservation by artificial reproductive treatment (ART) was not. Pregnancy and delivery following treatment for breast cancer were achieved in 18 (19%) and 15 (16%) patients who underwent fertility preservation with ART.ConclusionFertility preservation with ART was not associated with treatment delay in patients with breast cancer who were referred to reproductive specialists before cancer treatment.

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Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment

Geospatial health ◽

10.4081/gh.2018.622 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 5

Author(s):

Yan Lin ◽

Michael C. Wimberly ◽

Patricia Da Rosa ◽

Joseph Hoover ◽

William F. Athas

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Cancer Treatment ◽

South Dakota ◽

Cancer Patients ◽

Early Stage ◽

Breast Cancer Treatment ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

To Receive

Few studies of breast cancer treatment have focused on the Northern Plains of the United States, an area with a high mastectomy rate. This study examined the association between geographic access to radiation therapy facilities and receipt of breast cancer treatments among early-stage breast cancer patients in South Dakota. Based on 4,209 early-stage breast cancer patients diagnosed between 2001 and 2012 in South Dakota, the study measured geographic proximity to radiation therapy facilities using the shortest travel time for patients to the closest radiation therapy facility. Two-level logistic regression models were used to estimate for early stage cases i) the odds of mastectomy versus breast conserving surgery (BCS); ii) the odds of not receiving radiation therapy after BCS versus receiving follow-up radiation therapy. Covariates included race/ethnicity, age at diagnosis, tumour grade, tumour sequence, year of diagnosis, census tract-level poverty rate and urban/rural residence. The spatial scan statistic method was used to identify geographic areas with significantly higher likelihood of experiencing mastectomy. The study found that geographic accessibility to radiation therapy facilities was negatively associated with the likelihood of receiving mastectomy after adjustment for other covariates, but not associated with radiation therapy use among patients receiving BCS. Compared with patients travelling less than 30 minutes to a radiation therapy facility, patients travelling more than 90 minutes were about 1.5 times more likely to receive mastectomy (odds ratio, 1.51; 95% confidence interval, 1.08-2.11) and patients travelling more than 120 minutes were 1.7 times more likely to receive mastectomy (odds ratio, 1.70; 95% confidence interval, 1.19-2.42). The study also identified a statistically significant cluster of patients receiving mastectomy who were located in south-eastern South Dakota, after adjustment for other factors. Because geographic proximity to treatment facilities plays an important role on the treatment for early-stage breast cancer patients, this study has important implications for developing targeted intervention to reduce disparities in breast cancer treatment in South Dakota.

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Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2013.52.8877 ◽

2014 ◽

Vol 32 (11) ◽

pp. 1151-1156 ◽

Cited By ~ 168

Author(s):

Kathryn J. Ruddy ◽

Shari I. Gelber ◽

Rulla M. Tamimi ◽

Elizabeth S. Ginsburg ◽

Lidia Schapira ◽

...

Keyword(s):

Breast Cancer ◽

Fertility Preservation ◽

Endocrine Therapy ◽

Young Women ◽

Early Stage ◽

Treatment Decisions ◽

Baseline Survey ◽

Newly Diagnosed ◽

Multicenter Cohort Study ◽

To Receive

Purpose Most research regarding fertility in young women with breast cancer has focused on long-term survivors. Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial cancer diagnosis. Patients and Methods As part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age ≤ 40 years. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items. Univariable and multivariable modeling were used to investigate predictors of greater fertility concern. Results Among the first 620 eligible respondents included in this analysis, median age was 37 years (range, 17 to 40 years); 425 women (68%) discussed fertility issues with their physicians before starting therapy, and 319 (51%) were concerned about becoming infertile after treatment. Because of concerns about fertility, four women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy regimen over another, six (1%) considered not receiving endocrine therapy, 19 (3%) decided not to receive endocrine therapy, and 71 (11%) considered receiving endocrine therapy for < 5 years; 65 (10%) used fertility preservation strategies. Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy. Conclusion Many young women with newly diagnosed breast cancer have concerns about fertility, and for some, these substantially affect their treatment decisions. Only a minority of women currently pursue available fertility preservation strategies in this setting.

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Faculty Opinions recommendation of Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.12371.469860 ◽

2006 ◽

Author(s):

Riccardo A Audisio

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Primary Breast Cancer ◽

Elderly Women ◽

Primary Endocrine Therapy

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Helical Electron Avoidance Radiation Therapy (HEART) for Breast Cancer Treatment

10.21236/ada439261 ◽

2005 ◽

Author(s):

Lijun Ma

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Cancer Treatment ◽

Breast Cancer Treatment

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Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

10.21236/ada485555 ◽

2007 ◽

Author(s):

Andrea L. Cheville

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Lymph Node ◽

Lymph Node Dissection ◽

Primary Breast Cancer ◽

Node Dissection

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Cancer Treatment–Induced Bone Loss (CTIBL): State of the Art and Proper Management in Breast Cancer Patients on Endocrine Therapy

Current Treatment Options in Oncology ◽

10.1007/s11864-021-00835-2 ◽

2021 ◽

Vol 22 (5) ◽

Author(s):

Anna Diana ◽

Francesca Carlino ◽

Emilio Francesco Giunta ◽

Elisena Franzese ◽

Luigi Pio Guerrera ◽

...

Keyword(s):

Breast Cancer ◽

Bone Loss ◽

Cancer Treatment ◽

Endocrine Therapy ◽

Aromatase Inhibitors ◽

Bone Health ◽

Optimal Time ◽

Breast Cancer Patients ◽

Antiresorptive Agents

Opinion statementAbout 70–80% of early breast cancer (BC) patients receive adjuvant endocrine therapy (ET) for at least 5 years. ET includes in the majority of cases the use of aromatase inhibitors, as upfront or switch strategy, that lead to impaired bone health. Given the high incidence and also the high prevalence of BC, cancer treatment–induced bone loss (CTIBL) represents the most common long-term adverse event experimented by patients with hormone receptor positive tumours. CTIBL is responsible for osteoporosis occurrence and, as a consequence, fragility fractures that may negatively affect quality of life and survival expectancy. As recommended by main international guidelines, BC women on aromatase inhibitors should be carefully assessed for their fracture risk at baseline and periodically reassessed during adjuvant ET in order to early detect significant worsening in terms of bone health. Antiresorptive agents, together with adequate intake of calcium and vitamin D, should be administered in BC patients during all course of ET, especially in those at high risk of osteoporotic fractures, as calculated by tools available for clinicians. Bisphosphonates, such as zoledronate or pamidronate, and anti-RANKL antibody, denosumab, are the two classes of antiresorptive drugs used in clinical practice with similar efficacy in preventing bone loss induced by aromatase inhibitor therapy. The choice between them, in the absence of direct comparison, should be based on patients’ preference and compliance; the different safety profile is mainly related to the route of administration, although both types of drugs are manageable with due care, since most of the adverse events are predictable and preventable. Despite advances in management of CTIBL, several issues such as the optimal time of starting antiresorptive agents and the duration of treatment remain unanswered. Future clinical trials as well as increased awareness of bone health are needed to improve prevention, assessment and treatment of CTIBL in these long-term survivor patients.

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