This article is more than 5 years old. Information may no longer be current.
Fertility concerns may cause women to forgo, cease endocrine therapy
Click Here to Manage Email Alerts
Premenopausal women with breast cancer may decline or discontinue the use of tamoxifen due to fertility concerns, according to results of a multi-institutional study.
Although adjuvant tamoxifen reduces the risk for breast cancer recurrence and mortality, younger patients tend to have poor treatment initiation and persistence. Jacqueline S. Jeruss, MD, PhD, associate professor of surgery in the division of surgical oncology at University of Michigan Cancer Center, and colleagues sought to identify the reasons behind that poor usage and hypothesized that fertility concerns, among other unique factors, may play a role. Tamoxifen is teratogenic and, thus, pregnancy is contraindicated during treatment.
The investigators identified 515 premenopausal women aged younger than 45 years with stage 0 to stage III hormone receptor-positive breast cancer for whom a tamoxifen regimen was recommended between 2007 and 2012. Twenty-two percent of the patients expressed a desire to remain fertile for possible future pregnancy at the time of breast cancer diagnosis.
Overall, 69 women (13.4%) declined initiation of tamoxifen and 80 (15.5%) discontinued tamoxifen use prior to 5 years. Of the 69 patients who declined initiation of tamoxifen, 34% stated they planned to become pregnant and 36% said they were concerned about possible adverse effects such as the development of uterine cancer (24%), thromboembolism (20%) and hot flashes (12%).
Of the 80 patients who discontinued therapy, 25% did so because they either planned to become pregnant or did become pregnant while on tamoxifen.
Results of a multivariable analysis indicated fertility concerns increased the risk for non-initiation (OR = 5.04; 95% CI, 2.29-11.07) and early discontinuation of tamoxifen (HR = 1.78; 95% CI, 1.09-3.38).
Additionally, a diagnosis of ductal carcinoma in situ (P < .001), declining radiation (P < .001), or, for those with invasive disease, not receiving chemotherapy (P = .012) independently predicted non-initiation or discontinuation of tamoxifen.
Other significant predictors of early withdrawal from tamoxifen-based therapy included a history of smoking and not receiving radiotherapy.
Researchers conducted additional interviews with 88 of the patients who did not initiate or discontinued tamoxifen and found the primary reasons for doing so concerned fertility (35.2%) and other adverse effects (53.4%). Ten women (11.4%) perceived little benefit from therapy.
“Despite the importance of fertility to young breast cancer patients, availability of fertility preservation options and relative safety of pregnancy among breast cancer survivors, fertility preservation is often underutilized and under-discussed in clinical settings,” the researchers wrote.
Ann H. Partridge
These data shed light on the concerns of young women with breast cancer, Shoshana M. Rosenberg, ScD, instructor in medicine at Dana-Farber Cancer Institute, and Ann H. Partridge, MD, MPH, founder and director of the program for young women with breast cancer, director of the adult survivorship program and senior physician at Dana-Farber, wrote in an accompanying editorial.
“Because young women are at higher risk for recurrence and death from breast cancer, adherence to endocrine treatment is especially critical to ensure optimal survival outcomes in this population,” Rosenberg and Partridge wrote. “In helping to answer the question as to why young women might be more likely to non-initiate or discontinue endocrine therapy, [this study] highlights the importance of understanding how issues unique to young women with breast cancer affect treatment decisions. In turn, accounting for their concerns and identifying effective strategies to manage them may enhance quality of care, quality of life and survival.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts