Georgetown University School of Medicine, Washington, DC, USA.
Division of Breast Surgery, Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
Ann Surg Oncol. 2019 Oct;26(10):3210-3215. doi: 10.1245/s10434-019-07563-w. Epub 2019 Jul 24.
Ten percent of new breast cancer diagnoses occur in premenopausal women, and oncologic therapies may compromise fertility. Thus, fertility preservation discussions (FPDs) and referral to fertility specialists are imperative prior to initiation of therapy. A previous retrospective chart review showed 45% FPD rates at our institution. The aim of this study is to investigate physician perspectives and limitations regarding FPD.
An electronic survey was distributed to 30 surgical, medical, and radiation oncologists across ten regional hospitals. Questions addressed provider demographics, and barriers to and facilitators of FPD.
The survey response rate was 63.3%. Only 31.6% of physicians reported "always" documenting FPD. Respondents opined that the physician prescribing systemic therapy was the most appropriate person to provide FPD. Patient age, treatment with chemotherapy, and patient desire for FPD were more likely to increase FPD (p < 0.0001, p < 0.05, and p < 0.0001, respectively). The majority of physicians (84.2%) expressed intent to increase FPD rates.
Fertility preservation is an integral aspect of breast cancer care, requiring thorough discussion and clear documentation. This study identified that physicians believe the medical oncologist is the most appropriate person to have FPDs with patients and that empowering patients to bring up fertility concerns may improve rates of FPDs. Education of physicians and patients about fertility preservation techniques is likely to improve FPDs.
百分之十的新诊断乳腺癌患者为绝经前女性，而肿瘤治疗可能会损害生育能力。因此，在开始治疗之前，必须进行生育力保留讨论（FPD）并转介给生育专家。先前的回顾性图表审查显示，我们机构的 FPD 率为 45%。本研究旨在调查医生对 FPD 的看法和局限性。
向十家地区医院的 30 名外科医生、内科医生和放射肿瘤学家分发了电子调查。问题涉及提供者的人口统计学资料，以及 FPD 的障碍和促进因素。
调查的回复率为 63.3%。只有 31.6%的医生报告“总是”记录 FPD。受访者认为开具系统治疗药物的医生最适合提供 FPD。患者年龄、化疗治疗和患者对 FPD 的渴望更有可能增加 FPD（p<0.0001、p<0.05 和 p<0.0001）。大多数医生（84.2%）表示有意提高 FPD 率。
生育力保留是乳腺癌护理的一个重要方面，需要进行彻底的讨论和明确的记录。本研究表明，医生认为内科肿瘤医生最适合与患者进行 FPD，让患者主动提出生育问题可能会提高 FPD 率。对医生和患者进行生育力保留技术的教育可能会提高 FPD 率。
