Program for Young Patients, International Breast Cancer Study Group, Bern, Switzerland.
Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano - Bicocca, Milan, Italy.
Breast. 2019 Oct;47:85-92. doi: 10.1016/j.breast.2019.07.001. Epub 2019 Jul 10.
Most research addressing needs and concerns of young patients with breast cancer (≤40 years) is retrospective. The HOHO European protocol is a prospective multicenter cohort study of young women with newly diagnosed breast cancer, about fertility, psychosocial and quality of life concerns. Here we report the baseline data and focus on predictors of fertility concerns.
Patient surveys and medical record review were used. The baseline survey included sociodemographic, medical and treatment data as well as questions on fertility concerns and preservation strategies. Subscales from the CAncer Rehabilitation Evaluation System-Short Form (CARES-SF) were administered to measure specific quality of life aspects. Uni- and multivariable modeling were used to investigate predictors of greater fertility concern.
Among 297 eligible respondents, 67% discussed fertility issues before starting therapy, 64% were concerned about becoming infertile after treatment, and 15% decided not to follow prescribed therapies. Fifty-four percent of women wished future children before diagnosis; of these, 71% still desired biologic children afterwards. In multivariable analysis, not having children was the only patient characteristic significantly associated with fertility concerns at diagnosis. Twenty-seven percent used fertility preservation strategies. Women who received chemotherapy reported greater physical (p = 0.021) and sexual difficulties (p = 0.039) than women who did not. Women who were married or had a partner reported less psychosocial problems than single women (p = 0.039).
Young women with newly diagnosed breast cancer have several concerns, including, but not limited to, fertility. The HOHO European study provides valuable information to develop targeted interventions.
大多数针对≤40 岁年轻乳腺癌患者（young patients with breast cancer）的需求和关注点的研究（addressing needs and concerns of young patients with breast cancer）都是回顾性的（retrospective）。HOHO 欧洲方案（HOHO European protocol）是一项针对新诊断为乳腺癌的年轻女性（young women with newly diagnosed breast cancer）的前瞻性多中心队列研究（prospective multicenter cohort study），内容涉及生育能力（fertility）、心理社会和生活质量关注点。在这里，我们报告了基线数据（baseline data），并重点介绍了生育能力关注点的预测因素。
使用患者问卷调查和病历回顾（patient surveys and medical record review）。基线调查包括社会人口统计学（sociodemographic）、医疗和治疗数据（treatment data），以及关于生育能力关注点和保护策略（preservation strategies）的问题。使用癌症康复评估系统-简表（Cancer Rehabilitation Evaluation System-Short Form，CARES-SF）的子量表来测量特定的生活质量方面。采用单变量和多变量模型（univariate and multivariable modeling）来研究生育能力关注点的预测因素。
在 297 名符合条件的应答者中，67%的人在开始治疗前讨论了生育问题（discussed fertility issues），64%的人担心治疗后会不孕（concerning about becoming infertile），15%的人决定不遵循规定的治疗方案（decided not to follow prescribed therapies）。54%的女性在诊断前希望有孩子（future children）；其中，71%的人仍希望以后能有生物学上的孩子（biologic children）。在多变量分析中（multivariable analysis），没有孩子是与诊断时生育能力关注点显著相关的唯一患者特征（only patient characteristic significantly associated with fertility concerns）。27%的人使用了生育保护策略（fertility preservation strategies）。接受化疗的女性报告了更多的身体困难（physical difficulties）（p=0.021）和性困难（sexual difficulties）（p=0.039），而没有接受化疗的女性则没有这些困难。已婚或有伴侣的女性报告的心理社会问题（psychosocial problems）比单身女性少（p=0.039）。
新诊断为乳腺癌的年轻女性有多种关注点，包括但不限于生育能力。HOHO 欧洲研究提供了有价值的信息，以制定有针对性的干预措施（targeted interventions）。
