Factors associated with accepting chemotherapy despite the risk of fertility loss in Latin American breast cancer patients-LACOG 0414 study.

IF 4.2 2区医学 Q2 ONCOLOGY

Therapeutic Advances in Medical Oncology Pub Date : 2025-10-02 eCollection Date: 2025-01-01 DOI:10.1177/17588359251378946

Gustavo Werutsky, Cynthia Villarreal-Garza, Henry L Gomez, Saúl Campos-Gómez, Rosa Ortiz Reyes, Pedro E R Liedke, Tomás Reinert, Vanessa Dybal, Jeovany Martinez-Mesa, Paulo Ricardo Nunes Filho, Rafaela Gomes de Jesus, Facundo Zaffaroni, Vitória Silva Garcia, Mariana Fauth Seibel, Pablo Barrios, Matheus Soares Rocha, Carlos H Barrios

{"title":"Factors associated with accepting chemotherapy despite the risk of fertility loss in Latin American breast cancer patients-LACOG 0414 study.","authors":"Gustavo Werutsky, Cynthia Villarreal-Garza, Henry L Gomez, Saúl Campos-Gómez, Rosa Ortiz Reyes, Pedro E R Liedke, Tomás Reinert, Vanessa Dybal, Jeovany Martinez-Mesa, Paulo Ricardo Nunes Filho, Rafaela Gomes de Jesus, Facundo Zaffaroni, Vitória Silva Garcia, Mariana Fauth Seibel, Pablo Barrios, Matheus Soares Rocha, Carlos H Barrios","doi":"10.1177/17588359251378946","DOIUrl":null,"url":null,"abstract":"Background: Fertility loss due to chemotherapy is a major concern for young patients with breast cancer (BC), influencing treatment decisions and quality of life. Despite established guidelines recommending fertility counseling, access to fertility preservation remains limited in Latin America.Objectives: This study evaluated attitudes and preferences regarding fertility-related concerns and chemotherapy decision-making among young Latin American women with early-stage BC.Design: A prospective cohort study was conducted at seven institutions in Brazil, Mexico, and Peru.Methods: Premenopausal women aged 18-40 years with stage I-III BC requiring (neo)adjuvant chemotherapy completed a fertility questionnaire before treatment, along with validated quality-of-life assessments (EORTC QLQ-C30 and EORTC QLQ-BR23). One year after chemotherapy initiation, the patients were reassessed for ovarian function status and quality of life. Factors associated with chemotherapy acceptance despite potential infertility risks were analyzed using univariate and multivariate Poisson regression models.Results: A total of 270 patients were included (mean age, 33.9 years). Prior to diagnosis, 41.5% of the women had children, and 31.1% expressed a desire for future childbearing. Among the participants, 8.5% were unaware of chemotherapy-induced infertility risks, 21.5% would decline chemotherapy if the infertility risk exceeded 25%, and 20.0% would accept treatment despite a 76%-100% infertility risk. In addition, 44.1% of patients required at least a 20% increase in survival probability to accept chemotherapy. In the multivariate analysis, married patients were significantly less likely to refuse chemotherapy (risk ratio: 0.88, 95% confidence interval: 0.82-0.94; p < 0.01). One year post-treatment, 73.1% of the patients experienced chemotherapy-induced amenorrhea.Conclusion: Fertility concerns significantly impact chemotherapy decision-making in young Latin American patients with BC. Limited fertility awareness, socioeconomic disparities, and restricted access to fertility preservation contribute to these challenges. Strengthening fertility counseling and improving access to preservation options are essential for supporting informed treatment decisions in this population.Trial registration: (ClinicalTrials.gov): NCT02862990.","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251378946"},"PeriodicalIF":4.2000,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491814/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Medical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17588359251378946","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Fertility loss due to chemotherapy is a major concern for young patients with breast cancer (BC), influencing treatment decisions and quality of life. Despite established guidelines recommending fertility counseling, access to fertility preservation remains limited in Latin America.

Objectives: This study evaluated attitudes and preferences regarding fertility-related concerns and chemotherapy decision-making among young Latin American women with early-stage BC.

Design: A prospective cohort study was conducted at seven institutions in Brazil, Mexico, and Peru.

Methods: Premenopausal women aged 18-40 years with stage I-III BC requiring (neo)adjuvant chemotherapy completed a fertility questionnaire before treatment, along with validated quality-of-life assessments (EORTC QLQ-C30 and EORTC QLQ-BR23). One year after chemotherapy initiation, the patients were reassessed for ovarian function status and quality of life. Factors associated with chemotherapy acceptance despite potential infertility risks were analyzed using univariate and multivariate Poisson regression models.

Results: A total of 270 patients were included (mean age, 33.9 years). Prior to diagnosis, 41.5% of the women had children, and 31.1% expressed a desire for future childbearing. Among the participants, 8.5% were unaware of chemotherapy-induced infertility risks, 21.5% would decline chemotherapy if the infertility risk exceeded 25%, and 20.0% would accept treatment despite a 76%-100% infertility risk. In addition, 44.1% of patients required at least a 20% increase in survival probability to accept chemotherapy. In the multivariate analysis, married patients were significantly less likely to refuse chemotherapy (risk ratio: 0.88, 95% confidence interval: 0.82-0.94; p < 0.01). One year post-treatment, 73.1% of the patients experienced chemotherapy-induced amenorrhea.

Conclusion: Fertility concerns significantly impact chemotherapy decision-making in young Latin American patients with BC. Limited fertility awareness, socioeconomic disparities, and restricted access to fertility preservation contribute to these challenges. Strengthening fertility counseling and improving access to preservation options are essential for supporting informed treatment decisions in this population.

Trial registration: (ClinicalTrials.gov): NCT02862990.

查看原文本刊更多论文

拉丁美洲乳腺癌患者接受化疗的相关因素，尽管有生育能力丧失的风险- lacog 0414研究

背景：化疗导致的生育能力丧失是年轻乳腺癌（BC）患者主要关注的问题，影响治疗决策和生活质量。尽管制定了建议生育咨询的指导方针，但在拉丁美洲，获得生育保护的机会仍然有限。目的：本研究评估了拉丁美洲早期BC年轻女性对生育相关问题和化疗决策的态度和偏好。设计：一项前瞻性队列研究在巴西、墨西哥和秘鲁的七个机构进行。方法：年龄18-40岁的I-III期BC需要（neo）辅助化疗的绝经前妇女在治疗前完成生育问卷调查，并进行有效的生活质量评估（EORTC QLQ-C30和EORTC QLQ-BR23）。化疗开始一年后，重新评估患者卵巢功能状态和生活质量。使用单变量和多变量泊松回归模型分析了与化疗接受相关的因素，尽管有潜在的不孕风险。结果：共纳入270例患者，平均年龄33.9岁。在诊断之前，41.5%的女性有孩子，31.1%的女性表示希望将来生育。在参与者中，8.5%的人不知道化疗导致的不孕风险，21.5%的人在不孕风险超过25%的情况下会放弃化疗，20.0%的人在不孕风险为76%-100%的情况下接受治疗。此外，44.1%的患者需要至少增加20%的生存概率才能接受化疗。在多因素分析中，已婚患者拒绝化疗的可能性显著降低（风险比：0.88,95%可信区间：0.82-0.94;p）结论：生育问题显著影响拉丁美洲年轻BC患者的化疗决策。有限的生育意识，社会经济差异和有限的获得生育保护促成了这些挑战。加强生育咨询和改善获得保留选择对于支持这一人群的知情治疗决策至关重要。试验注册：（ClinicalTrials.gov）： NCT02862990。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Therapeutic Advances in Medical Oncology ONCOLOGY-

CiteScore

8.20

自引率

2.00%

发文量

160

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Medical Oncology is an open access, peer-reviewed journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of cancer. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in medical oncology, providing a forum in print and online for publishing the highest quality articles in this area. This journal is a member of the Committee on Publication Ethics (COPE).