Education and Support of Young Survivors of Breast Cancer Breast Cancer Diagnosis and Pretreatment

Approximately 6% of invasive breast cancer is diagnosed in women younger than age 40 of age childbearing potential. Cancer-directed therapies can cause hormonal and anatomical changes that negatively affect the reproductive potential of young survivors of breast cancer. Recent national guidelines on fertility preservation are widely available. However, gaps in care exist in the interdisciplinary evidence-based management of young survivors of breast cancer with fertility and parenting concerns after cancer treatment. JOGNN, 43, 374-381; 2014. DOI: 10.1111/1552-6909.12301 Accepted November 2013 Correspondence Karen Meneses PhD, RN, FAAN, Professor & Associate Dean for Research, 1701 University Blvd, School of Nursing, University of Alabama at Birmingham. menesesk@uab.edu Karen Meneses, PhD, RN, FAAN, is a professor and the associate dean for Research, School of Nursing, University of Alabama at Birmingham, Birmingham AL. Aimee Chism Holland, DNP, WHNP-BC, NP-C, RD, is an assistant professor in the School of Nursing, University of Alabama at Birmingham, Birmingham, AL. The authors and planners for this activity report no conflict of interest or relevant financial relationships. The article includes no discussion of off-label drug or device use. No commercial support was received for this educational activity. (Continued) I n the United States, breast cancer is the most common cancer to affect women and the second leading cause of cancer-related deaths in women in the United States (American Cancer Society [ACS], 2013). About 6% of invasive breast cancer is diagnosed in women with childbearing potential younger than age 40 (ACS, 2013). Thus, the possible loss of reproductive potential due to toxicities from cancer therapy has a profound impact on quality of life and can increase psychosocial distress among young survivors of breast cancer (Howard-Anderson, Ganz, Bower, & Stanton, 2012). Trends in our management of the fertility-related concerns of young survivors of breast cancer have changed dramatically during the past 20 years. Recently, fertility discussions were infrequently or rarely provided by oncology specialists and other care providers (Dow, 1990). Young women had to actively seek reproductive counseling (Dow, 1994). With the wider availability of accepted assisted reproductive technology (ART), young women are being referred for reproductive counseling earlier after a breast cancer diagnosis. In addition, key professional and advocacy organizations have issued recent statements or updated guidelines to support discussions of fertility preservation. Young survivors of breast cancer demand and deserve the most current evidence-based information about fertility preservation to achieve their goals of becoming pregnant and having children after breast cancer. Yet gaps remain in two key areas: the broader interdisciplinary dissemination of national fertility guidelines and research focusing on young women with breast cancer. The purpose of this review article is to provide the evidence for (a) the effects of cancer treatment on gonadal function in young women with breast cancer, (b) national fertility guidelines and the role of breast cancer advocacy, (c) implications for nursing practice, and (d) future implications in interdisciplinary care of young women with breast cancer with concerns related to fertility and pregnancy. Effects of Cancer Treatment on Gonadal Function The incidence of ovarian failure with breast cancer treatment is related to type of chemotherapy regimen, age at diagnosis, and tamoxifen use. Chemotherapy regimens containing alkylating agents such as cyclophosphamide deplete of ovarian reserves and induce temporary or permanent amenorrhea. The incidence of chemotherapy induced amenorrhea among younger women ranges from 15% to 75% when cyclophosphamide is part of the regimen (Jung et al., 2010; Lambertini, Anserini, Levaggi, Poggio, & DeMastro, 2013; Pagani et al., 2011) compared to 9% in regimens that omit cyclophosphamide (Lambertini et al., 2013). 374 C © 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org Meneses, K., and Holland, A. C. I N F O C U S