title: Impact of Fertility Concerns on Tamoxifen Initiation and Persistence.
abstract: BACKGROUND
  Adjuvant tamoxifen reduces breast cancer recurrence risk and mortality; however, initiation and treatment persistence are poor for younger patients. We hypothesized that a unique set of factors, including fertility concerns, would contribute to the poor tamoxifen use among premenopausal patients.
  
  
  METHODS
  From 2007 to 2012, 515 premenopausal patients younger than age 45 years, with stage 0 to III hormone receptor-positive breast cancer, for whom tamoxifen was recommended, were identified. Clinical and pathologic tumor characteristics, treatment regimens, and fertility concerns were recorded. Clinical factors associated with tamoxifen noninitiation and discontinuation were identified using univariate and multivariable analysis. After the recommendation for tamoxifen, patient reasons for tamoxifen noninitiation or discontinuation were also documented. All statistical tests were two-sided.
  
  
  RESULTS
  Based on multivariable analysis, fertility concerns were statistically associated with both noninitiation (odds ratio = 5.04, 95% confidence interval (CI) = 2.29 to 11.07) and early discontinuation (hazard ratio = 1.78, 95% CI = 1.09 to 3.38) of tamoxifen. Other independent predictors of noninitiation included a diagnosis of ductal carcinoma in situ, declining radiation, and not receiving chemotherapy (stage I-III). Additionally, smoking and not receiving radiation therapy were statistically significant predictors of early withdrawal from therapy. Primary patient reasons for noninitiation and early discontinuation included concerns about side effects and fertility.
  
  
  CONCLUSIONS
  This study provided insight into factors associated with tamoxifen use for reproductive-aged breast cancer survivors, with a new focus on fertility. Fertility concerns negatively impacted tamoxifen initiation and continuation among premenopausal patients. Interventions to optimize treatment initiation and persistence for young cancer patients should include access to fertility preservation options.
authors: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Natalia C
authors: NC
authors: Llarena
authors: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Samantha L
authors: SL
authors: Estevez
authors: Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Susan L
authors: SL
authors: Tucker
authors: Department of Surgery, University of Michigan, Ann Arbor, MI.|Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Jacqueline S
authors: JS
authors: Jeruss
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000517:prevention & control; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy; D004334:Drug Administration Schedule; D020847:Estrogen Receptor Modulators / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced* / Q000517:prevention & control / Q000523:psychology; D055118:Medication Adherence / Q000523:psychology; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D017697:Premenopause; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage* / Q000009:adverse effects; D016903:Drug Monitoring
chemical_list: D018931:Antineoplastic Agents, Hormonal; D020847:Estrogen Receptor Modulators; D013629:Tamoxifen